Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned? / Mortes por COVID-19 em um hospital de uma cidade da região da Amazônia Legal: que lições podem ser aprendidas?

Objective: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environmen (AU).

Objetivo: Descrever a epidemiologia de mortes por COVID-19 em um hospital na região da Amazônia em um período de 64 dias, que corresponde à curva de crescimento da primeira onda da pandemia de COVID-19 em 2020. Métodos: Os dados foram obtidos de 152 óbitos registrados em prontuários de adultos e idosos hospitalizados. Os dados foram também comparados com o número de óbitos em anos anteriores, no mesmo período estudado, de forma a avaliar o impacto da pandemia neste hospital. O estudo também avalia o impacto das transferências intra-hospitalares, contabilizando o número de vezes que os pacientes que faleceram realizaram transferências entre setores do hospital. Resultados: No período analisado, houve aumento de óbitos em relação aos anos anteriores. A maioria dos pacientes mortos era do sexo masculino, com idade entre 34 e 96 anos. Os óbitos foram associados a comorbidades como hipertensão arterial, diabetes mellitus e doença renal. A infecção por SARS-CoV-2 foi confirmada em 91 casos. Entre eles, 15 indivíduos foram internados sem condições relacionadas à infecção por SARS-CoV-2; eles tiveram um número três vezes maior de transferências hospitalares do que aqueles admitidos com sintomas de infecção por SARS-CoV-2. Dezesseis pacientes com infecção por SARS-CoV-2 desenvolveram sintomas respiratórios logo após a hospitalização. O exame diagnóstico para infecção por SARS-CoV-2 foi realizado em média 4 (± 6) dias após o início dos sintomas e 6 (± 6) dias após a admissão, e o tempo médio do início dos sintomas respiratórios até o óbito foi de 4 ( ± 6) dias. Conclusões: Esses dados sugerem alta presença de infecção hospitalar por SARS-CoV-2 na região amazônica brasileira, o que pode estar relacionado ao número de transferências setoriais, demora na confirmação do diagnóstico e falta de manejo. Relatamos um grave problema de saúde pública, pois demonstra a fragilidade das instituições de saúde no ambiente hospitalar (AU).

Incidence of intestinal constipation during the COVID-19 pandemic period in medical students from a private institution in São Paulo, SP

Introduction: Chronic intestinal constipation (CIC) presents an incidence of 2.6 to 30.7% in the overall population and due to the social reality imposed by the coronavirus pandemic, some behavior changes in the Brazilian population occurred that might or not be associated with alterations of CIC prevalence. Objective: To assess CIC incidence in medical students before and during the COVID-19 pandemic in Brazil in a private higher educational institution in the city of São Paulo, state of São Paulo. Methods: Clinic data were collected through Google Forms software from the same students seeking to analyze the variables before (year of 2019) and during the coronavirus pandemic. The data were: age, sex, body mass index, constipation referred in a subjective way and confirmed through the ROME III criteria, feces consistency and anxiety and/or depression during the pandemic. Results: A total of 126 medical students from a private higher education institution from São Paulo, SP were included. The average age was 22.9 years old, 70.6% were female and the average BMI was 23.3 kg/m2. Regarding the ROME III criteria, 32.5% presented >2 in 2019 and 42.1% during the pandemic. Concerning the feces consistency, 31.75 and 35.71% presented dry Bristol 1 feces or in both periods, respectively. Conclusion: It was observed an increase in the prevalence of chronic intestinal constipation in medical students from a private higher education institution from São Paulo, state of São Paulo, during the COVID-19 pandemic, as well as dryness in the feces. (AU)

Boosting COVID-19 vaccine inoculation and booster shots: a systematic review and meta-analysis of factors that influence coronavirus vaccine uptake in practice

Introduction: Vaccines alone do not control pandemics, but vaccinations. The hope of COVID-19 pandemic control is hinged on vaccinations and other public health measures. This systematic review/meta-analysis (SR/MA) investigated the factors that inform coronavirus vaccine uptake globally in an attempt to improve COVID-19 immunization. Method: The PRISMA 2020 methodology was used for this review. A total of 2902 articles were identified from electronic databases and other sources. After screening, 33 articles were included in the review and quantitative meta-analysis. Comprehensive meta-analysis software version 3 was used for the meta-analysis. Results: We observed that vaccine effectiveness, side effects and the proportion of acquaintances vaccinated significantly influenced respondents' COVID-19 immunization decision. Also, associations of vaccine effectiveness, smaller risks to serious side effects, free and voluntary vaccinations and fewer vaccine doses, and longer duration to wanning were observed. We also observed variations in vaccine hesitancy trends in studies carried out in Asia, Europe, America, and Africa. Conclusion: Wanning and acquaintance's vaccination status as factors to vaccination are insights the present paper is bringing to the limelight. Health promotion and COVID-19 vaccination planning are crucial for enhancing vaccine uptake

Consideration of Definition of Solitary Death, and Changes before and after Coronavirus Pandemic: A Survey of Post-mortem Examination Cases in Shizuoka City / 日本プライマリ・ケア連合学会誌

Introduction: The aim of this study was to consider the definition of solitary death by examining characteristics of cases, and to explore the impact of the coronavirus pandemic.Methods: Subjects were individuals with post-mortem examination and autopsy imaging data recorded between 2017 and 2022. Subjects were classified by whether they passed away at home (solitary). We investigated differences between groups in their causes of death, time elapsed between death and discovery, presence or absence of housemates, and prior symptoms.Results: There were 129 cases (79.9%) of solitary death and 41 cases (24.1%) of death outside the home. Solitary death cases were significantly younger. Among these, less than half were discovered more than a day after death, lived alone, or were older adults. Older adults and those discovered more than a day after death were more likely to have trauma as their official cause of death. The frequency and characteristics of solitary death did not change before or after the coronavirus pandemic.Conclusion: Preventive measures for solitary death should not be limited to older adults or those living alone. In particular, deaths from diseases other than sudden death, trauma in older adults, and cases where symptoms were present or medical attention was sought before death are potentially preventable. Countermeasures for solitary death are important in the post-coronavirus pandemic period.

