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This work describes food experiences during the Covid-19 pandemic, according to the urban or rural ecological configuration and the socioeconomic level (SES) in households in the province of Tucumán (Argentina). A digital field work was carried out in 1342 households classified as urban (942) or rural (400) according to the criteria of the Instituto Nacional de Estadísticas y Censos. Food experiences were assessed through primary data analysis applying the Latin American and Caribbean Scale for the measurement of Food Security and SES through the Family Affluence Scale. Likewise, secondary information sources were used to characterize the structural living conditions of the urban and rural population. The results showed a higher affectation in the experiences of the home in general, compared to the experiences of adults and children and adolescents, in particular. Rural households were the most affected, as were those with low SES. However, the experiences and practices in both environments had in common the care of feeding children and adolescents. © Editado por D. Demarchi
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Protected areas are under immense pressure to safeguard much of the remaining global biodiversity and can be strained by unpredicted events such as the Covid-19 pandemic. Understanding the extent of the effects of the pandemic on protected area management and conservation outcomes is critical for recovery and future planning to buffer against these types of events. We used survey and focus group data to measure the perceived impact of the pandemic on protected areas in Mexico and outline the pathways that led to these conservation outcomes. Across 62 protected areas, we found substantial changes in management capacity, monitoring and tourism, and a slight increase in non-compliant activities. Our findings highlight the need to integrate short-term relief plans to support communities dependent on tourism, who were particularly vulnerable during the pandemic, and to increase access to technology and technical capacity to better sustain management activities during future crises.
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The CoVID-19 pandemic constitutes a macro-social event that reinforces territorial inequalities. The objective of this study is to increase knowledge of food security in the province of Tucumán during the first months of the CoVID-19 pandemic, by describing the extent and distribution of food insecurity at a departmental level, and analyzing, in particular, households with children and adolescents. A quantitative and cross-sectional study was carried out by means of a digital questionnaire. The Latin American and Caribbean Scale for the measurement of Food Security was applied to distinguish between households with food security and households with food insecurity (mild, moderate, severe). Information from 3,915 households was obtained. Prevalences of food insecurity were calculated at a departmental level and according to the presence or absence of minors in the household. In addition, spatial indicators and thematic cartography were developed and census data were analyzed. Comparisons were made considering the presence of minors in the home (chi-square tests). The results indicated that, during the first months of the pandemic, food insecurity showed marked socio-spatial differences. The most affected households were those where children and adolescents lived. The analysis at departmental level confirms this trend and reveals critical areas of food insecurity and perception of hunger associated with conditions of persistent inequality. The results and cartographic developments obtained provide evidence on the vulnerability of child populations in the context of a pandemic. © 2023 Universitat de Valencia. All rights reserved.
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Background: The poly(ADP-ribose) polymerase inhibitor niraparib showed clinical activity in advanced gBRCAm ovarian and breast cancers. LUZERN aims to assess the effectiveness of niraparib plus AI in HR+/HER2–, AI-resistant ABC with a pathogenic variant in homologous recombination-related genes. Here we report findings from the stage 1 interim analysis. Methods: This open-label, single-arm, Simon’s 2-stage, phase II trial is enrolling HR+/HER2– ABC patients (pts) with gBRCAm (cohort A;n=6 in stage 1, n=7 in stage 2) and gBRCA wild-type/HRd (cohort B;n=9 in stage 2). Pts had to have received ≤1 prior line of chemotherapy for ABC, 1–2 prior lines of endocrine therapy for early or ABC with secondary endocrine resistance to the last AI regimen. Pts receive niraparib (200/300mg daily orally) plus AI (same agent given with the prior regimen) on each 28-day cycle. Primary endpoint: clinical