Telemonitoring of older anticoagulant users during the COVID-19 pandemic

The COVID-19 pandemic brought challenges to the monitoring of anticoagulant users, especially older adults, making telemonitoring an alternative to provide continuity of care for these patients. The present study aimed to describe the experience of telemonitoring of older anticoagulant users during the COVID-19 pandemic. This is a descriptive study concerning the telemonitoring pharmaceutical service for older adults (>= 60 years old) using oral anticoagulants in a private geriatric outpatient clinic (Belo Horizonte). Older people had parameters of effectiveness and safety of anticoagulants monitored monthly by telephone (Apr-Dec/2021). Identified problems generated interventions for the patient or the multidisciplinary team. A total of 425 older adults were included in the service. Most used apixaban (189;41.9%), rivaroxaban (146;34.4%) and warfarin (47;11.1%). There was a mean age of 82.1 years, mostly female (65.2%), most at high risk of vulnerability (69%), and an incidence of 9.9% of COVID-19. There were 219 interventions related to warfarin (average of 4.6 interventions/patient);including requests for an INR test (57.5%), health guidelines (19.6%), dosage change (reduction -10.5%;increase -5.9%;suspension -0.6%), or referral (5.9%). Users of other anticoagulants did not show alterations in the monitored parameters. Eleven older adults suffered falls and 10 required hospitalizations due to thromboembolic or hemorrhagic events. There was no statistically significant difference in hospitalization rates between users of warfarin or other anticoagulants (p=0.314). Monitoring older anticoagulant users is important, especially considering the high level of frailty identified and the thromboembolic and non-thromboembolic risks that COVID-19 brings. Telemonitoring was important, allowing for multiple interventions to be performed.

COVID-19 vaccines effectiveness against symptomatic disease and severe outcomes, 2021-2022: a test-negative case-control study.

OBJECTIVES: This study evaluated the effectiveness of COVID-19 vaccines in preventing symptomatic and severe disease. STUDY DESIGN: This was an observational test-negative case-control study. METHODS: Study participants were adults with at least one symptom included in the World Health Organization COVID-19 definition who sought health care in a public emergency department between 1 November 2021 and 2 March 2022 (corresponding with the fifth pandemic wave in Portugal dominated by the Omicron variant). This study used multivariable logistic regression models to estimate and compare the odds ratio of vaccination between test-positive cases and test-negative controls to calculate the absolute and relative vaccine effectiveness. RESULTS: The study included 1059 individuals (522 cases and 537 controls) with a median age of 56 years and 58% were women. Compared with the effectiveness of the primary vaccination scheme that had been completed ≥180 days earlier, the relative effectiveness against symptomatic infection of a booster administered between 14 and 132 days earlier was 71% (95% confidence interval [CI]: 57%, 81%; P < 0.001). The effectiveness of the primary series against symptomatic infection peaked at 85% (95% CI: 56%, 95%) between 14 and 90 days after the last inoculation and decreased to 34% (95% CI: -43%, 50%) after ≥180 days. CONCLUSIONS: Despite the known immunological evasion characteristics of the Omicron variant, results from this study show that vaccine effectiveness increases after booster administration. COVID-19 vaccine effectiveness decreases to less than 50% between 3 and 6 months after completion of the primary cycle; therefore, this would be an appropriate time to administer a booster to restore immunity.

Food Insecurity in Portugal during the COVID-19 Pandemic: Prevalence and Associated Sociodemographic Characteristics

Introduction: The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern. Aim: The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics. Methodology: This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated. Results: Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling;OR 2.966;95% CI 1.250-7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602;95% CI 1.004-6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007;95% CI 0.001-0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic. Conclusions: These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.

Impact of the COVID-19 pandemic on tuberculosis services.

