Challenges for exercising health advocacy to hospitalized children during the COVID-19 pandemic

Objective: To analyze the challenges for exercising health advocacy to hospitalized children during the COVID-19 pandemic.Methods: This is an online descriptive-exploratory qualitative study. Participants were 28 nursing professionals enrolled in the subject Nursing in Health Care for Children and Adolescents in a graduate program at a federal university in northeastern Brazil. Data collection took place in June 2021 through a conversation wheel and press conference. As instruments, we used Google forms and a semi-structured script. The study was approved by the Research Ethics Committee. As an analysis method, Discursive Textual Analysis (DTA) was used. For data organization, Atlas.ti 8.4.15 software (Qualitative Research and Solutions) was used.Results: Two categories emerged: 1) Impacts of the pandemic on pediatric care and advocacy: child isolation and a health care scenario where children were placed in the background were observed. 2) Existing barriers that worsened with the health crisis: work overload, precarious structure and difficulty in working conditions were identified, which led to violations of children's rights and aggravated the overview of difficulties in the provision of pediatric services.Conclusion: The challenges for exercising health advocacy for hospitalized children during the pandemic, evidenced by the impacts and barriers to care, have expanded health teams' work, making the exercise of advocacy in pediatric care even more difficult. It is necessary to rethink and adjust access and care policies after the pandemic to ensure that child care is not restricted.

'We were the Guinea pigs': Police uncertainty enforcing coronavirus regulations in the UK

The regulations introduced under the UK's Coronavirus Act 2020 to help curb the spread of COVID-19 caused considerable confusion due to conflation between what was regarded as 'guidance' and what was 'law'. The fast-paced nature of the pandemic meant that restrictions on public liberty and increased police powers to enforce the new 'rules' led to accusations of over-zealous enforcement behaviour of some officers, including a record number of Fixed Penalty Notices (FPNs) issued. This paper explores the experiences of police officers in a range of English police forces, using 28 h of qualitative interview data at two research points in time (2020 and 2022). The extracts presented here illustrate some of the challenges that officers faced enforcing the frequently changing rules and regulations during the COVID-19 pandemic in the UK.

Rupturas biogr?ficas por la pandemia del COVID-19 en adolescentes y j?venes hombres trans y transmasculinos: demandas para la enfermer?a

Objetivo: comprender las rupturas biogr??ficas provocadas por la pandemia del COVID-19 en adolescentes y j??venes hombres trans y personas transmasculinas en el contexto de Brasil. M??todo: estudio cualitativo ??? encuesta en l??nea ??? multic??ntrico. Participaron 97 hombres trans y 22 personas transmasculinas autoidentificadas, que respondieron un formulario semiestructurado en dos etapas. Los datos se sometieron al An??lisis de Contenido Tem??tico Reflexivo. La interpretaci??n se realiz?? sobre una base sociol??gica a partir del concepto de ruptura biogr??fica. Resultados: surgieron cinco categor??as: interrupci??n de la terapia hormonal, cirug??as y seguimiento especializado;malestares precipitados por la interrupci??n de las caracter??sticas masculinas, autoimagen, autopercepci??n e identidad;vulnerabilidad por la p??rdida de familiares y seres queridos, empleo y debilitamiento de las redes de apoyo;aparici??n de problemas psicoemocionales, como la p??rdida del sentido de la vida;demandas de atenci??n de enfermer??a y valoraci??n de la vida de adolescentes y j??venes transexuales en el pospandemia. Conclusi??n: las rupturas biogr??ficas provocadas por la pandemia amenazaron las identidades de los hombres trans y personas transmasculinas adolescentes y j??venes, produjeron degradaci??n y discontinuidad de las biograf??as, llev??ndolas a perder el sentido de la vida. Los profesionales de enfermer??a pueden ser estrat??gicos e imprescindibles en la superaci??n de estas amenazas al promover una intervenci??n anticipada.

