ABSTRACT
COVID-19 and associated shutdowns have had numerous, negative, physical and mental health effects on families and children. These effects were disproportionately experienced by groups marginalized prior to the pandemic's onset, including BIPOC families, those living in communities characterized by higher levels of poverty, and those with children with special educational and health needs. Thus, the pandemic has dramatically widening pre-existing social, health, and educational disparities. This chapter reviews this literature, and provides recommendations for future research and policy. © 2023 Elsevier Inc. All rights reserved
ABSTRACT
Introduction Amapá is a state in the Brazilian Amazon, located on the left bank of the Amazon River, which in 2020 had a population of 860,000 inhabitants. It is one of the Brazilian states with the greatest socioeconomic vulnerability and with low medical and hospital density. In the context of COVID-19, the health services of the State presented a high burden, with the lack of personal protective equipment for health professionals and many absences from work due to illness. Objective To analyze factors associated with the death of health professionals by COVID-19 in the State of Amapá. Methods Case-control study that used official data produced and made publicly available by the State Department of Health of Amapá. The events of interest were deaths of health professionals, residing in the State, by COVID-19 and the controls were individuals cured of the disease. Active cases of the disease were excluded from the analysis. The analyzed data were recorded between March 2020 and January 2021. Logistic regression was used for analysis, with a significance level of p-value < 0.05. Results Data from 1,258 professionals were included in the analysis. Of this total, 20 had an outcome of death and 1,238 had a cured outcome of COVID-19. The majority were female (67.7%), race/brown (66.9%), without comorbidity (86.6%), living in the Metropolitan Region of Macapá (capital of the State) (56.7%). Factors associated with death were: age > 65 years (odds ratio (OR) 10.43;95% confidence interval (CI) 2.78-39.11), presence of comorbidity (OR 4.52;95% CI 1.74-11.74) and residence in the region metropolitan area of Macapá (OR 4.37;95% CI 1.25-15.29). The model was adjusted by the gender variable. Conclusion Protective actions for workers most susceptible to death, such as moving to activities with less exposure and/or teleworking, are necessary.
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Introduction The new coronavirus pandemic affected the lives of millions of people across the planet in 2020. Brazil, in just a few months, became the epicenter of the pandemic in Latin America. This, due to the absence of vaccines and the ineffective isolation measures adopted. In this context, health professionals stand out as a group with greater exposure and risk of being affected by COVID-19. Objective To analyze clinical and sociodemographic characteristics associated with death and hospitalization of health professionals due to COVID-19, in addition to calculating the incidence rates per occupation. Methods We conducted a cross-sectional observational study that used secondary data from the State of Espírito Santo Health Department. COVID-19 cases in healthcare professionals were recorded between February 27 and August 17, 2020 in Espírito Santo, Brazil. Cases with a lack of information were excluded. To compare the sociodemographic and clinical characteristics of health professionals with the clinical outcomes (cure or death) and the need for hospitalization, a bivariate analysis was performed using the X2 tests of independence or Fisher's exact test. Data analysis was performed using the SPSS 20.0 software. Results 75.6% (n = 9,191) of the cases were female;the general lethality rate was 0.27% and the general hospitalization rate was 1.0%. The clinical outcome of death and the occurrence of hospitalization were associated with: male gender, age greater than or equal to 50 years, higher education, fever, difficulty breathing, cough, cardiac comorbidity, diabetes and obesity (p <0.05). Only the occurrence of hospitalization was associated with: case reported in the metropolitan region of Vitória-ES, runny nose, sore throat, headache and renal comorbidity (p <0.05). The occupation with the highest incidence rate was nurses (16,053 cases/100,000 nurses). Conclusion The study demonstrated a high frequency of cases in females, low general lethality and high incidence in nurses.
ABSTRACT
Objective: To evaluate the inter-rater reliability of the mUPDRS-III in Mexican PD patients evaluated during the COVID19 pandemic through telemedicine. Background: A modified version of the MDS-UPDRS part III for virtual administration has been previously validated, and has been proposed as a useful alternative to face-to-face follow-up of patients with PD. Limitations of it's use include the lack of evaluation of rigidity and postural impairment and technological barriers such as low-speed connection and poor access to webyielding devices in remote areas (e.g. rural Mexico). Design/Methods: 46 PD patients (mean age 65.34 ± 11.87 years, 58.7% male) were evaluated through web-based consultation (Cisco Webex). A brief follow-up questionnaire of symptoms, medications and current status was performed. Motor evaluation with the mUPDRS-III scale was applied independently by three movement disorders specialists. Agreement and reliability were evaluated using inter-rater correlation coefficient (ICC) and Kendall's concordance coefficient accordingly. Results: Total mUPDRS-III score (ICC 0.96, 95%CI 0.94-0.97;Kendall's W 0.038, p<0.005) and four motor domain sub-scores-Language and Facial Expression (ICC 0.85, 95%CI 0.76-0.91;Kendall's W 0.18, p<0.005), Bradykinesia (ICC 0.93, 95%CI 0.88-0.96;Kendall's W 0.25, p 0.005), Tremor (ICC 0.86, 95%CI 0.78-0.92;Kendall's W 0.233, p<0.005), Gait and Posture (ICC 0.97, 95%CI 0.95-0.98;Kendall's W 0.018, p 0.434)-showed good to excellent agreement but slight to poor concordance. Conclusions: We observed good agreement for motor domain sub-scores, as well as for the total scale score. This might confirm that the mUPDRS-III, albeit its intrinsic limitations, is a reproducible tool for the clinical follow-up of patients when face-to-face visits are not available. Nonetheless, the concordance values were poor which could be attributed to differences in rater perception of individual items due to technological barriers and to the sample's homogeneity. Further analysis and test-retest might be useful to elucidate this phenomenon.