Retorno a la presencialidad: factores protectores y de riesgo identificados por trabajadores de instituciones de Educación Superior chilenas

Fundamento: la pandemia asociada a la COVID-19 obligó a buscar formas de sostener procesos y servicios. La modalidad de teletrabajo se convirtió en aliada para poder sobrellevar desde los hogares el quehacer laboral. En el año 2022 se inició el proceso de retorno a la presencialidad en la Educación Superior chilena. Objetivo: identificar factores protectores y obstaculizadores que identifican los trabajadores académicos y no académicos de instituciones de Educación Superior chilenas para volver a la presencialidad. Método: se realizó un estudio descriptivo y de corte transversal. Se trabajó con una muestra total de 124 participantes. La muestra se obtuvo de la participación voluntaria de funcionarios académicos y no académicos quienes respondieron una encuesta por formulario. Los datos fueron recogidos entre octubre de 2021 y marzo de 2022. Se aplicó cuestionario acerca de factores protectores y obstaculizadores presentes en el retorno seguro. Se recodificaron los datos, para trabajar con frecuencias y porcentajes de respuestas. Resultados: los mayores obstáculos percibidos para el retorno a la presencialidad laboral se correspondieron con personas que declararon presencia de enfermedad crónica y algún síntoma asociado a salud mental (52-58 %). Las personas menores de 40 años identificaron el factor inmunización y poseer un buen estado de salud como factores facilitadores para el retorno a la presencialidad (54-62 %). Conclusiones: las organizaciones deben desarrollar programas de apoyo para el retorno laboral, de manera que estas acciones favorezcan mejores niveles de bienestar en el trabajo. Se consideran las diferencias de edad, género y presencia de patologías crónicas previas como factores obstaculizadores del retorno.

Background: the pandemic associated with COVID-19 forced the search for ways to sustain processes and services. The teleworking modality became an ally to be able to cope with work from home. In 2022, the process of returning to presence in Chilean Higher Education began. Objective: to identify protective and hindering factors identified by academic and non-academic workers of Chilean Higher Education institutions to return to attendance. Method: a descriptive and cross-sectional study was carried out. We worked with a total sample of 124 participants. The sample was obtained from the voluntary participation of academic and non-academic officials who responded to a survey via form. The data was collected between October 2021 and March 2022. A questionnaire was applied about protective and hindering factors present in safe return. The data was recoded to work with frequencies and percentages of responses. Results: the greatest obstacles perceived for the return to work presence correspond to people who declare the presence of chronic disease and some symptom associated with mental health (52-58 %). People under 40 years of age identified the immunization factor and being in good health as facilitating factors for returning to attendance (54-62 %). Conclusions: organizations must develop support programs for return to work, so that these actions favor better levels of well-being at work. Differences in age, gender and the presence of previous chronic pathologies are considered as factors that hinder return.

DKA and new-onset type 1 diabetes in Brazilian children and adolescents during the COVID-19 pandemic

ABSTRACT We assess the severity and frequency of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus (T1D) patients and in patients with previous diagnosis of T1D in a referral Brazilian university hospital in the first five months of the COVID-19 pandemic. We also compare the data with data from pre-pandemic periods. Forty-three new-onset T1D patients were diagnosed between April and August of the years 2017, 2018, 2019, and 2020. During the COVID-19 pandemic, the number of new-onset T1D was over twice the number of new-onset T1D in the same period in the three previous years. All the 43 patients survived and are now on outpatient follow-up. We also compared the characteristics of the T1D patients hospitalized between April and August of the years 2017, 2018, and 2019 (32 hospitalizations) to the characteristics of the T1D patients hospitalized between April and August/2020 (35 hospitalizations; 1 patient was hospitalized twice in this period). Fourteen of the 34 patients admitted during the pandemic presented with COVID-19-related symptoms (any respiratory symptom, fever, nausea, vomiting, and diarrhea), but only one had positive SARS-CoV-2 RT-PCR test. Samples from 32 out of these 34 patients were assayed for SARS-CoV-2 antibodies, and four patients were positive for total antibodies (IgM and IgG). In agreement with recent reports from European countries, we observed increased frequency of DKA and severe DKA in new-onset and previously diagnosed T1D children and adolescents in a large referral public hospital in Brazil in the first five months of the COVID-19 pandemic. The reasons for this outcome might have been fear of SARS-CoV-2 infection in emergency settings, the more limited availability of primary healthcare, and the lack of school personnel's attention toward children's general well-being.

