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Objective: The present article is the result of a research that has as it's goal the analysis of some of the consequences of the COVID-19 pandemic related to the Fundamental Rights, which resulted in what has been called "a new vision for citizenship" and "the new normal" within Law. All this within the current social parameters and the clear necessity of preservation of both the health and the lives of Brazilian citizens. Methodology: To serve these demands, the utilized methodology was bibliographic review, searching in legislation, articles, books and more, seeking critical reflection to compile the current understanding of the theme. The deductive hypothetical method was chosen for the composition of a valid and relevant theoretical basis. Results: The verified results were that the current pandemic scenario has reinforced what was expected: The 21st century citizen cannot remain ignorant of the basic knowledge of citizenship, of their personal guarantees and especially of their moral, legal and democratic duties. It's a fact that the more educated a group is about their duties, the more civilized they become, and therefore becoming conscious of their protagonist role in conducting the state. As such, we can affirm that Citizenship avoids conflicts, establishes tolerance and respect within collectivity and provides to each citizen the ability to act and react within abnormal situations. That is exactly what has been experienced through the campaigns to fight COVID-19, a reflection of the behavior of each individual for the benefit of society. Contributions: The contribution of the research resides in the evolution of the study on the consequences of the Covid-19 pandemic for s new vision of citizenship, fruit of this "new normal" to which all of mankind had to adapt, having direct repercussions in the dominion of Fundamental Rights. © 2023, Centro Universitario Curitiba - UNICURITIBA. All rights reserved.
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Introduction: During COVID-19 pandemic, the massive use of ventilatory support made its complications even more common. This study aimed to analyse the incidence of barotrauma in COVID-19 patients as well as its consequences. Method(s): Retrospective cohort study. All patients undergoing mechanical ventilation in an intensive care unit (ICU) during 2020- 2021 were included. The time of both noninvasive and invasive ventilation was considered together. Statistical analysis was performed using IBM SPSS Statistics 28.0. Result(s): A total of 967 patients were included, with 42 cases of barotrauma being reported (28 men and 14 women, median age 69 years [interval 22-94] and median APACHE 13). Out of those, 40 had severe COVID-19. Regarding patients with and without COVID-19, the incidence of barotrauma (episodes/1000 days of ventilation) was 0.64 and 9.22 (RR 14.86, p < 0.001) and the barotrauma rate (episodes/number of patients) was 0.4% and 8.5% (RR 21.25, p < 0.001), respectively. The most common type of barotrauma was subcutaneous emphysema (52.4%, CI 95% 37.3-67.5%), followed by pneumomediastinum (47.6%, CI 95% 32.5-62.7%) and pneumothorax (35.7%, IC 95% 21.2-50.2%). The median time to diagnosis was 11.5 days after initiation of ventilatory support [interval 1-67]. In the COVID-19 group, barotrauma was associated with longer ventilation (14.06 vs 7.91 days, p < 0.001), longer ICU stay (16.74 vs 8.17 days, p < 0.001) e higher mortality rates (45.0% vs 26.2%, RR 1.72, p 0.011). Conclusion(s): We found a higher susceptibility to developing barotrauma as a potential complication of COVID-19 patients undergoing mechanical ventilation. From those, subcutaneous emphysema and pneumomediastinum seem to be more prevalent than pneumothorax. Barotrauma seems to be associated with longer periods undergoing mechanical ventilation, longer ICU stays and higher hospital mortality rates.
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The purpose of this study is to evaluate the impact of confinement measures on the mental health of university students, taking into account gender differences. The pandemic caused by COVID-19 has led to drastic changes in public and private life for people with a huge impact on the world's economic and social population, but also on mental health. Educational institutions were forced to change the teaching-learning system, affecting the forms of socialization of students. This is a cross-sectional study carried out on a sample of 724 university students. The instruments used were the sociodemographic questionnaire and the DASS-21. The results found are alarming in terms of the mental health for this population. Gender differences are significant, with high level of mental disorders in female students. In this sense, this study alerts us to the need to take into account the different psychological reactions of students in traumatic events like a pandemic situation. Promote psychological support measures at universities by implementing psychological counselling.
