Education in Emergency: Lessons Learned About School Management Practices and Digital Technologies

In a period strongly marked by constraints and abrupt societal changes, school leaders had to manage the pandemic crisis, guide changes, and find new solutions to respond to the demands of increasingly digitalised schools. In this context, a study was carried out to identify the main challenges faced by school leaders in Portugal and how digital technologies (DTs) were used by school leaders to address those challenges. From the methodological point of view, a questionnaire with closed and open questions on DTs during the COVID-19 pandemic was submitted to Portuguese school leaders between November 2020 and March 2021. Based on a descriptive statistical analysis of the closed questions and the content analysis of the open answers of 145 school leaders, the results point to aspects related to lack of training, lack of resources, widening inequalities and communication issues. The DTs are the same as used before. However, these technologies were used more frequently. These findings imply the need to invest in continuous training for school leaders in managing crises, how to optimise the use of DT in schools;and to capitalise on internal and external partnerships in collaborative efforts and to network to overcome the lack of resources, social needs, and inequalities. The lessons learned during the process of finding and evaluating solutions can contribute to improving school management processes in crises, in a post-pandemic future.

Psychosocial risk in healthcare workers after one year of COVID-19.

BACKGROUND: The COVID-19 pandemic overwhelmed the capacity of the healthcare system, affecting the volume of demands and the care tasks of healthcare workers. AIMS: To examine the health indicators and exposure to psychosocial risks of Spanish healthcare workers 1 year into the COVID-19 pandemic and compare them with the results of the first wave. METHODS: We conducted a cross-sectional study using an online questionnaire (April-May 2020 and 2021). The data stem from the COTS 1 project database, corresponding to the first wave of COVID-19 (n = 1989) and COTS 2 (n = 1716) corresponding to 1 year later. The samples were independent. The prevalence of exposure to psychosocial risks and adverse health indicators was estimated for every occupational group, segregating the data by sex. RESULTS: Professionals of all types presented worse perception of health. In general, the results were worse for women, while geriatric assistants presented the greatest exposure to psychosocial risk in COTS 2 compared to COTS 1. Sleep problems, high quantitative demands and high concern about becoming infected and spreading COVID-19 were cross-disciplinary in COTS 1, while worse perception of health, high pace of work, high work-life conflict and low development opportunities stood out in COTS 2. CONCLUSIONS: Exposure to psychosocial risks was already high during the first wave and a significant decline in working conditions was observed. The prolongation of the pandemic exacerbated these results and seems to have multiplied the pre-existing inequalities between the axes of segregation in the labour market.

The use of digital technologies in education: Future paths for a digital education

This study aimed to: identify digital platforms and technologies (DPT) most used in school activities;check effects of the pandemic due to COVID-19, on this use;systematize the advantages or contributions and problems/difficulties perceived. Questionnaires answered by 1,753 teachers and 2,041 students from Portuguese public schools revealed an increase in the frequency of use of DPT, for purposes identical to the pre-pandemic ones. Both groups considered that DPT promote innovative educational practices, being the internet access and the lack of knowledge in this area obstacles. During the quarantine, teachers referred mainly to the lack of communication with students and the subsequent social inequality, and students referred to the difficulty in understanding the subjects and the lack of contact with colleagues and teachers. In conclusion, it is necessary to invest in generalized access to the internet an DPTs and in the development of digital skills of teachers and students, in order to reduce social inequalities. © 2022 Universidade Estadual de Ponta Grossa, Editora. All rights reserved.

Classification of Chileans public hospitals based on healthcare production using clustering techniques

Governments worldwide have adopted different strategies fronting the pandemic associated with the SARS-CoV-2. These measures include different approaches to assign and manage the resources, control the spread of the virus, and mitigate the contagious. The technical efficiency allows evaluating the success rate in government managing and health facilities performance. Since technical efficiency is a relative measure, experts must compare the hospitals by adjusting their production according to the type of patient treated: case-mix. The literature recommends using the Related Groups for Diagnosis system (DRG) to adjust hospitals' production. However, only 80 of the more than 195 public hospitals have implemented this system in Chile, limiting the evaluation of technical efficiency. The Ministry of Health of Chile (MINSAL) has proposed an administrative categorisation for the public hospitals: high, medium, and low complexity. Managers can use this classification to group the hospitals avoiding bias. However, how good is this classification according to the data science point of view? In this work, we evaluate the categorisation proposed by MINSAL by applying internal clustering indexes and input features associated with healthcare production related to case-mix, considering different clustering techniques and an ad-hoc NSGA-II strategy. After evaluating alternative partitions where the latter obtains the best quality scores, we propose a new classification for technical efficiency analyses.

