A Longitudinal Study on Sustainability Perceptions in Portugal

This study aims to advance the understanding of sustainable behaviour by exploring the perceptions, knowledge, and opinions about the sustainability of nearly graduated students in Portugal. A three-wave exploratory and longitudinal study was conducted with Management and Marketing students in 2020, 2021, and 2022. The findings come from both quantitative and qualitative approaches. First, the results reveal low levels of knowledge about sustainability, Sustainable Development Goals, and other related concepts. Then, by a qualitative analysis, this study highlights the terms related to sustainability and perceived sustainable practices. It also examines changes perceived since the COVID-19 pandemic and what their threats and opportunities in the coming years are. The main conclusion of this study is the critical need for education on sustainability and related concepts beyond simple recycling practices. The use of sustainability as a marketing tool is insufficient to create a viable future. Higher education must develop a new shared and sustainable vision for sustainability education. © 2023 by the authors.

Use of video classes as a health education tool during the COVID-19 pandemic: an experience report

Introduction: The pandemic caused by the new coronavirus SARS-CoV-2 is considered the first major pandemic of the digital media era. The social isolation resulting from the disease prevention measures favored a greater use of social networks among people, enabling the insertion of educational technologies in the networks. Video classes present themselves as a didactic and innovative resource that allows to introduce different contents in an attractive and dynamic way, configuring themselves as a great strategy to carry out health education activities in times of COVID-19. Objective: To report the experience on the use of video classes as a health education tool during the COVID-19 pandemic. Method: The video classes were built weekly, from a theoretical stance, addressing different themes, and were made available in a group created in the WhatsApp (R) application. Results: Using video classes, it was possible to maintain and carry out health education activities, transmit information, exchange knowledge and experiences, and interact with the group without the necessity of face-to-face meetings. In addition, video classes were well accepted by the target audience, who actively interacted with each topic addressed. Conclusions: The experiences of this project allowed a reflection on the reinvention of new methods to carry out health education, emphasizing the importance of using video classes as a tool that allows to produce educational activities in the face of the current pandemic scenario.

Case-case study on comparative vaccine effectiveness against Delta and Omicron SARS-CoV-2 infections : Irina Kislaya

Introduction Vaccination is the primary pharmacological measure to reduce SARS-CoV-2 transmission and its complications. Timely information on vaccines effectiveness in a context of novel variants of concern (VOC) emergence is essential for public health policies. This study aimed to provide a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.627.2) VOC according to vaccination exposure (complete primary regimen or booster dose) for Portuguese population aged 12 or more years old using routinely collected data from electronic health records. Methods We used a case-case study design linking national electronic vaccination registry and surveillance data on 13,134 SARS-CoV-2 RT-PCR laboratory-confirmed cases notified in Portugal during weeks 49-51 of 2021. Notified cases were classified as Omicron or Delta based on whole-genome sequencing or S-gene Target Failure (SGTF) status using the RT-PCR TaqPath™ Covid 19 CE IVD Kit (Thermo Scientific™) assay. The odds of vaccination was compared between Omicron cases and Delta cases using logistic regression adjusted for age group, sex, region and week of diagnosis and laboratory of origin. Results The odds of vaccination were higher in laboratory-confirmed cases infected by Omicron (BA.1) VOC compared to Delta (B.1.627.2) VOC for both complete primary vaccination (Odds ratio (OR)=2.1;95% Confidence Interval (95%CI): 1.8 - 2.4) and booster dose (OR = 5.2;95%CI: 3.1 - 8.8), indicating vaccine effectiveness reduction against Omicron. Conclusions We found significantly higher odds of vaccination in Omicron cases compared to Delta, suggesting lower effectiveness of the primary vaccination and the booster dose in preventing infections by Omicron. Case-case study design has proven to be feasible approach to rapidly compare vaccine effectiveness between VOC in context of novel VOC emergence to timely inform public health stakeholders. Key messages • Reduction of vaccine-induced protection against SARS-COV-2 infection with the Omicron compared to Delta after primary and booster vaccination. • Continuous monitoring of COVID-19 vaccine effectiveness is essential to support public health policies in context of novel VOC emergence.