BACKGROUND: In Portugal, Outpatient Tuberculosis Centres (OTBC) are responsible for the diagnosis, treatment, screening and prevention of tuberculosis (TB), and only severe or resistant cases are hospitalized. AIM: To understand how infection control norms and standards were applied and how these centres responded during the pandemic. METHOD: We sent an electronic questionnaire to all coordinators of OTBC. The questionnaire included questions on infection control during the COVID-19 pandemic and evaluation of the functioning of the OTBC in two periods: during the 1st National State of Emergency and after 1 year. RESULTS: Thirty-two responses were obtained (52.5%). The infection control norms were globally applied; diagnosis, treatment, and prevention were kept, and contact screening was only affected during the 1st State of Emergency. However, half of the respondents (53.1%) believed that there were diagnostic delays during the 1st State of Emergency, rising to 68.8% after 1 year. Only 31.3% performed Directly Observed Therapy (DOT) in all patients during the 1st State of Emergency, and 59.4% after 1 year. Half the inquiries expected an increase in TB incidence in the near future. CONCLUSION: The pandemic affected OTBC functioning, although the services were kept open; diagnostic delay and DOT appliance were the most affected.

Pfizer-biontech COVID-19 vaccine: Suspected allergic reactions to the first dose

Background: The coronavirus disease 2019 (COVID-19) was first identified in December 2019 in Wuhan, China. The WHO declared the outbreak a Public Health Emergency of International Concern in January 2020 and a pandemic in March 2020. Until March 28 2021, more than 125 million cases have been confirmed, with more than 2.7 million deaths attributed to COVID-19. On December 21, 2020, the EMA issued an Emergency Use Authorization for Pfizer-BioNTech COVID-19 vaccine to prevent COVID-19, to be administered in 2 separate doses 21 days apart. The aim of this study was to identify and describe the suspected allergic reactions to first dose of Pfizer-BioNTech COVID-19 vaccine in health care professionals of our center. We also aimed to know if these reactions interfered with the compliance of vaccination protocol. Method: All health care professionals that receipt the vaccine were included. A prospective study was carried out using an online questionnaire to access the demographic data, personal allergic history and description of reaction to the vaccine. Results: In our hospital, the vaccination began on December 29, 2020. A total of 3040 first doses were administered. A total of 2095 (69%) questionnaire responses were collected. It was reported 1649 (79%) adverse events. Among these, 16 (1%) were identified as suggestive allergic reaction. These reactions occurred in professionals, 13 cases (81%) female, with a median age of 41 years (28-52y). The median interval from vaccine administration to symptom onset was 6 hours (5 min-48h). Eight professionals had late cutaneous reactions: 6 had mild reactions and tolerated the second dose;and 2 had severe reactions and it was decided not to administer the vaccine. The other 8 professionals had immediate reactions: 7 performed allergological study that was negative. The second dose vaccine was administered with vigilance and it was observed cutaneous reaction similar to prior reaction in only one case. Conclusion: In our study population, only 0.8% (16 of 2095) had a suggestive allergic reaction to first dose of the Pfizer-BioNTech COVID-19 vaccine. Half of them had immediate reactions and only 1 professional had a reproducible episode with the second dose;the other had late reactions and only 2 (0.1%) professionals did not complete the vaccination protocol. We can conclude that this vaccine has a good safety profile. and that mild reactions do not interfere with compliance with vaccination schedule.

Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study.

BACKGROUND: The COVID-19 outbreak and consequent physical distance measures implemented worldwide have caused significant stress, anxiety, and mental health implications among the general population. Unemployment, working from home, and day-to-day changes may lead to a greater risk of poor mental health outcomes. OBJECTIVE: This paper describes the protocol for a web-based cross-sectional study that aims to address the impact of the COVID-19 pandemic on mental health. METHODS: Individuals from the general population aged 18 years or more and living in Portugal were included in this study. Data collection took place between November 10, 2020, and February 10, 2021. An exponential, nondiscriminative, snowball sampling method was applied to recruit participants. A web-based survey was developed and shared on social media platforms (eg, Facebook, Instagram, Twitter, LinkedIn, and WhatsApp groups) and through e-mail lists for recruitment of the seeds. RESULTS: Data analysis will be performed in accordance with the different variables and outcomes of interest by using quantitative methods, qualitative methods, or mixed methods, as applicable. A total of 929 individuals had completed the web-based survey during the 3-month period; thus, our final sample comprised 929 participants. Results of the survey will be disseminated in national and international scientific journals in 2021-2022. CONCLUSIONS: We believe that the findings of this study will have broad implications for understanding the psychological impact of the COVID-19 pandemic on Portuguese residents, as well as aspects related to the informal economy. We also hope that the findings of this study are able to provide insights and guidelines for the Portuguese government to implement action. Finally, we expect this protocol to provide a roadmap for other countries and researchers that would like to implement a similar questionnaire considering the related conclusions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28071.