Impacto negativo de la COVID-19 en la salud mental de la población / The Negative Impact of COVID-19 on the mental health of the population / Impacto negativo da COVID-19 na saúde mental da população

A inicios del año 2020, desde la declaratoria de la emergencia sanitaria a nivel global a consecuencia de la pandemia producida por la COVID-19, el mundo fue testigo de un cambio drástico que definitivamente modificaría la denominada normalidad para siempre. Se realizó una búsqueda sistemática de publicaciones en las bases de datos Pubmed, Google y Google Académico. Para la búsqueda se incluyeron las siguientes palabras clave: COVID-19, SARS-CoV-2, 2019nCoV, salud mental, mental health. Se comprobó, que las alteraciones de salud mental, desarrolladas durante la pandemia y diagnosticadas previamente, representan un cuadro de vulnerabilidad bastante complejo en relación a edad, entorno laboral, antecedentes patológicos, genero e idiosincrasia, lo cual se traduce en actitudes violentas, consumo de sustancias nocivas, instauración de trastornos mentales lo que puede generar complicaciones ante un inminente contagio. Se concluyó que factores como desigualdad socio-económica, cese de actividades comerciales e industriales, confinamientos obligados, contagio y fallecimiento de familiares o personas cercanas influyen de forma negativa en la salud mental de la población.

At the beginning of the year 2020, since the declaration of the global health emergency as a consequence of the pandemic produced by COVID-19, the world witnessed a drastic change that would definitely modify the so-called normality forever. A systematic search of publications was carried out in the Pubmed, Google and Google Scholar databases. The following keywords were included in the search: COVID-19, SARS-CoV-2, 2019nCoV, mental health, mental health. It was found that mental health alterations, developed during the pandemic and previously diagnosed, represent a fairly complex vulnerability picture in relation to age, work environment, pathological background, gender and idiosyncrasy, which translates into violent attitudes, consumption of harmful substances, establishment of mental disorders, which can generate complications before an imminent contagion. It was concluded that factors such as socioeconomic inequality, cessation of commercial and industrial activities, forced confinement, contagion, and death of family members or close relatives have a negative influence on the mental health of the population.

No início de 2020, desde a declaração da emergência sanitária global como resultado da pandemia causada pela COVID-19, o mundo testemunhou uma mudança drástica que definitivamente modificaria para sempre a chamada normalidade. Foi realizada uma busca sistemática de publicações nas bases de dados Pubmed, Google e Google Scholar. As seguintes palavras-chave foram incluídas na busca: COVID-19, SARS-CoV-2, 2019nCoV, saúde mental, saúde mental. Verificou-se que os distúrbios de saúde mental, desenvolvidos durante a pandemia e previamente diagnosticados, representam um quadro bastante complexo de vulnerabilidade em relação à idade, ambiente de trabalho, antecedentes patológicos, gênero e idiossincrasia, o que se traduz em atitudes violentas, consumo de substâncias nocivas, estabelecimento de distúrbios mentais, o que pode levar a complicações diante de um contágio iminente. Concluiu-se que fatores como desigualdade sócio-econômica, cessação das atividades comerciais e industriais, confinamento forçado, contágio e morte de familiares ou pessoas próximas têm uma influência negativa sobre a saúde mental da população.

Using signalling theory to assess the Government of Ghana's risk communication during the COVID-19 pandemic

Background: The proliferation of information through social media and on other communication networks during the corona virus disease 2019 (COVID-19) era altered information transfer in many countries. The content of the messages from government officials, media coverage and alternative narratives, affected the level of compliance in adhering to the various health protocols amongst the public. Aim: This article aimed to determine the relationship between the message used, media coverage, alternative narratives, the public's attitude towards staying at home and their commitment to stay at home during the COVID-19 pandemic campaign period in Ghana. Setting: A total of 352 respondents was sampled from the Kumasi metropolis. Methods: A survey sample strategy and a convenience sampling technique were used while structural equation modelling with Partial least square (PLS) version 3.0 was used for the analysis. Results: The study revealed that the nature of media coverage employed and the alternative narratives had a significant positive effect on the attitude of the respondents, whilst the content of the message had insignificant effects on the attitude of the public. Finally, the attitude of the people had a significant positive influence on their respective commitment to stay home. Conclusion: Developing countries in Africa need to fight pandemics using purely subsidised health officials or directorates rather than have government-appointed health experts and officials spearheading activities during a pandemic.

Impacto de la teledermatología en pacientes con cáncer cutáneo durante la COVID-19

RESUMEN Fundamento: durante la pandemia de la COVID-19 hubo dificultad para acceder a las interconsultas de dermatología por lo que se imposibilitaba priorizar los casos de cáncer de piel. Se diseñó e implementó un sistema de teledermatología, a través de la telefonía móvil, para el estudio de pacientes con esta patología. Objetivo: evaluar el impacto del sistema de teledermatología para el estudio del cáncer de piel, en pacientes atendidos en Hospital Dermatológico Guillermo Fernández Hernández-Baquero durante la pandemia de la COVID-19. Métodos: se realizó un estudio descriptivo para evaluar el impacto de la teledermatología en 88 pacientes con lesiones sospechosas de cánceres de piel, remitidos, de la Atención Primaria y atendidos en el Hospital Dermatológico Guillermo Fernández Hernández-Baquero en el período desde el primero de abril de 2020 hasta el primero de abril de 2021. Se diseñó un sistema de teledermatología, de tipo teleconsulta con la posibilidad de telediagnóstico, basado en el intercambio de imágenes y textos, en un dispositivo móvil Android. Se utilizó el método estadístico descriptivo. Los resultados se expresaron en tablas para su mayor comprensión. Resultados: el carcinoma basocelular predominó en el 63,6 %. La correlación clínico-patológica para el carcinoma basocelular fue de 96,4 %, por teledermatología y por consulta presencial, respectivamente. La concordancia simple fue de 93,2 %. Las discordancias fueron leves para un 6,8 %. El nivel de satisfacción fue de 95,5 %, muy satisfechos con el sistema de teledermatología aplicado. Conclusiones: el sistema de teledermatología tiene viabilidad técnica, es eficiente, útil, con exactitud diagnóstica, fiabilidad y reproductibilidad, siendo efectivo en el diagnóstico del cáncer de piel, en condiciones epidemiológicas desfavorables como la pandemia de la COVID-19.