Mental health impact of coronavirus disease 2019 pandemic on children with psychiatric disorder

Introduction: The first full lockdown due to the coronavirus pandemic in Portugal started in March 2020 and sent home every child, only to return to school in September the same year. Children are thought to cope harder with this pandemic, but little is known about those already struggling with psychiatric conditions. Methods: We interviewed parents of 196 children in psychiatric follow-up in Clínica da Encarnação, a child psychiatry unit, Centro Hospitalar Universitário Lisboa Central, and reported their perception of the impact of the lockdown on the mental health of their children, as well as on their families. Results: The parents reported a slight deterioration of their children condition and symptomatology, particularly irritability and anxiety. We identified several important fragility factors such as female gender, lower school grade, higher daily screen time, lower housing quality, parental precarious job situation, parental psychiatric disorder, pharmacologic treatment, and shorter follow-up time. We also found some resilience factors such as coronavirus disease 2019 cases in the family and school failure, as well as male gender and shorter daily screen time. The parents who reported a deterioration of familial conflicts also reported a worse lockdown impact on their children psychiatric condition. Discussion: Our findings suggest a heterogeneous impact on these children’s psychiatric symptomatology. Efforts should be made towards prevention along with interventions. The fragility and resilience factors identified should help direct these interventions. © 2022, Portuguese Society of Paediatrics. All rights reserved.

The importance of nurses and their health in the face of the COVID-19 pandemic

Objective: To promote the importance of nurses and their health in the face of a covid-19 pandemic. Methodology: This is a qualitative research, descriptive of an integrative literature review in the databases. The articles selected at this stage were read in full and obtained according to the eligibility criteria.

Early mortality linked to COVID-19 in cancer patients as compared to historical control in pre-pandemic times

Background: The COVID-19 pandemic remains a public health emergency of global concern, with higher mortality rates in cancer patients as compared to the general population. However, early mortality of COVID19 in cancer patients has not been compared to historical real-world data from oncology population in pre-pandemic times. Methods: Longitudinal multicenter cohort study of patients with cancer and confirmed COVID-19 from Oncoclínicas Group in Brazil from March to December 2020. The primary endpoint was 30-day mortality after isolation of the SARS-CoV-2 by RT-PCR. As historical control, we selected patients from Oncoclínicas Data Lake treated before December 2019 and propensity score-matched to COVID-19 cases (3:1) based on the following clinical characteristics: age, gender, tumor type, disease setting (curative or palliative), time from diagnosis of cancer (or metastatic disease) to COVID-19 infection. Results: In total, 533 cancer patients with COVID-19 were prospectively registered in the database, with median age 60 years, 67% females, most frequent tumor types breast (34%), hematological (16%), gastrointestinal (15%), genitourinary (12%) and respiratory tract malignancies (10%). Most patients were on active systemic therapy or radiotherapy (84%), largely for advanced or metastatic disease (55%). In the overall population, early death rate was 15%, which was numerically higher than the Brazilian general population with COVID-19 diagnosis in 2020 (2.5%). We were able to match 442 cancer patients with COVID-19 to 1,187 controls with cancer from pre-pandemic times. The 30-day mortality rate was 12.4% in COVID-19 cases as compared to 5.4% in pre-pandemic controls with cancer (Odds Ratio 2.49, 95%CI 1.67 - 3.70;P value < 0.01, Power 97.5%). COVID-19 cancer patients had significantly higher death events than historical controls (Hazard Ratio 2.18, 95%CI 1.52 - 3.12;P value < 0.01, Power 99.7%), particularly from 20 to 30 days after diagnosis of the infection. Conclusions: Cancer patients with COVID-19 have an excess mortality 30 days after the infection when compared to matched cancer population from pre-pandemic times and the general population with COVID-19, reinforcing the need for priority vaccination in public health strategies. Legal entity responsible for the study: Oncoclínicas Group. Funding: Amgen. Disclosure: All authors have declared no conflicts of interest.

Point of view and expectation of parents with children diagnosed with autism spectrum disorder enrolled in regular and special schools

IntroductionAutism Spectrum Disorder (ASD) is a neurodevelopmental disorder that can cause social and professional harm in an individual. Many teachers are unprepared to receive students with ASD. They find it difficult to communicate with other professionals or to comfort the family. And parents often do not feel that their children at school benefit socially and in their academic skills.ObjectivesTo know the point of view and expectations of parents with children with Autism Spectrum Disorder about the academic future and professional life.MethodsAn online questionnaire was applied with 38 multiple choice questions about the future academic perspectives and expectations of their children, the job market and about school adaptations and the school year during the COVID-19 pandemic.ResultsSo far, 16 parents of a Speech-Language Pathology laboratory in which they assist children with Autism Spectrum Disorder (ASD) have answered the questionnaire. When asked if there were teachers who work with TEA individuals, nine guardians 56.3% answered that they did not, 50% of the guardians said they had received adapted material during the COVID-19 pandemic, 100% of the guardians believe that their child will finish high school, 93.8% of those in charge do not believe that the job market is prepared for individuals with ASD.ConclusionsParents are dissatisfied with the education their children receive and most of them did not get adequate support during the COVID-19 pandemic. There are also low expectations for the future in the job market.