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The literature associates the pandemic with populist far right parties' growth, creating the conditions for democracy weakening. The pandemic must be seen, thus, as more than a natural or medical-scientific issue given its political impact. In that sense, the pandemic politics, that is, the way governments managed the COVID-19 crisis, can be seen as a kind of "bare-life-politics,” characterised by preserving life for life's sake. This means that governments, given the urgency of the threat, were less concerned with proposing fairer forms of economy or better modes of living. In this vein, an important political and media hegemonic topic took over discourse: "life vs. economy.” This false dichotomy suggested that the economic means were unimportant for life, given that a bare life does not need much to survive. Meanwhile, far-right politics claimed that mere survival is not enough as a political promise because an economy must promise to life. Far-right politics, given the exceptional pandemic context, appeared opportunistically and paradoxically as infusing more transformative promises for political life than the political parties responsible for managing the pandemic. These far right-wing movements show that politics cannot survive if reduced to a biological business of keeping people simply alive. © 2023 EURICOM.
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Introduction: Long COVID is defined as the presence of symptoms that develop during or after COVID-19, continue for more than 12 weeks, and are not explained by an alternative diagnosis. Post-COVID radiological sequelae may occur and could be associated with dyspnea and cough. Decreased DLCO has been described as the main feature of PFTs abnormalities. Aims and objectives: The aim of this study was to identify potentially correlated with long COVID and its association with radiological and lung function sequelae in previously hospitalized patients. Method(s): We conducted a cross-sectional study with 93 patients that were evaluated in an outpatient setting following discharge from the hospital for COVID-19 pneumonia. Result(s): The mean age was 64 (+/-11) years old, 54 (59.1%) were male. The evaluation occurred on average 20 (+/-4) weeks after hospital discharge and 42 (45.2%) patients presented with long COVID. The most common symptoms were fatigue (31.2%) and dyspnea (26.9%). The prevalence of long COVID was higher in females (61%) (P=0.015). Obesity (OR 5.000, P=0.005), admission to ICU (OR 10.276, p=0.006), and the need for NIV (OR 7.85, p=0.01) were associated with long COVID. 65 patients performed CT scan and 43 (66%) had no or mild radiological sequelae. Radiological sequelae were more common in patients with long covid (n= 13, 30%) (p=0.024) and dyspnea/fatigue (p=0.04). Lung function was evaluated in 86 patients;decreased DLCO was the most common altered feature (n=32, 37%) and was associated with the presence of dyspnea/fatigue (p= 0.029). Conclusion(s): Obesity, ICU admission and the need for NIV were associated with a higher incidence of long COVID. The presence of radiological sequalae and/or decreased DLCO were associated with long COVID.
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BACKGROUND: Regular cognitive training can boost or maintain cognitive and brain functions known to decline with age. Most studies administered such cognitive training on a computer and in a lab setting. However, everyday life activities, like musical practice or physical exercise that are complex and variable, might be more successful at inducing transfer effects to different cognitive domains and maintaining motivation. "Body-mind exercises", like Tai Chi or psychomotor exercise, may also positively affect cognitive functioning in the elderly. We will compare the influence of active music practice and psychomotor training over 6 months in Mild Cognitive Impairment patients from university hospital memory clinics on cognitive and sensorimotor performance and brain plasticity. The acronym of the study is COPE (Countervail cOgnitive imPairmEnt), illustrating the aim of the study: learning to better "cope" with cognitive decline. METHODS: We aim to conduct a randomized controlled multicenter intervention study on 32 Mild Cognitive Impairment (MCI) patients (60-80 years), divided over 2 experimental groups: 1) Music practice; 2) Psychomotor treatment. Controls will consist of a passive test-retest group of 16 age, gender and education level matched healthy volunteers. The training regimens take place twice a week for 45 min over 6 months in small groups, provided by professionals, and patients should exercise daily at home. Data collection takes place at baseline (before the interventions), 3, and 6 months after training onset, on cognitive and sensorimotor capacities, subjective well-being, daily living activities, and via functional and structural neuroimaging. Considering the current constraints of the COVID-19 pandemic, recruitment and data collection takes place in 3 waves. DISCUSSION: We will investigate whether musical practice contrasted to psychomotor exercise in small groups can improve cognitive, sensorimotor and brain functioning in MCI patients, and therefore provoke specific benefits for their daily life functioning and well-being. TRIAL REGISTRATION: The full protocol was approved by the Commission cantonale d'éthique de la recherche sur l'être humain de Genève (CCER, no. 2020-00510) on 04.05.2020, and an amendment by the CCER and the Commission cantonale d'éthique de la recherche sur l'être humain de Vaud (CER-VD) on 03.08.2021. The protocol was registered at clinicaltrials.gov (20.09.2020, no. NCT04546451).