ABSTRACT Background: during the COVID-19 pandemic, there was difficulty in accessing dermatology consultations, making it impossible to prioritize skin cancer cases. A teledermatology system was designed and implemented, through mobile telephony, for the study of patients with this pathology. Objective: to evaluate the impact of the teledermatology system for the study of skin cancer in patients treated at the Guillermo Fernández Hernández-Baquero Dermatological Hospital during the COVID-19 pandemic. Methods: a descriptive study was carried out to evaluate the impact of teledermatology in 88 patients with lesions suspected of skin cancers, referred from Primary Care and treated at the Guillermo Fernández Hernández-Baquero Dermatological Hospital in the period since April 1 2020 until April 1, 2021. A teledermatology system was designed, of the teleconsultation type with the possibility of remote diagnosis, based on the exchange of images and texts, on an Android mobile device. The descriptive statistical method was used. The results were expressed in tables for better understanding. Results: basal cell carcinoma predominated in 63.6 %. The clinic pathological correlation for basal cell carcinoma was 96.4 %, by teledermatology and by face-to-face consultation, respectively. Simple agreement was 93.2 %. Disagreements were slight for 6.8 %. The level of satisfaction was 95.5 %, very satisfied with the applied teledermatology system. Conclusions: the teledermatology system has technical feasibility, is efficient, useful, with diagnostic accuracy, reliability and reproducibility, being effective in the diagnosis of skin cancer, in unfavorable epidemiological conditions such as the COVID-19 pandemic.

Dexamethasone for treating SARS-CoV-2 infection: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Considering the disruptions imposed by lockdowns and social distancing recommendations, coupled with overwhelmed healthcare systems, researchers worldwide have been exploring drug repositioning strategies for treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE: To compile results from randomized clinical trials on the effect of dexamethasone, compared with standard treatment for management of SARS-CoV-2. DESIGN AND SETTING: We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in a Brazilian public university. METHODS: We sought to compile data from 6724 hospitalized patients with confirmed or suspected SARS-CoV-2 infection. RESULTS: Treatment with dexamethasone significantly reduced mortality within 28 days (risk ratio, RR: 0.89; 95% confidence interval, CI: 0.82-0.97). Dexamethasone use was linked with being discharged alive within 28 days (odds ratio, OR: 1.20; 95% CI: 1.07-1.33). CONCLUSIONS: This study suggests that dexamethasone may significantly improve the outcome among hospitalized patients with SARS-CoV-2 infection and associated severe respiratory complications. ­Further studies need to consider both dose-dependent administration and outcomes in early and later stages of the disease. PROSPERO platform: CRD42021229825.

El triaje de las vacunas / Triagem vacinal / Vaccine triage

El proceso de vacunación está generando problemas muy similares a los que se plantearon al inicio de la pandemia debido tanto a la escasez de vacunas como a la implacable letalidad del virus. La celeridad con que avanzan los contagios está obligando a establecer criterios de triaje, pero de una naturaleza diferente a la propiamente hospitalaria. En efecto, el número de factores se ha incrementado, ya que no solo hay que tener en cuenta los recursos sanitarios, sino variables geoestratégicas y de equilibriosde poder a escala internacional. En un contexto completamente mercantilizado, los planes de vacunación están tratando de conciliar los principios éticos con la eficacia, en un difícil equilibrio no siempre resuelto satisfactoriamente. En el presente artículo analizaremos el proceso de implementación de las vacunas en Europa, comenzando por las características específicas de las primeras vacunas aprobadas hasta descender a los criterios de ordenación de la población en España.

The vaccination process is creating problems very similar to those that arose at the beginning of the pandemic due to both the shortage of vaccines and the relentless lethality of the virus. The speed with which the infections are progressing is forcing triage criteria to be established, but of a different nature from the hospital itself. Indeed, the number of variables has increased, since it is not only necessary to take into account health resources, but also geostrategic variables and international power balances. In a completely mercantilist context, vaccination plans are trying to reconcile ethical principles with efficacy, in a difficult balance not always resolved. In this article, we will analyze the vaccine implementation process in Europe, starting with the specific characteristics of the first approved vaccines until descending to the criteria for ordering the population in Spain.

O processo de vacinação está a criar problemas muito semelhantes aos que surgiram no início da pandemia, devido quer à falta de vacinas, quer à letalidade implacável do vírus. A rapidez com que as infeções progridem está a obrigar ao estabelecimento de critérios de triagem, mas de natureza diferente do próprio contexto hospitalar. De facto, o número de variáveis tem aumentado, uma vez que não é apenas necessário levar em conta os recursos da saúde, mas também as variáveis ​​geoestratégicas e os equilíbrios de poder internacionais. Num contexto totalmente comercializado, os planos de vacinação procuram conciliar os princípios éticos com a eficácia, num equilíbrio difícil nem sempre resolvido de forma satisfatória. Neste artigo, iremos analisar o processo de implementação de vacinas na Europa, partindo das características específicas das primeiras vacinas aprovadas até aos critérios de ordenação da população em Espanha.