benefit rate (CBR) as per RECIST 1.1. Secondary endpoints: overall response rate, progression-free survival (PFS), and safety per CTCAE 5.0. If ≥1/6 pts experienced clinical benefit, the trial should proceed to stage 2. Results: Six pts were enrolled in stage 1. Median age was 46 years (range 32–76), 66.7% of pts had visceral disease, and 83.3% had received prior CDK4/6 inhibitor-containing regimen for ABC. At data cut-off, 50.0% of pts were ongoing and median duration of treatment was 4.6 months (range 2.4–5.7). One patient achieved complete response, meeting the criterion to proceed to stage 2. Median investigator-assessed PFS was 5.3 months (95%CI 3.9–NA). The most frequent adverse events (AEs) of any grade (G) were nausea (3 [50.0%]), neutropenia (2 [33.3%];16.7% G3), constipation (2 [33.3%]), and vomiting (1 [16.7%]). Serious AEs occurred in 3 pts (50.0%;G3 COVID-19 pneumonia;G3 pseudomonal bacteriemia;G2 sacral pain). No treatment-related discontinuations/deaths were reported. Conclusions: Niraparib plus AI showed preliminary activity with a tolerable safety profile in gBRCAm HR+/HER2– AI-resistant ABC pts. Based on the steering committee recommendation, enrolment in cohorts A and B is ongoing. Clinical trial identification: ClinicalTrials.gov identifier: NCT04240106. Legal entity responsible for the study: MEDSIR. Funding: GlaxoSmithKline. Disclosure: J.Á. García Saenz: Financial Interests, Personal, Advisory Board: Seagen, Gilead;Financial Interests, Personal, Invited Speaker: Novartis, Celgene, Eli Lilly, Eisai, AstraZeneca, Daiichi Sankyo, MSD, Exact Sciences;Financial Interests, Institutional, Funding: AstraZeneca. J. De la Haba Rodriguez: Financial Interests, Personal, Other, Consultant and Advisory Role, Research Funding and Speaking: Pfizer, Novartis, Roche, Lilly;Financial Interests, Personal, Other, grant support: Pfizer. J.E. Ales Martínez: Financial Interests, Personal, Other, travel grant: Pfizer;Financial Interests, Personal, Research Grant: MEDSIR. E. Alba Conejo: Financial Interests, Personal, Advisory Role: Roche, Novartis, Pfizer, Lilly, BMS, Astrazeneca, Pierre Fabre, Daiichi, Exact Sciences;Financial Interests, Personal, Research Grant: Pfizer. J. Balmaña: Financial Interests, Personal, Advisory Role: AstraZeneca, Pfizer;Financial Interests, Institutional, Other, Steering committee member: AstraZeneca;Financial Interests, Institutional, Principal Investigator: Medsir, Pfizer. J.M. Perez Garcia: Financial Interests, Personal, Advisory Role: Lilly,Roche, Eisai, Daichii Sankyo, AstraZeneca, Seattle Genetics, Medsir;Financial Interests, Personal, Other, travel expenses: Roche. M. Sampayo-Cordero: Financial Interests, Personal, Other, honoraria: Medsir, Syntax for Science, Optimapharm, and Ability pharma;Financial Interests, Personal, Research Grant: Medsir;Financial Interests, Personal, Other, travel expenses: Medsir, Syntax for Science, Optimapharm, and Roche;Financial Interests, Personal, Other, consultant: Medsir, Syntax for Science, and Optimapharm;Financial Interests, Personal, Speaker’s Bureau: Medsir;Financial Interests, Personal, Full or part-time Employment: Me sir. A. Malfettone: Non-Financial Interests, Personal, Full or part-time Employment: MEDSIR. J. Cortés: Financial Interests, Personal, Advisory Role: Roche, Celgene, Cellestia, Astrazeneca, Seattle Genetics, Daiichi Sankyo, Erytech, Athenex, Polyphor, Lilly, Merck Sharp&Dohme, GSK, Leuko, Bioasis, Clovis Oncology, Boehringer Ingelheim, Ellipses, Hibercell, BioInvent, Gemoab, Gilead, Menarini, Zymeworks;Financial Interests, Personal, Other, honoraria: Roche, Novartis, Celgene, Eisai, Pfizer, Samsung Bioepis, Lilly, Merck Sharp&Dohme, Daiichi Sankyo;Financial Interests, Institutional, Research Grant: Roche, Ariad pharmaceuticals, AstraZeneca, Baxalta GMBH/Servier Affaires, Bayer healthcare, Eisai, F.Hoffman-La Roche, Guardanth health, Merck Sharp&Dohme, Pfizer, Piqur Therapeutics, Puma C, Queen Mary University of London.;Financial Interests, Personal, Stocks/Shares: MEDSIR, Nektar Pharmaceuticals, Leuko (relative);Financial Interests, Personal, Other, travel, accomodation: Roche, Novartis, Eisai, pfizer, Daiichi Sankyo, Astrazeneca. A. Llombart Cussac: Financial Interests, Personal, Leadership Role: Eisai, Celgene, Lilly, Pfizer, Roche, Novartis, and MSD;Financial Interests, Personal, Stocks/Shares: MEDSIR and Initia-Research;Financial Interests, Personal, Advisory Role: Lilly, Roche, Pfizer, Novartis, Pierre-Fabre, GenomicHealth, GSK;Financial Interests, Personal, Speaker’s Bureau: Lilly, AstraZeneca, and MSD;Financial Interests, Personal, Research Grant: Roche, Foundation Medicine, Pierre-Fabre, and Agendia;Financial Interests, Personal, Other, travel compensation: Roche, Lilly, Novartis, Pfizer, and AstraZeneca. All other authors have declared no conflicts of interest.