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COVID-19 , Cognitive Dysfunction , Music , Humans , Aged , Pandemics , Cognitive Dysfunction/psychology , Cognition , Randomized Controlled Trials as Topic , Multicenter Studies as TopicABSTRACT
Aim/Introduction: Neurological sequelae of Covid-19 have been widely documented by anatomic and functional methods [1,2]. Brain metabolism studies using 18F-FDG PET/CT during the subacute phase of the disease have also been published [1]. On the other hand, there is a lack of information about the influence of SARS-Cov2 infection on brain metabolism during the acute phase of the disease. The aim of this study was to identify and quantify changes in brain metabolism during the acute onset of Covid-19. Material(s) and Method(s): We studied 23 patients (13 women, median age 55.5[33-78] years) hospitalized with positive nasopharyngeal swab test (RT-PCR) for Covid-19 and requiring supplemental oxygen. Dedicated PET/CT images of the brain were acquired for 10 minutes, 1h after injection of 4.4 MBq/kg of 18F-FDG. Visual analysis was performed by two nuclear medicine specialists and one radiologist. Quantitative analysis was performed using dedicated software. 18F-FDG uptake in multiple brain regions was evaluated and the standard deviation (SD) of brain uptake in each region was automatically calculated in comparison with a group of normal subjects. More than 2 SD above or below the control group was considered significant in each area. Result(s): Serum C-reactive protein at admission ranged from 6.43 to 189.0 mg/L (mean 97.0 +/- 55.5 mg/L). The mean supplemental oxygen demand was 2.8 +/- 1.5 L/min. PET/CT images were acquired between 4 and 20 days of symptoms (mean 12.9 +/- 3.8 days). The images showed increased glycolytic metabolism in basal ganglia and relatively reduced brain metabolism in cortical regions. Basal ganglia metabolism was bilaterally increased in 18/23 (78.3%) and normal in 5 (21.7%) patients. Lenticular nucleus presented increased metabolism in 21/23 (91.3%) and was normal in 2 (8.7%) patients. Frontal and parietal lobes metabolism was respectively reduced in 9/24 (37.6%) and 8/23 (34.8%) patients. The whole brain metabolism was normal in 20/23 (86.9%) patients. Olfactory cortex metabolism was normal in 18/23 (78.3%) patients. Conclusion(s): Brain metabolism is clearly affected during the acute phase of SARS-Cov2 infection. The most frequent finding was increased basal ganglia metabolism, with most patients presenting marked lenticular nucleus hypermetabolism. Frontal and parietal lobes presented reduced metabolism in some patients. Interestingly, olfactory cortex is not affected in most patients, suggesting that anosmia, reported by some patients, is not related to the direct involvement of the brain by the disease.