Vacunación programática 2020 en Chile en tiempos de pandemia por SARS-CoV-2 / Routine immunization 2020 in Chile during the SARS-CoV-2 pandemic

Resumen En marzo de 2020, la Organización Mundial de la Salud (OMS) hizo un llamado a mantener la vacunación programática siempre que se pudieran garantizar condiciones seguras frente a la circulación de SARS-CoV-2. Asimismo, advirtió sobre el riesgo de interrupción de la vacunación programática secundaria a la pandemia por SARS-CoV-2. La interrupción de la vacunación genera un aumento en el número de personas susceptibles a las enfermedades que se busca prevenir y, así, de la probabilidad de uno o más brotes epidémicos. Estos, junto con incrementar la morbilidad y mortalidad en los grupos de riesgo, significarían una carga adicional al ya demandado sistema de salud por COVID-19. En agosto 2020, la OMS reportó interrupción de los servicios de salud esenciales en distintos países a raíz de la pandemia de SARS-CoV-2, afectando con mayor frecuencia a la vacunación de rutina y extramural. En Chile, la vacunación programática durante el 2020 disminuyó respecto del promedio del período 2015-2019, con la menor caída en la vacunación de los 2 meses de edad con hexavalente (0,39%) y la mayor a los 18 meses también con hexavalente (12,02%). La excepción fue la vacunación antineumocócica del adulto, con un incremento de 0,8% respecto del período 2015-2019.

Abstract In March 2020, the World Health Organization (WHO) recommended that vaccination not be interrupted as long as countries could safely maintain this service in the context of the SARS-CoV-2 pandemic. WHO also warned about the risk of interruption of programmatic vaccination that generates an increase in the number of people susceptible to infections that are sought to be prevented with the use of vaccines and, therefore, an increase in the probability of disease outbreak. Along with increased morbidity and mortality in risk groups, vaccine-preventable disease outbreaks would put additional demand on the health system already burdened by COVID-19. In August 2020, WHO reported the interruption of essential health services in different countries as a result of the SARS-CoV-2 pandemic, which mainly affected routine and extramural vaccination. In Chile, routine vaccination coverage decreased during 2020 compared to the average coverage for the 2015-2019 period. The smallest decline was 0.39% for the hexavalent vaccine at 2 months of age and the largest decrease was 12.02% at 18 months for the same vaccine. The exception to the fall in coverage in 2020 was adult pneumococcal vaccination, which showed an increase of 0.8% compared to 2015-2019.

Necessidade de mudanças na educação médica e a percepção de professores antes da pandemia da Covid-19 / Necesidad de cambios en la educación médica y la percepción de profesores antes de la pandemia de Covid-19 / The need for changes in medical education and the perception of teachers before the Covid-19 pandemic

Este estudo objetiva analisar questões da educação médica evidenciadas pelas medidas de distanciamento social provocadas pela pandemia do coronavírus19 associadas às percepções de professores de medicina sobre esses mesmos aspectos, em um momento prévio à eclosão da crise sanitária. Realizamos um recorte de resultados de uma pesquisa de natureza qualitativa e conduzimos a discussão com base na triangulação de dados entre observações de campo e entrevistas com professores. A pandemia reacendeu debates sobre a relevância de conteúdos, a utilização de tecnologias digitais para fins pedagógicos e o valor do trabalho colaborativo. Além disso, resgatou questões que envolvem habilidades de comunicação e a saúde de estudantes nas práticas do cuidado. Discutiremos a experiência passada articulando-a às experiências recentes e o que poderemos recolher para (re)construirmos os rumos da formação dos médicos.(AU)

El objetivo de este estudio es analizar cuestiones de la educación médica puestas en evidencia por las medidas de distancia social adoptadas por la pandemia del coronavirus 19, asociadas a las percepciones de profesores de medicina sobres esos mismos aspectos, en un momento previo a la eclosión de la crisis sanitaria. Realizamos un recorte de resultados de una investigación de naturaleza cualitativa y dirigimos la discusión a partir de la triangulación de datos entre observaciones de campo y entrevistas con profesores. La pandemia reencendió debates sobre la relevancia de contenidos, la utilización de tecnologías digitales para fines pedagógicos y el valor del trabajo colaborativo. Además, rescató cuestiones que envuelven habilidades de comunicación y la salud de estudiantes en las prácticas del cuidado. Discutiremos la experiencia pasada articulándola con las experiencias recientes y lo que podremos recoger para (re)construir los rumbos de formación de los médicos.(AU)

This study aims to analyze medical education issues evidenced by the measures of social distancing due to the coronavirus pandemic19, associated with the perceptions of medical professors about these same aspects, in a moment prior to the outbreak of the health crisis. We focused in the results of a qualitative research and conducted a discussion based on the triangulation of data between field observations and interviews with professors. The pandemic has rekindled debates about the relevance of contents, the use of digital technologies for educational purposes and the value of collaborative work. Additionally, it provoked the emergence of issues involving communication skills and the health of students in care practices. We discuss past experiences articulating them with recent experiences and what we can collect to (re)build the direction of medical training.(AU)