Elevated HScore is Associated with Poor Clinical Outcomes in COVID-19, Even in the Absence of Secondary Hemophagocytic Lymphohistiocytosis. (preprint)

Introduction: Patients with Coronavirus Disease 2019 (COVID-19) frequently experience a hyperinflammatory syndrome, that leads to unfavorable outcomes. This condition resembles Secondary Hemophagocytic Lymphohistiocytosis (sHLH) described in neoplastic, rheumatic and other infectious diseases. However, it has not been prospectively studied on these patients. A scoring system (HScore) has been validated for sHLH, and recently proposed to evaluate hyperinflammation in COVID-19. Methods: 143 patients aged [≥]18 years admitted because of COVID-19 were enrolled in a prospective, single-center, cohort study. HScore was calculated within the 72 hours since admission. The incidence of sHLH during hospitalization was evaluated. Additionally, the relationship between HScore [≥]130 points and either the requirement of mechanical ventilation or 60-days mortality was explored. Results: The median age of enrolled patients was 57 (21-100), and 63.6% were male. The median HScore was 96 (33-169). One patient was diagnosed with sHLH (incidence 0,7%), due to a HScore of 169. After adjusting for age, sex, comorbidities and obesity, HScore [≥]130 was independently associated with the composite clinical outcome (HR 2.13, p=0.022). Conclusion: sHLH is not frequent among COVID-19 patients. HScore can efficiently predict the risk for poor outcomes.

Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: A multicenter prospective observational study

Background and objectives There is limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March–April pandemic peak. Methods Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. Results A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34–45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. Conclusions A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%. Resumen Antecedentes y objetivos Existe poca información sobre la evolución, complicaciones y los tratamientos recibidos por los pacientes críticos con COVID-19 que requieren ingreso en una unidad de cuidados intensivos (UCI). El objetivo de este estudio es describir la evolución clínica, los tratamientos utilizados, las complicaciones y resultados de pacientes críticos COVID-19 ingresados en siete UCI de Anestesiología en la Región de Galicia durante el pico de la pandemia en marzo-abril 2020. Métodos Entre el 21 de marzo y el 19 de abril de 2020 evaluamos todos los pacientes críticos COVID-19 ingresados en las UCI de Anestesiología de siete hospitales en Galicia, en el Noroeste de España. Los resultados, complicaciones y los tratamientos administrados se registraron hasta el 6 de Mayo de 2020, fecha final del seguimiento. Resultados Un total de 97 pacientes críticos COVID-19 fueron incluidos. Durante su estancia en UCI, 80 pacientes (82,5%) necesitaron ventilación mecánica, y 22 pacientes (22,7%) traqueotomía. El decúbito prono se usó frecuentemente en pacientes intubados (67,5%) y despiertos (27,8%). Las medicaciones usadas fueron antivirales (92,7%), corticoides (93,8%), tocilizumab (57,7%), y dosis intermedias y altas de anticoagulantes (83,5%). Las complicaciones más frecuentes fueron infecciones adquiridas en UCI (52,6%), eventos trombóticos (16,5%), y reintubationes (9,3%). Tras un seguimiento medio de 42 (34–45) días, 15 pacientes fallecieron (15,5%), 73 pacientes (75,2%) habían sido dados de alta de UCI y nueve pacientes (9,3%) permanecían todavía en la unidad. Conclusiones Un alto porcentaje de nuestros pacientes críticos COVID-19 requirieron ventilación mecánica, posición prona, medicaciones antivirales, corticoides y anticoagulantes. Las complicaciones en UCI fueron frecuentes, principalmente infecciones y eventos trombóticos. Tuvimos una mortalidad relativamente baja del 15,5%.

Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study. / Pacientes críticos COVID-19 atendidos por anestesiólogos en el Noroeste de España: estudio multicéntrico, prospectivo, observacional.

BACKGROUND AND OBJECTIVES: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak. METHODS: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. RESULTS: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. CONCLUSIONS: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.

Everyday challenges and caring possibilities for children and adolescents with Autistic Spectrum Disorder (ASD) in the face of COVID-19

Introduction: In the current scenario of COVID-19 and its emergency demands, it is essential to understand the pandemic and its possible impacts, especially with regard to the most vulnerable social groups, such as children and adolescents with Autistic Spectrum Disorder (ASD). Objectives: This article aims to reflect on theoretical and clinical aspects of the challenges and possible implications of the current pandemic in everyday lives of children and adolescents with ASD, presenting possibilities of care based on Psychosocial Care for this population and their families. Method: This is a reflective essay, elaborated from the actions developed in a university project entitled "Caring strategies in Child and Adolescent Mental Health in the face of the COVID-19 pandemic", at Federal University of Sao Carlos (UFSCar). Results: Different caring strategies regarding the implications of the pandemic in the daily lives of children and adolescents with ASD are presented and discussed, and they include the organization of routine, informational interventions, support for the families, among others. It is understood that the caring strategies permeate the individual level and the demands of the family, as well as, more broadly, the importance of the collective and the community. Conclusion: There is a need for further studies related to clinical practices and studies that are based on the particularities of this population during the pandemic, in order to better cope with the situation.