The poisonous garden: The chemistry behind the intoxication by domestic ornamental plants

In times of the COVID-19 pandemic, despite the fact families have spent more time together, the job demands and commitments that adults have now brought into their homes may mean their attention has been taken away from their children. This, combined with the absence of older family members or domestic helpers that assist in looking after the children has left them potentially more exposed to domestic accidents. Data from the National Toxic-Pharmacological Information System indicate that two-thirds of domestic intoxications with plants (usually the ornamental ones) occur in children. These accidents can be caused either by inhalation, contact with the skin, eyes and mucous membranes, as well as by ingestion. The toxicity of ornamental plants is due to the presence of substances such as oxalic acid and its highly irritating salts, alkaloids, glycosides, flavonoids, and toxic terpenes, among several other classes of secondary metabolites. In the present study, we carried out a survey of the main ornamental plants used in the country and analyzed the toxic substances that can cause numerous conditions from dermatitis in milder cases to death in more severe cases. © 2021 Sociedade Brasileira de Quimica. All rights reserved.

Thrombotic events and COVID-19 vaccines.

COVID-19 vaccines are considered promising agents in the control of the pandemic. Although their safety was assessed in randomised clinical trials, severe adverse events (AEs) have been reported after large-scale administration. This study aims to evaluate thromboembolic AEs reported after vaccination in a real-world context and how they led to the interruption of vaccination campaigns. We also review the benefits and risks of the vaccines approved in the European Union and provide recommendations. A review of the literature was performed using Medline/PubMed electronic database as well as institutional and pharmacovigilance official reports. Our findings show that vaccine-induced prothrombotic immune thrombocytopenia has been suggested as a very rare AE associated with viral vector vaccines. Unusual thrombotic events combined with moderate-to-severe thrombocytopenia were reported mainly in women under 60 years of age. As safety signals emerged, Vaxzevria and Janssen´s COVID-19 vaccine campaigns have been paused while investigations proceed. On the other hand, the number of deep vein thrombosis and pulmonary embolism reports have not increased. Post-marketing surveillance indicated that mRNA vaccines are safe and should continue to be used. The thrombotic events report rate is not increased in people over 60 years. As they are at greater risk for COVID-19 complications and death, no vaccine restrictions are recommended in this group. Risk factors for vaccine-induced prothrombotic immune thrombocytopenia should be established so that evidence-based decisions can be made. Systematic monitoring of COVID-19 vaccine safety is essential to ensure that the benefits of vaccination outweigh the risks.

Different disease, same challenges: Social determinants of tuberculosis and COVID-19.

Infectious diseases, such as tuberculosis (TB) and the novel coronavirus (COVID-19) relate to environmental factors, understanding of which is essential to inform policy and practice and tackle them effectively. The review follows the conceptual framework offered by the World Health Organization Commission on Social Determinants of Health (defined as "all those material, psychological and behavioural circumstances linked to health and generically indicated as risk factors' in the conventional epidemiological language"). It describes the social factors behind TB and COVID-19, the commonalities between the two diseases, and what can be learned so far from the published best practices. The social determinants sustaining TB and COVID-19 underline the importance of prioritising health and allocating adequate financial and human resources to achieve universal health coverage and health-related social protection while addressing the needs of vulnerable populations. Rapid and effective measures against poverty and other major social determinants and sources of inequality are urgently needed to develop better health in the post-COVID-19 world.