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We analysed how psychologists in the media approached a recent case of mass murder "attempt" by a universi-ty student. Contrary to previous media studies focused on the relationship be-tween crime and mental health, we do not take for granted the scientificity of psychology in order to understand how its trembling epistemic status affects its public discourse. The case was one of the first happening in Europe during the COVID-19 crisis, an event that is known for its impacts on mental health. Using Foucault's genealogical -archaeo-logical method we found that there was a prominent level of speculation that, dangerously, linked mental illness with criminal behaviour, especially when there was a lack of information about the student and his intentions. The pan-demic context constituted a renewed opportunity for experts to talk about 'collective mental illness' in alarming terms. Interestingly, the experts present-ed naive versions of the "magic bullet theory" to explain the power that me-dia have on subjects with mental illness who engage in criminal behaviour. We also found that specialists proposed hypotheses that cannot be disproven, creating a dogmatic sense of a fearful inescapability from mental illness that can lead to criminal behaviour.
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Background. SARS-CoV-2 has been a leading cause of mortality worldwide for over two years. It continues to be a group effort to discover treatment to prevent further deterioration during the disease course. Positive outcomes have been observed in select patients with immune modulator therapy. Although large randomized controlled trials have investigated the use of immunomodulators in COVID-19 therapy, few have compared the differences in safety profiles and clinical outcomes between the different drugs. We studied the differences in outcomes in hospitalized patients with COVID-19 pneumonia treated with baricitinib versus tocilizumab. Methods. Adult patients admitted to Stony Brook University Hospital between April 2020 and April 2021 with high flow oxygen requirements due to severe COVID-19 pneumonia were retrospectively analyzed. The primary endpoint was the time to reduction of highest oxygen requirement 14 days after immune modulator therapy was administered or hospital discharge, whichever came first. Secondary endpoints include length of hospital stay (LOS), 28-day mortality, and serious adverse events. Results. 132 patients with COVID-19 pneumonia were treated with immune modulators. One patient was excluded from primary and secondary analysis due to having received both tocilizumab and baricitinib. All patients received steroids and remdesivir. 73 received baricitinib and 58 received tocilizumab. Oxygen requirements at the initiation of either baricitnib or tocilizumab had a mean of 5.84+/-0.6 and 5.9 +/-0.7, respectively using the WHO ordinal scale. The mean time to oxygen down titration in the baricitinib group was similar (5.7+/-2.6 and 6.07+/-2.7 days). In continuous variable analysis, patients who received baricitinib had a longer duration of fever (6.0 days vs 3.6 days, p=0.04) and lower serum ferritin (909.9 ng/ml vs. 1331.8 ng/ml, p=0.09). LOS was not similar between the groups (mean 24.4 vs. 25.8, p=0.89). Hospital mortality was not statistically significant between the two groups (32.9% vs. 27.6%, p=0.514). Conclusion. This study suggests similar outcomes for oxygen requirements, hospital length of stay, and mortality between baricitinib and tocilizumab when given in conjunction with remdesivir and steroids for severe COVID-19 pneumonia.
