Determinants of severe COVID-19 infection in Patients with Breast Cancer from a Community Oncology Practice in Brazil

Purpose: The SARS-CoV-2 pandemic was declared a global public health emergency. Determinants of mortality in the general population are now clear, but specific data on patients with breast cancer (BC) remain limited, particularly in developing nations. Material(s) and Method(s): We conducted a longitudinal, multicenter cohort study in patients with BC and confirmed SARS-CoV-2 infection. The primary end point was the proportion of patients on treatment for severe SARS-CoV-2 infection (defined as need for hospitalization) or early death (within 30 days of diagnosis). Data were evaluated sequentially in the following way: i) univariate Fisher's exact test;ii) multivariable logistic regression analysis;and iii) multivariable logistic regression. In items i and ii only those with P< 0.1 are considered significant and in stage iii only those with p< 0.05 were the final significant variables. We divided patients' data into three major variable domains: a) signs and symptoms;b) comorbidities;and c) tumor and treatment characteristics;in item ii each variable domain was tested separately, finally, in item iii the significant variables of all domains were tested together and we called it the integrative step. Result(s): From April 2020 to June 2021, 413 patients with BC and COVID-19 were retrospectively registered, of which 288 (70%) had an identified molecular subtype and 273 (66%) had stage information. Most patients were on active systemic therapy or radiotherapy (73.2%), most of them in the curative setting (69.5%). The overall rate of severe SARS-CoV-2 was 19.7% (95% CI, 15.3-25.1). In the integrative multivariate analysis, factors associated with severe infection were metastatic setting, chronic pain, acute dyspnea, and cardiovascular comorbidities. Recursive partitioning modeling used acute dyspnea, metastatic setting, and cardiovascular comorbidities to predict nonprogression to severe infection, yielding a negative predictive value of 84.9% (95% CI, 78.9%-88.3%). Conclusion(s): The rate of severe COVID-19 in patients with BC is influenced by prognostic factors that partially overlap with those reported in the general population. High-risk patients should be considered candidates to active preventive measures to reduce the risk of infection, close monitoring in the case of exposure or SARS-CoV-2 -related symptoms and prophylactic treatment once infected.

COVID-19 policies and recommendations for foodservice reopening: an integrative review. (Special Issue: The impact of the covid-19 pandemic and the foodservice industries.)

This study aims to present and discuss the different COVID-19 policies and recommendations for food service reopening. We aimed to understand each plan's profile, showing the most prominent concerns and summarizing the strategies. This study was carried out using an integrative review strategy of documents written in English, Spanish, Portuguese, Italian, French, and German. We found 17 guides, 15 from the countries' health departments and institutions. The findings suggested four main categories reflecting the main concerns about safety regarding the resumption of food services during the pandemic: 1. Physical distancing;2. environmental aspects and safety;3. personal hygiene and occupational health;and 4. educational and legal measures. Because COVID-19 is a new disease, the measures were designed and adapted to a scenario full of uncertainties and improved information for each discovery. All the categories are grounded on recent or late biomedical literature. Some minor recommendations are based on the precautionary principle. The practical and policy implications are discussed. Health agencies in countries that do not yet have their regulations or guidelines for operating food services can use the categories described here as a basis for suggestions.

An unusual cause for hypoxemia and breathlessness

Thanks to the author's interest, complementary diagnostic tests were performed and the diagnosis was made. The author also made it possible to treat the patient through contact with the colleagues that performed the procedure. 75-year-old woman with past medical history of ischemic stroke in 2019, when complementary diagnostic tests were performed and it was found that the patient had a patent foramen ovale (PFO). Current hospitalization due to COVID-19 pneumonia, which was complicated by bacterial co-infection and intermediate-low risk right main pulmonary artery thromboembolism. The patient was successfully treated, with improvement of the clinical condition and evident imaging resolution of pulmonary cavitations and recanalization of the right pulmonary artery. However, something intriguing was observed: The patient presented dyspnea in the upright position and a decline in transcutaneous oxygen saturation from 96% in the supine position to 85% in orthostatism, with reversal of these findings with the recumbency. This led to the suspicion of platypnea-orthodeoxia syndrome. A transesophageal echocardiogram with bubble test was then performed, revealing an atrial shunt in the supine position without Valsalva maneuver. With these evidences, the diagnosis of platypnea-orthodeoxia syndrome was made. Even though the patient was >60 years, due to important right-to-left shunt, the history of stroke and the current platypnea-orthodeoxia, it was decided to close the PFO. The day after the procedure, the patient was placed in the upright position, maintaining an oxygen saturation of 96%. This case is an example that the decision of closing PFO must be individualized, not focusing only on patient's age, but also on his medical history and current situation, as indicated in the 2022 Guidelines for the Management of Patent Foramen Ovale. (Figure Presented).