ECT no contexto da pandemia COVID-19: readequar é necessário / Electroconvulsive therapy in terms of the COVID-19 pandemic: adaptation is needed

Introdução: A pandemia pelo COVID-19 representa um desafio para os serviços de saúde, impactando, inclusive, na realização da eletroconvulsoterapia (ECT), um procedimento essencial. Objetivo: O objetivo deste trabalho é revisar artigos que relatam a adaptação de serviços de ECT ao cenário de pandemia por COVID-19 e propor adequações visando sua manutenção. Métodos: Foi realizada uma revisão narrativa a partir dos resultados encontrados nos bancos de dados do PubMed e do PubMed Central até 27 de maio de 2020. Os termos utilizados na pesquisa foram: "ECT" AND "COVID-19", "ECT" AND "Coronavirus", "electroconvulsive therapy" AND "COVID-19", "electroconvulsive therapy" AND "coronavirus". Foram encontrados 23 artigos no PubMed Central e 8 artigos no PubMed. Onze deles foram selecionados para a revisão de acordo com a relevância. Resultados: Os artigos demonstram uma redução significativa de ECT durante a pandemia. Dentre os motivos, estão: a teórica eletividade da ECT, escassez de relaxantes musculares, receio da transmissão do vírus principalmente por meio da ventilação não invasiva e receio de que profissionais de saúde necessitem de ser realocados para a linha de frente de assistência aos pacientes infectados. Discussão: Discutimos neste artigo as adaptações necessárias para a manutenção dos serviços de ECT: revisão de indicação de ECT, organização do serviço antes, durante e depois do procedimento, inclusive logística e transporte, screening da equipe e pacientes, revisão no uso de equipamentos de proteção individual e o manejo de vias aéreas, avaliar teleconsultas para acompanhamento entre as sessões, além de fiscalização se as adaptações estão sendo seguidas.

Introduction: The COVID-19 pandemic is a challenge for health services and has affected the electroconvulsive therapy (ECT) services performed as an essential procedure. The aim of this study was to the review articles that reported on the adaptation of ECT services to the COVID-19 pandemic scenario and to propose some adjustments to help in maintaining this service. Objective: A narrative review was performed based on the literature review of the PubMed and PubMed Central databases by searching articles published up to May 27, 2020. The search terms used were as follows: "ECT" AND "COVID-19," "ECT" AND "Coronavirus," "electroconvulsive therapy" AND "COVID-19," and "electroconvulsive therapy" AND "coronavirus". Overall, 23 articles were found in PubMed Central and eight in PubMed. Further, 11 of these were selected. Methods: These articles showed that ECT procedures have significantly reduced during the pandemic. The reasons for this are as follows: theoretical electivity of ECT; scarcity of muscle relaxants; fear of transmission of the virus, particularly via noninvasive ventilation; and fear that health professionals need to be relocated to the front-line care for the infected patients. Discussion: In this article, we discussed the adaptations required to maintain ECT services. These adaptations are as follows: review of the indication for ECT; organization of the service before, during, and after the procedure including logistics and transportation; screening of staff and patients; review of the use of personal protection equipment and respiratory airway management; evaluation of teleconsultations for monitoring patients between sessions; and monitoring to ensure that the adaptations are being followed.

Agentes comunitárias de saúde: práticas, legitimidade e formação profissional em tempos de pandemia de Covid-19 no Brasil / Agentes comunitarias de salud: prácticas, legitimidad y formación profesional en tiempos de pandemia de Covid-19 en Brasil / Community health workers during Covid-19 pandemic: practices, legitimacy and professional education in Brazil

Agentes comunitárias de saúde (ACS) ocupam lugar estratégico no Sistema Único de Saúde (SUS). Este artigo objetiva analisar disputas quanto ao trabalho das ACS no contexto da pandemia de Covid-19, assim como experiências voluntárias análogas, refletindo sobre o futuro da profissão. Trata-se de uma pesquisa qualitativa de caráter analítico cujos dados são documentos e posições públicas de diversos sujeitos. As representações sindicais evocam a necessidade de capacitação e trabalho em home office. Gestores direcionaram o trabalho para o interior dos serviços e para ações de vigilância e não ofereceram apoio ao trabalho comunitário e de educação em saúde. Experiências de agentes voluntários apontam a importância de mais ACS no SUS e valores de solidariedade. Apresentam-se síntese das práticas, legitimidade e formação, indicando avanços e desafios da profissionalização. (AU)

Las agentes comunitarias de salud (ACS) ocupan un lugar estratégico en el Sistema Brasileño de Salud (SUS). El objetivo de este artículo es analizar disputas en lo que se refiere al trabajo de las ACS en el contexto de la pandemia de Covid-19, así como de experiencias voluntarias análogas, reflexionando sobre el futuro de la profesión. Se trata de una investigación cualitativa de carácter analítico, cuyos datos son documentos y posiciones públicas de diversos sujetos. Las representaciones sindicales evocan la necesidad de capacitación y trabajo en home office. Los gestores dirigieron el trabajo hacia el interior de los servicios, para acciones de vigilancia y no ofrecieron apoyo al trabajo comunitario y de educación en salud. Experiencias de agentes voluntarios señalan la importancia de más ACS en el SUS y valores de solidaridad. Se presenta la síntesis de las prácticas, legitimidad y formación, indicando avances y desafíos de la profesionalización. (AU)