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Background. Vaccine attitudes of healthcare providers (HCPs) influence patient vaccine acceptance. We sought to characterize vaccine knowledge, attitudes, and practices (KAP) among HCPs in NYS. Methods. An electronic survey was developed to assess vaccine KAP among HCPs. The questionnaires were sent to members of various national medical organizations via local chapter administrators. Results. 864 surveys were returned from 672 (78%) physicians and 192 (22%) mid-level practitioners (MLPs). 624/724 (86%) of HCPs report always recommending routine vaccines to eligible patients, yet only 76% recommend influenza vaccine (IV) and 77% strongly recommend HPV vaccine at 11-12 yrs. MLPs had a higher mean agreement level that recommending vaccines (4.6 vs 4.2 p < 0.01) or promoting HPV vaccine (4.2 vs. 3.9 p < 0.05) is within their scope of practice. Physicians had a higher mean agreement level that: vaccine benefits outweigh risks (4.9 vs 4.6 p < 0.01), HPV vaccine prevents cancer (4.7 vs 4.5 p < 0.01), and COVID-19 vaccine is safe (4.8 vs 4.5 p < 0.01) and effective (4.8 vs 4.7 p < 0.01). 82% (680/825) of HCPs knew that vaccines should not be deferred for mild illness. 14/836 (2%) believed that HPV vaccine could increase sexual activity, while 273/705 (39%) knew that the most common HPV associated malignancy is oropharyngeal cancer. HCPs who correctly answered >= 5/7 questions (462/507 91%) were more likely to recommend all vaccines to eligible patients than HCPs with lower scores (22/40 50% p < 0.05). Routine IV recommendation was more likely among HCPs who: strongly disagree that influenza is not serious enough for vaccination (292/397 (74%) vs 137/249 (55%) p < 0.01), strongly agree that it prevents severe disease (267/352 (76%) vs 162/294 (55%) p < 0.01), and receive annual IV (423/629 (67%) vs 6/17 (35%)) p < 0.01). HPV vaccine recommendation at 11-12 years was more likely among HCPs who strongly agree that the vaccine prevents cancer (273/326 (84%) vs 48/86, 56% p < 0.01) and those who stated that vaccination does not increase risk of unprotected sex (316/392 (79%) vs 3/12 (25%) p < 0.01). Conclusion. Vaccine recommendation practices are influenced by HCP vaccine misperceptions and hesitancy. Interventions to reduce misperceptions and improve vaccine confidence are needed.
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Objetivos: A manutencao dos estoques de sangue em niveis adequados para atender a demanda hospitalar requer dos hemocentros um trabalho sistematizado visando quais acoes torna possivel fidelizar o doador. Neste contexto, e necessario encontrar evidencias sobre a fidelizacao do doador de sangue para um direcionamento assertivo de recursos. Diante do exposto, este estudo teve como objetivo analisar fatores associados a fidelizacao do doador de sangue do Distrito Federal. Metodos: Realizou-se estudo de caso-controle com doadores de sangue em um hemocentro publico localizado no Distrito Federal, Brasil. Os "casos"foram definidos como aqueles que realizaram uma doacao em 2019, e pelo menos mais uma doacao nos 12 meses anteriores. Os "controles"foram doadores de primeira vez ou esporadicos, os quais realizaram apenas uma doacao de sangue no ano de 2019. Optou-se pelo ano supracitado por ser anterior a pandemia originada pelo Sars-CoV2, embora tenha sido considerada esta variavel como independente na analise. Excluiram-se os doadores convidados por fenotipagem, por aferese, doadores bloqueados para doacao ou que se recusaram a participar do estudo. Foi feita amostragem aleatoria simples dos doadores, com aplicacao de questionario estruturado por entrevistador que nao conhecia o status de caso ou controle dos participantes, via telefone. Foram abordadas variaveis socioeconomicas, relacionadas ao servico e ao ato de doacao. Realizou-se analise bivariada dos dados, com calculo da odds ratio (OR) e do seu intervalo de confianca (IC 95%). Este estudo foi apreciado e aprovado por um comite de etica em pesquisa (40370820.5.0000.5553). Resultados: Participaram deste estudo 153 doadores fidelizados e 133 controles doadores de primeira vez ou esporadicos, no periodo de janeiro a junho de 2021. Os doadores fidelizados tem mais chance de serem do sexo masculino (OR=1,79;IC95%=1,12-2,87), brancos (OR=1,68;IC95%=;1,01-2,8), da faixa etaria de 30 a 49 anos (OR=1,72;IC95%=1,17-2,55;referencia 16-29 anos), e com grau de escolaridade de ensino superior completo ou maior (OR=14,0;IC95%=5,65-34,68). Nao houve evidencia de diferenca entre os fidelizados e os nao-fidelizados em relacao a doacao de sangue estimulada por ajudar pessoas desconhecidas, por brindes/carteira do doador, ou por realizacao de exames laboratoriais. Ainda, acompanhar os estoques nas redes sociais/materias de TV nao se configurou como fator associado a fidelizacao. Tambem nao houve evidencia de alteracao da frequencia (aumento ou reducao) de doacao motivado pela pandemia da COVID-19. Discussao: Esta pesquisa evidenciou que sexo, raca/cor, faixa-etaria e escolaridade sao fatores associados a fidelizacao do doador de sangue. Nao houve diferenca entre os grupos para fatores relacionados ao ato de doar e a praticas do servico. Pesquisa semelhante aponta sobre a necessidade de ampliar as acoes para despertar o interesse dos individuos que nao se enquadram no perfil mais preponderante de doadores, como mulheres, casados, pertencentes a outras etnias, atingindo tambem individuos jovens e de baixa escolaridade.1 Conclusao: Doadores fidelizados tem mais chance de serem do sexo masculino, brancos, de alta escolaridade e adultos-jovens, com fatores individuais sendo associados a fidelizacao. Sugerem-se mais estudos sobre a tematica e estrategias institucionais que promovam a fidelizacao da doacao de sangue. Copyright © 2022
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The number of tourists who visited Portugal in 2019 reached historic highs, a trend that was eventually interrupted by the emergence of the pandemic caused by the SARS-CoV-2 virus. Several experts point out that tourism was one of the first sectors to suffer the impacts of the pandemic and one of the hardest to be hit. Tourism recovery is desirable and what needs to be clarified with this study is how the digital transition so present, for example, in the Recovery and Resilience Plan (PRR) can help to rescue this upward trend of visitors/tourists. The present research work intends to emphasize how digital can be decisive in the resumption of tourism in Portugal, taking into account the measures announced for this sector. The results are discussed in the light of the literature and future work is identified with a view to enhancing tourism, smart tourism and smart destinations. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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This study wants to examine the effect of the Benefits of Vaccines and the Ease of Getting Vaccines on the Intention to get vaccinated against Covid-19 and Covid-19 Vaccinated Behavior, while originality in terms of application lies in the analysis of Intention and Covid-19 Vaccinated Behavior. The approach used in this research is descriptive, exploratory, and explanatory using a mixed-method. This study uses several analytical methods, DNA is used to compose the questionnaire, cluster analysis is used to group several data sets that have been obtained, and path analysis is used to model Intention and Covid-19 Vaccinated Behavior. The variables in this study are the Benefits of Vaccines, Ease of Getting Vaccines, Intention to get vaccinated against Covid-19, and Covid-19 Vaccinated Behavior. The source of data used in this research is DNA by crawling data from various information in cyberspace, either in the form of articles, online news, journals, or content on social media. The location of this research will be carried out in the area of Malang City, Indonesia. The research will be carried out from July to September 2021 by taking primary data, in the form of assessments or perceptions from respondents, so that a survey is carried out with enumerators submitting questionnaires directly to the community as respondents. The population used in this study is the community throughout the city of Malang with a total of 635575 residents. The sampling technique used is simple random sampling. © 2022 by authors.