Analyzing diversity amongst visitors of Portuguese wine routes based on their wine involvement

Purpose: This paper focuses on the wine tourist market in the central region of Portugal, and it aims to analyze the wine tourist’s demographic and travel behavior and preferences profile, based on their level of wine involvement. Design/methodology/approach: This paper presents results from an exploratory study with a quantitative design, including a total of 1,029 survey responses from visitors of three wine routes. A K-mean cluster analysis was carried out, and the emerging groups of wine tourists were statistically compared (ANOVA or Chi-squared test). Findings: Participants present a demographic profile of the wine route visitor similar to that found in other studies, with an average involvement with wine. There were three clusters of wine tourists, with different levels of involvement with wine: less wine-involved;medium wine-involved;and highly wine-involved. Significant differences between the three mentioned categories are visible for gender, age and attractions visited and expenses, suggesting the possibility of a differentiated market approach. Additionally, most respondents report high interest in a variety of attractions that are not exclusively wine-related. This finding supports the conceptualization of (particularly rural) wine tourism as “terroir tourism.” Research limitations/implications: The pandemic context in which data collection was undertaken led to a smaller sample than expected, which was also more domestic than would have been in “non-COVID” times. Practical implications: This study provides relevant insights about visitors of wine routes in Central Portugal, which may resonate in other wine tourism destinations. Implications for both theory and practice are also discussed. Originality/value: This paper fulfills an identified need to study the wine tourism market in the Central Region of Portugal and expands our understanding about wine tourists’ profiles, behavior and interests, adding with empirical findings to the debate on heterogeneity in the wine tourist market, the role of wine involvement and of terroir. © 2022, Emerald Publishing Limited.

COVID-19, WINE ROUTES, CRISIS MANAGEMENT AND RESILIENCE AMONGST RURAL WINE TOURISM BUSINESSES

This paper addresses the impacts of the COVID-19 pandemic on wine route related rural tourism along two Portuguese wine routes, as perceived by agents of supply on those routes. Discourses from 47 interviews are subjected to content analysis, considering impact perception and crisis management approaches. The results highlight COVID-19’s impacts on wine tourism businesses, including financial losses, negative emotions and systemic effects, the latter illustrating the chain of adverse effects caused by COVID-19. Many uncoordinated strategies employed to cope with the pandemic are noted. The research suggests that perceived impacts of COVID-19 relate to business profiles, to the regional context, to the stage of the crisis and specific strategies adopted. The theoretical and practical implications for future tourism management, especially in the context of wine and rural tourism, as well as sustainable tourism, are discussed, including the need for social capital creation, partnership work and product development through innovation. © 2022 Akdeniz University Publishing House. All rights reserved.

Burnout in intensive care professionals: a pre and post pandemic analysis

Introduction: Exhaustion, cynicism or negative feelings related to work and reduced professional performance are the characteristics of Burnout syndrome, which has a high prevalence among health professionals, even more susceptible to professionals who have a more stressful work routine, such as in ICU. Discussion: Burnout among doctors is on the rise, and studies show that the risk and clinical features of the syndrome vary according to the specialty and conditions to which the professional is exposed, such as workload, emotional aspects of the patient and family, mortality rates, etc. Therefore, intensive care medicine is particularly highlighted in the presence of emotional and physical strain, a fact that was greatly aggravated at the time of the COVID-19 pandemic. Several distinct characteristics influence mental exhaustion, psychological imbalance and professional frustration related to intensive care doctors, including female professionals, with a higher prevalence. It was found that there are repercussions for both the professional's quality of life, such as emotional lability and susceptibility to other diseases, as well as impairment to medical care, a consequence of the professional's exhaustion.