Morbidity and mortality of pregnant women due to COVID-19 and racial biases: an intersectional analysis

Objective: to analyze racial biases in the context of morbidity and mortality due to COVID-19 of Brazilian pregnant women from an intersectional perspective. Method: an ecological, documental study using epidemiological bulletins intended to monitor the novel coronavirus in Brazil. Data were collected in March and April 2021 and analyzed using descriptive statistics mediated by the intersectional theory-based methodology. Results: Afro-descendant pregnant women presented an average prevalence rate of 65.18% hospitalizations and 70.85% deaths due to COVID-19 in 2020. On the other hand, the average prevalence rate of hospitalizations and deaths among Caucasian pregnant women was 32.32% and 27.23%, respectively. Conclusion: A greater difficulty to access prenatal care, a high prevalence rate of comorbidities, poor working conditions and impossibility to leave work during the pandemic, institutional racism, and necropolitics adopted by the Brazilian government are potential explanations for the vulnerable context faced by this population © All Rights Reserved.

THE SOCIAL, INTERCULTURAL AND PERSONAL CONDITIONING FACTORS THAT INTERFERE WITH INCLUSIVE EDUCATION IN TIMES OF COVID-19

The general objective of this work is to analyze the relationship between inclusive education and the social, intercultural and personal conditions of teachers in times of pandemic (COVID-19) through structural equation methodology. This methodology contributes to the research objective by being able to relate the study dimensions in a mathematical way. The sample, selected by convenience (Spain-Ecuador), is made up of 810 university teachers. The conclusion is that the highest relationship is between the dimensions intercultural condition and personal condition, while the lowest relationship is between intercultural condition and social condition. Inclusive education, therefore, is mediated by these conditioning factors and, in spite of COVID-19, it is manifested at the moment of sharing with people from other cultures, with empathy in difficult situations of pandemic. © 2022 Associação Nacional de Pós-Graduação e Pesquisa em Educação – ANPEd Este es un artículo de acceso abierto distribuido en términos de licencia Creative Commons.

Usage of Pediatric Telehealth by US Emergency Departments in 2019

Study Objectives: Though a growing number of EDs receive telehealth services to care for pediatric patients, little is known about the recent usage of pediatric telehealth across all US EDs. Building upon our prior work, we aimed to characterize the usage of ED pediatric telehealth in the pre-COVID-19 era. Methods: The 2019 National ED Inventory (NEDI)-USA survey characterized all US EDs open in 2019. Among EDs reporting receipt of pediatric telehealth services (n=469), we selected a random sample (n=130) for a second, in-depth survey on pediatric emergency care and pediatric telehealth usage (2019 Pediatric Telehealth Survey). We also recontacted a random sample of EDs that responded to a prior, similar 2017 Pediatric Telehealth Survey (n=107), for a total of 237 EDs in the final 2019 Pediatric Telehealth Survey sample. Descriptive statistics are presented as frequencies and proportions. Results: Overall, 193 (81%) of the 237 EDs responded to the 2019 Pediatric Telehealth Survey. Among the 107 EDs first surveyed in 2017, 89 (83%) responded to the 2019 survey. Among these 89 EDs, 63 (71%) reported receiving receiving pediatric telehealth in both 2017 and 2019, 1 (1%) in 2019 only, and 13 (15%) in 2017 only. Among the 130 EDs only surveyed in 2019, 104 (80%) responded and 85 (82%) confirmed their receipt of pediatric telehealth. Overall, 149 responding EDs confirmed pediatric telehealth receipt in 2019. Among these, few reported ever having a board-certified pediatric emergency medicine (PEM) physician (10%) or pediatrician (9%) available for emergency care. 60% reported using pediatric telehealth services less than once per month, and 20% reported using services every 3-4 weeks, although 96% reported that these services were available 24 hours per day, 7 days per week. Most received pediatric telehealth from either another hospital in their hospital system (39%) or a hospital in a different hospital system (38%). EDs most frequently used pediatric telehealth to assist with diagnosis (73%) and treatment (78%) of pediatric conditions, and with placement and transfer coordination (91%). Almost all (93%) reported using pediatric telehealth to evaluate children (1-17.9 years) and 62% for infants (<1 year). Among the 63 EDs that confirmed pediatric telehealth receipt in both 2017 and 2019, there was an increase in EDs using pediatric telehealth for diagnosis of pediatric conditions (+7%), placement and transfer coordination (+11%), and staff education (+13%). There was also an increase in EDs using pediatric telehealth to evaluate both children (+12%) and infants (+11%). Conclusion: Most EDs receiving pediatric telehealth in 2019 had no board-certified PEM physician or pediatrician available, suggesting that telehealth services are being used to supplement access to pediatric expertise. Most EDs used pediatric telehealth services infrequently. The most common usage of pediatric telehealth was for placement and transfer coordination. We encourage future research on the effect of the COVID-19 pandemic on national usage of ED pediatric telehealth.