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Introduction: In Portugal, in 2020, 5415 new lung cancer patients were diagnosed and 4797 deaths were caused by lung cancer. Lung cancer ranks third in terms of cancer incidence and is the leading cause of cancer mortality. Early diagnosis, complete and fast patient assessment and staging, multidisciplinary approach, access to personalized medicine, new treatment options and research are essential to improve survival and quality of life. Access to clinical trials is critical for this improvement.The aim of this study is to assess the techniques available to the diagnostic work-up, treatments, the waiting time and the needs perceived by physicians. Methods: The Portuguese Lung Cancer Study Group launched a survey in order to study the diagnostic approach and treatment of lung cancer patients in Portugal. An online survey with 47 questions was sent to all Portuguese hospitals that treat lung cancer, referring to the pre-COVID-19 pandemic experience. Results: Responses from 31 Portuguese hospitals were collected, between May and September 2020. Availability to bronchoscopy, image-guided transthoracic needle biopsy (TNB), endobronchial ultrasound- transbronchial needle aspiration (EBUS-TNBA), PET/CT, molecular biology testing is presented in table I. In 58% (n=18) the molecular biology test was performed as a "reflex test". About 68% (n=21) of hospitals used next generation sequencing. Two hospitals (7%) reported not having access to liquid biopsies.Video-assisted thoracoscopic surgery was the main surgical technique (61%;n=19). The waiting time for the first radiation oncology consultation was less than 15 days in 71% (n=26). About 61% (n=19) of hospitals had clinical trials. A wide majority of doctors (77%) would like to have more clinical trials. In 71% (n=22) of the hospitals, it was possible to refer patients to Palliative Care receiving systemic anticancer therapy. [Formula presented] Conclusions: Despite the limitations of the methods, this study allowed us to deepen our knowledge about the work-up technologies and treatments available for lung cancer patients in Portugal. It has also identified future opportunities, such as increasing accessibility to some diagnostic tools and clinical trials. Keywords: Diagnosis and treatment approach, Lung Cancer in Portugal, Health Services Research - Portugal
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Background: Even with the use of tocilizumab (TCZ), signifcant glucocorticoid exposure (usually ≥ 6 months) continues to be an important problem in giant cell arteritis (GCA). Objectives: We aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in combination with 2 months of prednisone in a group of patients with GCA. Methods: We conducted a prospective, single arm, open-label study of TCZ in combination with 2 months of prednisone for new-onset and relapsing GCA patients with active disease (ClinicalTrials.gov Identifer NCT03726749). GCA diagnosis required confrmation by temporal artery biopsy or vascular imaging. Active disease was defned as presence of cranial or polymyalgia rheumat-ica symptoms necessitating treatment within 6 weeks of baseline. All patients received TCZ 162 mg subcutaneously every week for 12 months and an 8-week prednisone taper starting between 20 mg and 60 mg daily (Figure 1). The primary endpoint, sustained prednisone-free remission, was defned as absence of relapse from induction of remission up to week 52 while adhering to the prednisone taper. Relapse was defned as the recurrence of symptoms of GCA requiring treatment intensifcation regardless of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Safety was also evaluated. 8-week prednisone taper starting between 20 mg and 60 mg Primary endpoint Prednisone-free remission at week 52 Figure 1. Clinical Trial Schema Results: Between 11/2018 and 11/2020 we enrolled 30 patients (mean age 74 years, 60% females, 50% new-onset disease, 77% temporal artery biopsy-proven, 47% imaging-proven). The mean ESR and CRP at screening were 45 mm/hour and 48 mg/L, respectively. The initial prednisone dose was 60 mg (n = 7), 50 mg (n = 1), 40 mg (n = 7), 30 mg (n = 6) and 20 mg (n = 9). All patients entered remission within 4 weeks of baseline. The primary endpoint was achieved by 23 (77%) patients (Table 1). The mean (SD) cumulative prednisone dose in these 23 patients was 1052 (390) mg. After a mean period of 16 weeks, 7 (23%) patients relapsed (Table 1). All relapses but one occurred after the completion of the study prednisone taper. Overall, 6 of the 7 patients with relapse received a second prednisone taper over 8 weeks. Of these 6 patients, 4 achieved and maintained remission for the remainder of the trial period, and 2 withdrew from the study after having a second relapse. One patient with relapse received a second prednisone taper over 26 weeks and stayed in remission until the end of the study. The mean (SD) cumulative prednisone dose in the 7 patients with relapse was 1883 (699) mg (Table 1). Overall, 4 (13%) participants developed a serious adverse event (Table 1). No cases of ischemia-related visual symptoms including permanent vision loss occurred during the study. Table 1. Efficacy and Safety Outcomes GCA patients (n = 30) Efficacy Sustained, prednisone-free remission by week 52 23.0 (76.7) Cumulative prednisone dose (mg) at week 52, mean (SD) 1051.5 (390.3) Relapse 70 (23.3) Time to relapse, weeks: mean (SD) 15.8 (14.7) Prednisone dose (mg/day) at relapse, mean (SD) 2.1 (5.2) Cumulative prednisone dose (mg), mean (SD) 1883.1 (699.2) Clinical manifestations at relapse Cranial symptoms 4 out of 7 patients schemic visual symptoms 0 out of 7 patients PMR symptoms 4 out of 7 patients Safety Serious adverse events 4.0 (13.3) Cellulitis 1 COVID-19 1 Fragility fracture 1 Cholecystitis 1 Values represent number and (%) unless otherwise specifed. SD, standard deviation;PMR, polymyalgia rheumatica Conclusion: These results suggest that 12 months of TCZ in combination with 8 weeks of prednisone could be efficacious for inducing and maintaining disease remission in patients with GCA. Confrmation of these fndings in a randomized controlled trial is required.