Community health workers (CHW) occupy a strategic place in the Brazilian National Health System (SUS). This article aims to analyze disputes regarding the work of CHW in the context of the Covid-19 pandemic, as well as similar voluntary experiences, reflecting on the future of the profession. It is a qualitative research of an analytical character whose data are documents and public positions of several subjects. Union representations evoke the need for training and working from home. Managers directed the work inside the services, for surveillance actions and did not offer support to community work and health education. Experiences of volunteer agents point to the importance of more CHWs in the SUS as well as to values of solidarity. A synthesis of practices, legitimacy and education is presented, indicating advances and challenges of professionalization. (AU)

Infancia y pandemia: Crónica de una ausencia anunciada / Childhood and the pandemic: Chronicle of an absence foretold

RESUMEN La infancia es el sur del virus, como ha visibilizado la pandemia de COVID-19: un mundo donde el cuidado no es un valor escogido desde el deseo, y donde la voz infantil es silenciada en virtud de una injusticia epistémica ancestral. Así, la transformación que las sociedades humanas están experimentando debido a la COVID-19 ha impactado significativamente en los derechos de la infancia, a niveles micro y macro. En España, como país especialmente golpeado por la pandemia, encontramos que tanto la primera infancia (a través especialmente de la violencia obstétrica) como ella misma en todas sus fases, están siendo víctimas de un paradigma adultocéntrico de control e injusticia epistémica basales. En este ensayo se analiza y discute algunas de las consecuencias negativas observadas en este país con relación al cuidado y el confinamiento de menores y sus familias, acaecidas a raíz de la pandemia, considerando que la crisis desencadenada por la COVID-19 puede ser una oportunidad para visibilizar situaciones de injusticia ancestral para con la niñez

ABSTRACT As the COVID-19 pandemic has made visible, childhood is the virus's proverbial south: a world where care is not a value chosen from a place of desire, and where children's voices are silenced at the hands of an ancestral epistemic injustice. Thus, the transformation that human societies are undergoing due to COVID-19 has significantly impacted the rights of children, both at the micro and the macro levels. In Spain - a country that has been particularly hard-hit by the pandemic - we find that both infancy (especially through obstetric violence) and childhood at all its stages fall victim to an adultcentric paradigm based on control and epistemic injustice. This essay analyzes and discusses some of the negative consequences observed in this country related to the care for and the confinement of minors and their families - which has occurred as a result of the pandemic - and considers that the crisis triggered by COVID-19 may be an opportunity to shed light on situations of ancestral injustice towards children.

Ease of use and validity testing of a point-of-care fast test for parasitic vaginosis self-diagnosis

@#There is a demand for patients to self-diagnose their sexually transmitted infections (selftesting), particularly during the coronavirus pandemic to prevent infection spread. We enrolled a cohort of Saudi women in a single-visit prospective study, which was the first of its kind performed in the country. Our aim was to evaluate the OSOM® Trichomonas (OSOM) test, a single-use, point-of-care rapid test, for its efficacy and accessibility as a self-test for Trichomonas vaginalis (Trichomonas) infection. At a public hospital’s gynecology clinic, women received sufficient training on specimen collection and OSOM self-testing. The women’s infection status was re-evaluated using direct wet mount microscopy and clinician performed OSOM using additional swabs. Specimens with discordant results were sorted using an inhouse polymerase chain reaction (PCR). 174 women aged 18 to 35 were registered and selftested at the clinic under the supervision of a gynecologist between June and December 2020, with 84.4 percent (147/174) having a valid result on the first or repeat OSOM. Infection was detected in 12.2% (18/147) of participants, with two-thirds of them symptomatic. Young age, low education, the existence of vaginitis symptoms, and unemployment were identified as key risk factors for infection in the study population, with statistically significant differences seen among women only in terms of education level and employment status (p<0.001). The OSOM self-test performed well (83.3% sensitivity and 98.4% specificity), outperforming the wet mount microscopy (72.2% sensitivity and 100% specificity) and comparable to the clinicians’ OSOM (88.8% sensitivity and 100% specificity). The patients’ and clinicians’ OSOM tests were strongly correlated, with a kappa of 0.89 and a 97.9% agreement. Self-collection of vaginal swabs was accepted and preferred by most women (94%) over the clinician-collection. Overall, our study’s findings may have important consequences for the implementation of Trichomonas screening based on OSOM self-testing approach in the study’s population.

Aplicación del modelo matemático SEIR en la pandemia por Covid-19, relevancia en salud pública / Application of the SEIR mathematical model in the Covid-19 pandemic, relevance in public health / Aplicação do modelo matemático SEIR na pandemia de Covid-19, relevância em saúde pública

INTRODUCCIÓN: El pasado 11 de marzo del 2020 la OMS (Organización Mundial para la Salud) realizó la declaratoria de pandemia por Sars-Cov 2, un nuevo coronavirus identificado en China a finales del 2019. Hasta la actualidad el virus se ha diseminado rápidamente en varios países poniendo a prueba los sistemas de salud de los mismos. Los modelos epidemiológicos matemáticos como SEIR (susceptible, expuesto, infectado, removido) han sido utilizados durante años para la gestión y estudio de enfermedades infecciosas. OBJETIVO: describir las características del modelo matemático SEIR y su aplicación en la gestión de la pandemia con su implicación en las decisiones de salud pública. METODOLOGÍA: se realizó una revisión bibliográfica de artículos originales escritos en español o inglés y publicados entre 2015-2020, sobre modelos matemáticos y de tipo SEIR, la relación con las enfermedades infecciosas, la pandemia por Covid-19 e influencia en las decisiones en salud pública. La búsqueda se realizó en las bases de datos google scholar, Medline, Science Direct. No se hicieron restricciones respecto al tipo de estudio. RESULTADOS: el modelamiento matemático para enfermedades infecciosas de tipo SEIR se utiliza como herramienta de predicción para la toma decisiones y deben valorarse objetivamente. Una opción para evaluar las ecuaciones y graficar sus resultados del modelo es el uso del software MATLAB. CONCLUSIÓN: se destaca su aporte en la comprensión del avance de la pandemia por Covid-19 y la influencia en la toma de decisiones para diseñar estrategias de prevención y respuesta en salud pública.