Metabolic Syndrome Is Associated With Worse Outcomes in SARS-CoV-2 Positive Emergency Department Patients

Study Objective: Increased body mass index (BMI) and metabolic syndrome (MetS) have been associated with adverse outcomes in numerous diseases. However, the role of BMI and MetS in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection remains unclear. We sought to examine the associations of increased BMI and MetS on several clinical outcomes in all ED patients tested for SARS-CoV-2 and then in the subset of COVID positive patients only. Methods: The REgistry of potential COVID-19 in emERgency care (RECOVER) is an observational study of SARS-CoV-2 tested patients from 155 US EDs. Inclusion criteria were a nucleic acid test at index visit. Body mass was categorized per CDC designations ie, BMI 18.5 to <25 kg/m2, 25 to <30 kg/m2, 30 to <35 kg/m2, 35 to <40 kg/m2 and ≥40 kg/m2. The presence of metabolic syndrome was defined as having 3 or more defining characteristics per the electronic medical record at the time of index visit;these included an elevated BMI (≥30 kg/m2), hyperlipidemia, hypertension, and diabetes. We used multivariable logistic regression to test for associations of several variables (including BMI, MetS, age, sex, race, ethnicity, and smoking) on the following clinical outcomes, first comparing SARS-CoV-2 positive and SARS-CoV-2 negative patients (N=27, 051) and then in the COVID+ subset (N=14, 056): hospital admission, intensive care unit (ICU) care, intubation, 30-day mortality and 30-day new or recurrent venous thromboembolism (VTE). Results: We report that BMI ≥ 30 kg/m2 was associated with SARS-CoV-2 test positivity (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.08-1.20). Analysis of BMI ≥ 40 kg/m2 revealed a stronger association with test positivity (OR 1.24, 95% CI 1.14-1.35). By contrast, MetS was not associated with testing positive (OR 0.95, 95% CI 0.89-1.01) in the overall cohort. In COVID+ patients, BMI ≥ 40 kg/m2 was associated with ICU care (adjusted odds ratio [aOR] 1.97;95% CI 1.65-2.35), intubation (aOR 2.69;95% CI 2.22-3.26) and mortality (aOR 1.50;95% CI 1.22-1.84). MetS was associated with worsened clinical outcomes: hospital admission (aOR 2.11;95% CI 1.89-2.37), ICU care (aOR 1.58;95% CI 1.40-1.78), intubation (aOR 1.46;95% CI 1.28-1.66), mortality (aOR 1.29;95% CI 1.13-1.48) and VTE (aOR 1.51;95% CI 1.07-2.13). Conclusions: In this large nationwide sample of ED patients undergoing SARS-CoV-2 testing, we report that BMI ≥ 30 kg/m2, BMI ≥ 40 kg/m2 and not MetS was associated with SARS-CoV-2 test positivity. Multivariable analysis in COVID positive patients only revealed significant associations of BMI ≥ 40 kg/m2 with three outcomes (ICU care, intubation and mortality) and of MetS with five outcomes (hospital admission, ICU care, intubation, mortality and VTE).