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OBJECTIVES: To analyze the frequencies of 3 types of hospital revisits by patients after treatment for COVID-19 in the emergency department.;MATERIAL AND METHODS: Retrospective observational study of consecutive patients who came to the emergency department in March and April 2020 and were discharged alive with a diagnosis of COVID-19. Baseline and acute episode data were collected and the patients were followed for 1 year. We analyzed variables associated with revisits for any reason, revisits related to COVID-19, and early COVID-19-related revisits (within 30 days).;RESULTS: A total of 1352 patients with a mean age of 62.1 years (52.9% male) were studied. A total of 553 revisits were made by 342 patients (25.3%) for any reason;132 (9.8%) revisited in relation to COVID-19 at least once. Of those, 103 (7.6%) revisited within 30 days (early) and 29 (2.2%) came later. COVID-19-related revisits were associated with thrombotic events (odds ratio [OR], 7.58;95% CI, 1.75-32.81) and pulmonary fibrosis (OR, 4.95;95% CI, 1.27-19.24);early revisits were inversely associated with follow-up management by a contracted health care support service (OR, 0.18;95% CI, 0.03-0.92). Hospital admission during the initial visit was significantly associated with fewer revisits for any reason or related to COVID-19 at any time.;CONCLUSION: Fewer than half the total number of emergency department revisits after initial care for COVID-19 were related to the novel coronavirus infection. Revisits occurred more often in the first 30 days after discharge. Later COVID-19-related revisits were uncommon, but given the large number of patients with this infection, such visits can be expected.
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NOVEL INTRODUCTION: With the presence of COVID-19 in all human activities, the medical world has faced a radical change in the way that medical practice develops all around the world. A necessary cog in the physician's life is the teaching-learning process that is lived daily in the clinical setting during medical residencies. The new reality that is being contemplated warrants a new way of thinking, acting, teaching, and learning. OBJECTIVE: To identify challenges and opportunities for the physician's formation in medical residencies ever since the onset of the pandemic. AUTHOR'S POSITIONING: One of the essential tools that a human being must have to survive any given crisis is his/her capability to adapt and modify conducts in order to better respond to uncertainty. The system under which physicians with specialties have developed throughout the years was sufficient for that specific reality under which it was first conceived;however, as time went by and with the current emergency, this is no longer efficient nor sufficient. Therefore, it's necessary to analyze the education model and reevaluate the competences required to instruct in a specialist. CONCLUSIONS: The clinical formation, particularly, represents a new opportunity to design, plan and implement the education process with a social responsibility sense and innovation through a new and different approach. In this new proposal, both education and health institutions work collaboratively in the generation of excellent medical specialists, not only in the cognitive aspect, but also, in the human aspect.
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Objectives: a) to describe the levels of food and nutrition security (SAN) perceived in households of the agglomerate of Gran San Miguel de Tucuman (Argentina) in the context of social, preventive and mandatory isolation (ASPO) due to the Covid-19 pandemic;b) Analyze whether there are differences in levels of food insecurity (AI) according to household size, the presence of children under 18 years, compliance with ASPO and socioeconomic level (NSE)and c) identify factors associated with the perception of hunger. Methods: Quantitative cross-sectional study in 2,558households.Data was collected using a digital questionnaire.Aspects related to the home and its responsible were investigated. The NSE was estimated using the Family Affluence Scale and the SAN through the Latin American and Caribbean Scale for the measurement of Food Security.Descriptive analyzes, binary and multivariate logistic regression tests were performed (p<0,05). Results: 36,9% of mild IA, 9,9% of moderate IA and 3,7% of severe IA were found, with variations according to household size, presence of minors, compliance with ASPO and NSE. Conclusions: In the context of ASPO arranged to mitigate the effects of Covid-19, the SAN is compromised in half of the homes of the GSMT agglomerate.The risk of perceiving AI and especially hunger was higher in the larger households, with medium and low SES, and in those did not comply with the quarantine.
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The recent detection of SARS-CoV-2 RNA in stool and sewage samples highlights the possibility of mapping the circulation of the virus and even estimating the number of infected people through the systematic monitoring of sewage in a specific region. Therefore, this is an important epidemiological tool for large-scale indirect testing, including symptomatic and asymptomatic carriers. This project was conceived for the detection and quantification of the SARS-CoV-2 in sewage samples collected in 15 watersheds of the Arrudas and Onca streams, aiming to understand the dynamics of spread and the prevalence of the virus in these regions/watersheds. These sub-basins exhaust the effluents generated by a population of approximately 1.5 million people in the municipality of Belo Horizonte and part of Contagem. Weekly composite samples were collected during the morning periods in seventeen monitoring points (15 water sheds + influent to 2 sewage treatment plants). RNA detection and quantification were performed in the laboratory using RT-qPCR. The results obtained in four weeks of monitoring (epidemiological weeks 21 to 24) showed an increase in the occurrence of the virus, reaching 100% of the monitored regions investigated in epidemiological week 24. The infected population, estimated by sewage monitoring in Belo Horizonte, showed exponential growth, being up to 20 times higher than those of accumulated confirmed cases. As for the dynamics of virus spread, RNA concentrations have shown to be quite variable in the monitored regions with higher percentages of the estimated infected population in the northern and north-eastern portions of Belo Horizonte.