Crowdsensing spatial data to follow epidemic evolution: Poster abstract

Covidmonitor is a crowdsensing tool to support epidemologists and public health authorities in monitoring the covid-19 pandemic. The tool collects data to support transdisciplinary studies aiming at improving the knowledge of the pandemic evolution as well as monitor the citizens' behaviour and mental health. Covidmonitor leverages a previously existing mobile crowdsensing platform, SenseMyCity, adapted in collaboration with epidemology, public health and psychology researchers. Our biggest challenge was to identify the relevant metrics for the target trans-disciplinary studies and map them to collectable data. Covidmonitor explores the concept of citizens as probes to sample collective behaviour. The mobile application launches questionnaires about hygiene practices, use of personal protection equipment, health and emotional state. The questionnaires are triggered by different logic, adequate to the multi-dimensional perspectives of the target studies. Covidmonitor also seamlessly collects relevant mobility data without significant battery consumption. Finally, it enables voluntary sharing of location and symptom history, to facilitate tracing in case of infection. The tool considers user privacy and data minimisation by design, and is currently under preliminary scrutiny of the data protection regulator in Portugal. © 2020 Owner/Author.

LIGA ACADÊMICA DE HEMATOLOGIA CLÍNICA E LABORATORIAL DA UFPE (LHCL): UM RELATO DE EXPERIÊNCIA SOBRE A IMPORTÂNCIA DA MULTIDISCIPLINARIDADE NA HEMATOLOGIA

Introdução e objetivo: Uma Liga Acadêmica é uma associação civil científica livre, de duração indeterminada, sem fins lucrativos que visa complementar a formação acadêmica em uma área específica por meio de atividades que atendam aos princípios do tripé universitário de ensino, pesquisa e extensão. O ingresso em uma liga permite ao acadêmico o desenvolvimento de habilidades como o trabalho em equipe, podendo construir consensos quanto aos objetivos e resultados a serem alcançados pelo conjunto, bem como quanto à maneira mais adequada de atingi-los. Normalmente, as Ligas Acadêmicas têm o intuito de integralizar alunos do mesmo curso, especificando uma determinada área. No entanto, diante da grande área que é a hematologia, pensando na necessidade de integralizar diferentes formações e visando a diversidade das vivências e percepções, a Liga Acadêmica de Hematologia Clínica e Laboratorial da UFPE (LHCL) surge com a proposta de inteirar conhecimentos de diversas áreas da saúde. O presente trabalho tem como objetivo relatar experiências obtidas na primeira gestão da LHCL, com enfoque no atendimento à população e na abordagem multiprofissional da hematolgia pelos seus integrantes. Relato de experiência: O conteúdo programático, desenvolvido pela gestão composta por um grupo de seis alunos do curso de biomedicina e um professor coordenador responsável, foram dividido em módulos para melhor entendimento e participação dos ligantes, e aconteceram quinzenalmente com participação de profissionais da área que conferiram palestras e aulas. O conhecimento foi aplicado por meio de discussão de casos clínicos reais, escrita de artigos de revisão e participação em eventos, priorizando atividades em grupo e debates entre diferentes cursos. Resultados: A LHCL representa, atualmente, a única Liga Acadêmica em hematologia de Pernambuco que propõe um enfoque multiprofissional. A inserção dos acadêmicos (que compõe a gestão) dos cursos de biomedicina, farmácia, ciências biológicas e enfermagem nas discussões sobre o manejo do pacientes tem sido de notável relevância no entendimento da hematologia em suas especificidades, já que os distúrbios abordados são de caráter multifatorial. Cada aluno participante age como replicador de conhecimentos e atitudes, respeitando as especificidades e limites de cada formação. Apesar das limitações encontradas por ser a primeira gestão e pelo contexto de COVID19 que estamos inseridos, ativididades foram desenvolvidas. Atualmente a LHCL promove uma semana de curso em hematologia clínicia e laboratorial que conta com mais de seis mil inscritos das mais diversas áreas, estados e até paises. Conclusões: A cada dia que passa, a contemporaneidade exige um novo perfil de profissional, que seja capaz de atender as novas perspectivas de trabalho. Desta forma, promover o espaço para que a conversa entre alunos de cursos diferentes ocorra é de extrema importância na formação de equipes multiprofissionais. Tornar a visão e o estudo da hematologia cada vez menos engessados e cada vez mais multidisciplinar é de extrema importância tanto em níveis acadêmicos como em abordagens hospitalares. Palavras-chave: Hematologia;Liga Acadêmica;Multiprofissionalidade;Relato.