SEM model for technological, ecological and inclusive teacher training in times of pandemic

This work tries to analyze the relationship between teacher training (TT), teacher training in inclusive education (TTIE), teacher training in technologies (TTT), teacher training in ecology (TTE) and teacher training in time of pandemic (TTP), through a confirmatory factor analysis (CFA) with structural equation model (SEM) of a Likert scale created ad hoc, validated and confirmed. For the search for answers, a non-experimental, descriptive, explanatory and correlational research process has been carried out. The instrument used to collect the data has been a scale, which has been validated in content and with an excellent Cronbach's alpha (.902). The construct validity has been carried out with an exploratory factorial analysis (EFA). The sample has been of 598 students of Master's Degree in Teacher Training and the last year (4th) of the Primary Education Degree from the University of Jaen (Spain). It can be concluded that there is a relationship between the different forms of teacher training, from the correlational analysis the highest coefficient is between teacher training and teacher training in ecology and teacher training in inclusive education. From the CFA it is confirmed that this correlation is a very strong one, so that inclusion and ecology should be central axes in all teacher training, on the other hand, it concludes the low relationship between teacher training and teacher training in times of pandemic, so that, at least in theory, covid-19 should not affect teacher training. © 2021 North Caucasian Institute of Mining and Metallurgy, State Technological University. All rights reserved.

Use of chlorochine and hydroxychlorocchine in the treatment of COVID-19 risks and benefits according to an integrative review

Introduction: Responsible for the disease COVID-19, the new coronavirus, called SARS-CoV-2, was discovered in China. Its rapid spread caused astonishment and concern in the population, and it ended up causing one of the largest pandemics ever recorded in history. Some professionals suggest using Chloroquine and Hydroxychloroquine, medicines that have been used to fight various diseases for more than 70 years, to treat this infection. Their effectiveness in controlling COVID-19 has not been confirmed, though. Objectives: This study aims to collect information in the scientific literature on the risks and benefits of the drugs Chloroquine and Hydroxychloroquine used as drug therapy for patients affected by the disease. Method: An integrative literature review was carried out, on three online databases (LILACS, SCIELO, and PUBMED) to describe the effects of Chloroquine and Hydroxychloroquine when used in the treatment of the disease, allowing the critical evaluation of certain knowledge on the subject, and gathering multiple studies and their main outcomes.

Vitamin D supplementation to prevent acute respiratory infections: Systematic review and meta-analysis of aggregate data from randomised controlled trials

Background: A 2017 meta-analysis of data from 10,933 participants in 25 randomised controlled trials (RCTs) of vitamin D supplementation for prevention of acute respiratory infections (ARI) revealed a protective effect. Since then, data from 15 new RCTs with over 20,000 participants have emerged. Methods: Systematic review and meta-analysis of data from RCTs of vitamin D for ARI prevention using a random effects model. Pre-specified sub-group analyses were done to determine whether effects of vitamin D on risk of ARI varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration or dosing regimen. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, ClinicalTrials.gov and the International Standard RCT Number (ISRCTN) registry from inception to 1st May 2020. Findings We identified 40 eligible RCTs (total 30,956 participants, aged 0 to 95 years). Data were obtained for 29,841 (96.5%) of 30,909 participants in 39 studies. For the primary comparison of vitamin D supplementation vs. placebo, the intervention reduced ARI risk overall (Odds Ratio [OR] 0.89, 95% CI 0.81 to 0.98;P for heterogeneity 0.009). No statistically significant effect of vitamin D was seen for sub-groups defined by baseline 25(OH)D concentration. However, protective effects were seen for trials using a daily dosing regimen (Table presented) (OR 0.75, 95% CI 0.61 to 0.93);at daily dose equivalents of 400-1000 IU (OR 0.70, 95% CI 0.55 to 0.89);and for a duration of ≤12 months (OR 0.82, 95% CI 0.72 to 0.94). Vitamin D did not influence the risk of experiencing a serious adverse event. Risk of bias within studies was assessed as being low for all but two trials. A funnel plot showed asymmetry, suggesting that small trials showing non-protective effects of vitamin D may have been omitted from the meta-analysis. Interpretation: Vitamin D supplementation was safe and reduced risk of ARI, despite evidence of heterogeneity across trials. The overall effect size may have been over-estimated due to publication bias. Protection was associated with administration of daily doses of 400-1000 IU vitamin D for up to 12 months. The relevance of these findings to COVID-19 is not known and requires investigation.

COVID-19: how fake news can influence the population during the pandemic

Introduction: The new coronavirus and the Covid-19 pandemic have shown that skepticism, the spread of fake news, and the devaluation of science can make a triad able to cause significant impacts to face the pandemic.