Brazil: The impact of the epicenter of the COVID-19 pandemic among medical doctors

Health-care workers (HCWs) on the frontlines of the 2019 Coronavirus Disease 2019 (COVID-19) have a high risk of acquiring and dying from the disease. Brazil is a country with high morbimortality and ranks highest in general mortality from COVID-19. A large proportion of medical doctors (MDs) is dying, impacting in the workforce. As part of the research by Fiocruz on working conditions among HCWs, we have conducted this study of death among MDs. We analyzed data from Federal Council of Medicine, the only national platform with details about deaths in MDs. A broad search of other sources, including the Ministry of Health, was done, but unfortunately, the data does not exist. A total of 622 MDs died from March 2020 to March 2021: 87.6% male and 75% over age 60. The Southeast had the highest percentage (34.7%), followed by the Northeast (27.2%), and rankings by state showed Rio de Janeiro (15.8%), followed by São Paulo, Pará, Paraná and Paraíba, totalizing 50.1%. The specialties with highest mortality were gynecology (12.2%), pediatrics (10.0%), internal medicine (9.3%), general surgery (7.8%) and cardiology (7.6%). May 2020 was the month of worst mortality (16.9%) followed by July and June. A slow decline was observed until October, when Brazil begun to experience the “second wave”. The vaccination of MDs began at the end of January 2021 and has not been sufficient time to evaluate the impact on morbimortality. The results of a study of 50 professional categories are under analysis and will be published soon as well as a study of “invisible” HCWs, who do not have specific training but are essential to supporting health care system, from primary care units to high-complexity hospitals. We hope that the results of these studies will improve links among managers, those who define public policies, and union leaders, achieving better workplace and living conditions, minimizing health and socioeconomic disparities. Key messages This study is about death by COVID-19 among medical doctors in Brazil, as part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ. This stdy is part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ.

A cost-effective trilateration-based radio localization algorithm using machine learning and sequential least-square programming optimization

Wireless communication systems play an essential role in everyday life situations and enable a wide range of location-based services to their users. The imminent adoption of 5G networks worldwide and the future establishment of next-generation wireless networks will allow various applications, such as autonomous vehicles, connected robotics, and most recently, crowd monitoring for fighting infectious diseases, such as COVID-19. In this context, radio localization techniques have become an essential tool to provide solid performance for mobile positioning systems, through increased accuracy or less computational time. With this in mind, we propose a trilateration-based approach using machine learning (ML) and sequential least-square programming (SLSQP) optimization to estimate the outdoor position of mobile terminals in cellular networks. The ML technique employed is the k-nearest neighbors (k-NN). The optimization methods analyzed are Nelder–Mead (NM), genetic algorithms (GA), and SLSQP. Different environments (noise-free and noisy) and network scenarios (different numbers of base stations) are considered to evaluate the approaches. Numerical results indicate that the k-NN/SLSQP technique has similar accuracy compared to the k-NN/GA with eight generations. Both perform better than k-NN/NM in all scenarios and environments. When comparing computational times, our proposal is considerably more time-efficient. Aside from that, SLSQP computational time is less affected by network scenarios with more base stations in comparison with GA. That feature is significant considering the ultra-dense base station deployment forecasted for the next-generation cellular networks. © 2021 Elsevier B.V.

Stress in palliative care nursing staff while coping with COVID-19

Objective: To identify the prevalence of occupational stress among nursing professionals working in palliative care during the SARS-CoV-2 pandemic, and associated sociodemographic and occupational factors. Methods: This was a cross-sectional study with a quantitative approach, conducted in an exclusive oncologic palliative care unit of a public oncology hospital of national reference. Data collection was performed between April and May of 2020, using two instruments. The Poisson regression model with robust variance was used for data analysis. Results: The sample was composed of 71 professionals, working with patients suspected of or with a confirmed diagnosis of COVID-19. The medium/high level of stress outcome was prevalent in 42.2% of professionals, with higher prevalence among nurses (65.0%), who worked during the day shift (55.2%) and who had worked for more than eight years in palliative care (45.1%). Only the variables "position" and "living alone" showed a significant association with medium/high stress. Conclusion: According the results, institutions must develop psychological and occupational interventions that can reduce the mental impact generated by nursing work during COVID-19.Increased stress was found among nurses, as they are involved in care and bureaucratic issues, which adds to their responsibility to the team, and among professionals who lived alone, due to impact generated by isolation and lack of close family support.