INTRODUCTION: on March 11, 2020, the WHO (World Health Organization) declared a pandemic for Sars-Cov 2, a new coronavirus identified in China at the end of 2019. Until now, the virus has spread rapidly in several countries testing their health systems. Mathematical epidemiological models such as SEIR (susceptible, exposed, infected, removed) have been used for years for the management and study of infectious diseases. OBJETIVE: to describe the characteristics of the SEIR mathematical model and its application in pandemic management with its implication in public health decisions. METHODOLOGY: a bibliographic review was carried out of original articles written in Spanish or English and published between 2015-2020 on mathematical and SEIR-type models, the relationship with infectious diseases, the Covid-19 pandemic and influence on health decisions public. The search was carried out in the google scholar, Medline, Science Direct databases. There were no restrictions regarding the type of study. RESULTS: mathematical modeling for infectious diseases of the SEIR type is used as a prediction tool for decision making and should be objectively assessed. One option for evaluating the equations and graphing your model results is to use MATLAB software. CONCLUSION: their contribution to understanding the progress of the Covid-19 pandemic and the influence on decision-making to design prevention and response strategies in public health is highlighted.

INTRODUÇÃO: em 11 de março de 2020, a OMS (Organização Mundial da Saúde) declarou uma pandemia de Sars-Cov 2, um novo coronavírus identificado na China no final de 2019. Até agora, o vírus se espalhou rapidamente em vários países testando sua saúde sistemas. Modelos epidemiológicos matemáticos comoo SEIR (suscetível, exposto, infectado, removido) são usados há anos para o gerenciamento e estudo de doenças infecciosas. OBJETIVO: descrever as características do modelo matemático SEIR e sua aplicação na gestão de pandemias com sua implicação nas decisões de saúde pública. METODOLOGIA: foi realizada uma revisão bibliográfica de artigos originais escritos em espanhol ou inglês e publicados entre 2015-2020, sobre modelos matemáticos e do tipo SEIR, a relação com doenças infecciosas, a pandemia de Covid-19e a influência nas decisões de saúde públicas. A pesquisa foi realizada nas bases de dados google scholar, Medline, Science Direct. Não houve restrições quanto ao tipo de estudo. RESULTADOS: A modelagem matemática para doenças infecciosas do tipo SEIR é utilizada como ferramenta de previsão para a tomada de decisão e deve ser avaliada objetivamente. Uma opção para avaliar as equações e representar graficamente os resultados do seu modelo é usar o software MATLAB. CONCLUSÃO: destaca-se a contribuição deles para a compreensão do progresso da pandemia Covid-19 e a influência na tomada de decisões para a formulação de estratégias de prevenção e resposta em saúde pública

Distanciamento social e tempo livre paradoxos vivenciados por estudantes da universidade estadual de minas gerais no âmbito do lazer / Social isolation and spare time: paradoxes experienced by students at the minas gerais state university with regard to leisure

A partir da oficialização do decreto sobre a pandemia do novo Coronavírus divulgado pela OMS em março/2020, esta pesquisa vislumbrou analisar as primeiras consequências do distanciamento social no dia-a-dia de discentes da Universidade Estadual de Minas Gerias (UEMG), através de três grandes eixos: moradia; trabalho/renda e saúde/bem-estar. Para tanto, um questionário, tipo survey, foi elaborado com 42 questões. Percebeu-se uma precariedade crescente quanto à qualidade de vida e acesso aos aparatos eletrônicos, devido à crise socioeconômica engendrada pela pandemia, dos discentes e seus familiares. Foi perceptível uma nova conjuntura em termos espaciais e temporais na vida dos discentes, afetando o tempo de trabalho, o tempo livre e os lazeres. Conclui-se que, caso não haja uma ação efetiva do poder público, a desigualdade social do país tende a estender-se de súbito, com impactos agudos na dimensão do lazer.

Based on the discussions about the contemporaneity and the officialization of law decree on the pandemic of the new coronavirus released by WHO in March / 2020, this research aimed to analyse the first consequences of social isolation in the day-to-day lives of students at the State University of Minas Gerais (UEMG), through three main axes: housing; work / income and health / well-being. In this aspect, a questionnaire, survey type, was elaborated with 42 questions. After material analysis, it is noticeable a growing precariousness in terms of quality of life, access to electronic devices, among others, due to the socioeconomic crisis engendered by the pandemic, of students and their families. In addition, a new conjuncture is perceived in spatial and temporal terms in the lives of students, greatly affecting the respondents' working time, spare time and leisure. It is concluded that, if there is no effective action by the public authorities, the country's social inequality tends to suddenly expand, opening up our social fracture.