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Background: The Azores, an autonomous region of Portugal, is an nine islands archipelago in the Atlantic Ocean, were mental health concerns have long been present. The pandemic of COVID-19, declared in march 2020, has put additional strain health systems. Moreover, there are initial signs that depression and anxiety's prevalence is expected to increase. Monitoring consumption can be an indirect way of assessing medicines' adherence and accessibility. Purpose: To explore how the pandemic of COVID-19 impacted the consumption of anxiolytics, the aim of this study was to assess patterns of Benzodiapezine consumption in the Azorean population, one year before and one year after the beginning of the COVID-19 pandemic. Method: For this ecological study, the Benzodiazepines consumption database was obtained from hMR, a health market research company. This database contains information relative to the total number of all benzodiazepines acquired in the Portuguese market, organized by Anatomical Therapeutic Chemical (ATC) classification, and information relative to dosage and package size. The number of total sold packages per drug was obtained for the years 2019 and 2020. Azorean population was obtained from government official data. The defined daily dose (DDD) was obtained from the WHO ATC/DDD index website, and the DDD/1000hab./day was calculated. Only oral dosage forms were analysed. Descriptive and inferential statistical analysis was performed to assess yearly, biannual and quarterly drug consumption and uncover seasonal trends. Findings: Total benzodiazepine acquisition pattern in DDD/1000hab/day was not different between 2019 and 2020 (p = 0.987). The most consumed benzodiazepines were alprazolam 69.5 DDD/1000hab/day (± 4.3), followed by diazepam 27.1 (± 1.7) and lorazepam 26.7 (± 1.5).Only clonazepam and potassium clorazepate showed a significant increase from 2019 to 2020 (p = 0.001 and p = 0.003). The maximum of total DDD/1000hab/day was registered at the onset of the pandemic (march 2020). For the remaining of 2020, higher standard deviations were observed. Two other peaks are noticed in july 2019 and july 2020, exceptions to the apparent seasonal effect with a biannual period of higher DDD/1000hab/day in the winter months (r2 = 0.567). Conclusion: The pandemic of COVID-19 did not aggravate the consumption of benzodiazepines in the Azorean population. However, a change in the pattern of benzodiazepines' acquisition during 2020, was noticed. Patients might have avoided frequent visits to health services and pharmacies in order to decrease the risk of COVID-19 infection. Nevertheless, the adherence is unclear, and should be further investigated. A weak seasonal pattern in benzodiazepine consumption in the Azorean population was also found.
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The Covid-19 pandemic had an unprecedented impact on the tourism industry. It is believed that the recovery of the sector goes through a strong investment in technologies that allow creating and managing tourists' perception of the virtual image of tourist destinations. This article proposes a discussion about the relevance of User Generated Content (UGC) to reveal the virtual image of a tourist destination, in order to contribute to the creation of a Smart Tourism Destination (STD). The virtual image is studied from the perspective of the public transport system due to the fact that its improvement is one of the objectives of the Tourism of Portugal strategic plan for the creation of a STD in the decade 2017 - 2027. The methodology used was qualitative, through a bibliographical research, in which the key factors of this theme were addressed. After the study carried out it was concluded that the exploration of UGCs can allow managers and regulatory and tourism promoting entities to extract a lot of interesting information about how to take better advantage of the technologies adopted to create value for tourists.