Machine learning prediction of COVID-19 mortality in cancer patients

Background: COVID-19 is a challenge for clinical decision-making in cancer patients and the allocation of healthcare resources. An accurate prognosis prediction to effectively triage patients is needed, especially in the community oncology practice. Methods:Nationwide cohort from Oncoclínicas Brazil was used to validate previously developed multivariable logistic regression (mLR) model (Ferrari et al, JCO GO 2021) and to construct a machine learning Random Forest (RF) algorithm as predictor of 30-day mortality after SARS-CoV-2 detection by RT-PCR in cancer patients diagnosed in an outpatient setting. To find the most important baseline clinical determinants of early COVID19-related death via Gini index, a RF with 100,000 trees was trained in 75% of the dataset, and the performance was assessed in the remaining 25%. We then compared the accuracy of different models in terms of sensitivity, specificity and area under the receiver operating characteristics curves (AUC). Results:From March to December 2020, 533 patients with COVID-19 were prospectively registered in the database. Median age was 60 years (19-93) and 67% were female. Most frequent cancers were breast in 34%, hematological in 16%, and gastrointestinal in 15%. Comorbidities were common (52%), as was current/former smoking history (17%). Most patients were on active systemic therapy or radiotherapy (84%) in the advanced or metastatic disease setting (55%). The overall mortality rate was 15% (CI95% 12%-18%). We validated the original mLR model trained in the first 198 patients: management in a noncurative setting (odds ratio [OR] 3.7), age ≥ 60 years (OR 2.3), and current/former smoking (OR 1.9) were significant predictors of death in the expanded cohort. Presence of comorbidities (OR 1.9) also defined poor outcome in the updated mLR model, which yielded low sensitivity (74%), specificity (68%) and AUC (0.78). With RF modeling, the most significant predictors of 30-day death after COVID-19 (in decreasing order) were older age, treatment of advanced or metastatic disease, tumor type (respiratory tract, brain and unknown primary cancers had higher mortality), COVID-related symptom burden at baseline evaluation and treatment regimen (immunotherapy combinations had higher mortality). The RF model demonstrated high sensitivity (89%), specificity (88%) and AUC (0.96). Conclusions:The results highlight the possibility that machine learning algorithms are able to predict early mortality after COVID-19 in cancer patients with high accuracy. The proposed prediction model may be helpful in the prompt identification of high-risk patients based on clinical features alone, without having to wait for the results of additional tests such as laboratory or radiologic studies. It can also help prioritize medical resources and redefine vaccination strategies. A web-based mortality risk calculator will be created for clinical decision support.

Psychodermatology in the Era of COVID-19

The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health has been reflected in different populations worldwide. It has caused significant psychopathological consequences in general population, healthcare professionals (e.g., dermatologists), patients with COVID-19, and patients with other diagnoses, including skin diseases. The prevalence of psychiatric comorbidities in dermatology has long been reported to be at least 30 percent. It is important to investigate the pandemic's impact on comorbid psychosocial and psychopathological symptoms seen in dermatology, including expected short- and long-term mental health consequences. The authors seek to raise awareness among healthcare professionals of the impact that COVID-19 is having on existing psychodermatological conditions and discuss the practical implications of this relationship in dermatology.

Technological and digital convergence, emergency remote education and ADHD students who attend the final years of elementary school

This article includes some inclusive educational practices that permeate cyberculture aimed at students with SEN (Special Educational Needs), emphasizing students with ADHD (Attention Deficit Hyperactivity Disorder) who attend the final years of elementary school. The goal is to show some digital resources that can encourage these students to read and write from remote education. By addressing some specificities and contributions of digital literacy in the teaching/learning process and its relationship with a world that is simultaneously experiencing a pandemic caused by COVI-19 and a progressive technological convergence, we conclude that most digital tools and apps were not properly developed for the use of students with ADHD who attend the final years of elementary school. However, we observed that, in the face of adequate intervention, some technological resources can be useful and facilitate the teaching/learning and life of these students. This study will be guided by research conducted by some scholars in the fields of reading and literacy, technologymediated education, special education and inclusive education such as Alexander and Fox (2004), Antunes (2001), Dalberio, Pereira, and Aquino (2012), Coscarelli and Ribeiro (2007), Menezes (2019), Silva Neto et al. (2018), Rojo and Eduardo (Org.) Moura (2012), Rojo (2013) and SINTOMAS. (2021) amorim (2010), as well as scholars who are interested in researching Specific Functional Disorders (TFEs), such as Andrade and Vasconcelos (2018), Goncalves (2019), Lopes (2011), Ribeiro (2005), Rohde (1999) and Pain (1985), among others.

COVID-19 seroprevalence in military police force, Southern Brazil.

BACKGROUND: Limited data is available regarding the frequency of COVID-19 in populations that are highly exposed to SARS-CoV-2. In this cross-section study we evaluated COVID-19 seroprevalence in military police forces of 10 major cities in Rio Grande do Sul, South of Brazil. METHODS: Sampling was randomly performed in clusters, in respect to the number of professionals at service per city and military unit. Research subjects were evaluated on July 23, 2020 (first wave peak in Brazil). Clinical information was obtained, and venous blood was taken for ELISA testing (IgA, and IgG antibodies). Sample size consisted of 1,592 military workers (33.6% of study population). They were mostly man (81.2%) and young (median 34 years-old). Most had been asymptomatic (75.3%) during pandemic, and 27.5% reported close contact with COVID-19 cases (after a median time of 21 days). Antibodies were detected in 3.3% of the participants, mostly IgA (2.7%), and IgG (1.7%). After 3 weeks, 66.7% of IgA and IgG results turned negative, in addition to 78.3% and 100% of borderline IgA and IgG results, respectively. CONCLUSION: The seroprevalence of COVID-19 amongst military police was at least 3.4 higher than the findings of other studies performed in the general population, in the same cities and dates. Most detectable antibodies were of IgA class, which implies recent exposure. Asymptomatic people were more prone to have negative antibody titters in the second run.

AKI due to COVID-19 in the intensive care unit: Analysis of a Brazilian Center

Background: The kidney may be affected by coronavirus (COVID) in the setting of acute kidney injury (AKI) or glomerular diseases. Data about AKI in Intensive Care Unit (ICU) patients of Latin-America are scarce. The aim of this study is evaluate the risk of AKI, dialysis (HD) and death in ICU patients diagnosed with COVID pneumonia in a brazilian center. Methods: Analysis from medical records of ICU patients with diagnosis of COVID pneumonia in a brazilian single-center. AKI was defined according to KDIGO criteria. Results: During the period of February 2nd to May 4th, 95 ICU patients diagnosed with COVID were analyzed. There was predominance of male (64.2%), median age of 64.9 years, previous diagnosis of hypertension, diabetes and obesity in 51.6%, 27.4 and 30.5% respectively. AKI was diagnosed in 54 (56.8%) patients and 32 (59.2%) of them required HD. Mortality rate was 17.9%. Patients with AKI, compared to no-AKI were statisticaly significant more frequently hypertensive and diabetic, worse SAPS3 and SOFA scores and need for organ support therapies. Laboratory tests depicted more anemia, lymphopenia, and higher levels of inflamatory markers as well as longer lenght of stay in ICU, hospital and death. Similar findings were seen in those ones who required HD compared to those with conservador treatment. Comparing patients who undergone death to survivors, they were older, more frequently diabetic, worse SAPS3 and SOFA scores and need for organ support therapies, AKI and dialysis. Multinomial logistic regression predicted that hypertension (p=0.01), mechanical ventilation (p=0.01) and use of hydroxychloroquine (p=0.009) were independent risks factors for AKI;hypertension (p=0.002), mechanical ventilation (p=0.03), use of vasopressor (p=0.04), and use of hydroxychloroquine (p=0.009) for HD patients;and age >;65 years (p=0.03) and AKI (p=0.04) for death. Conclusions: In our study, AKI was a common complication of ICU COVID patients, it was associated to hypertension, organ support therapies and use of hydroxichloroquine. As well as age >;65 years, AKI was an independent risk fator to death.

Cardiopulmonary rehabilitation in post-COVID-19 patients: case series

The natural history of the disease, and the treatment of post-COVID-19 patients, are still being built. Symptoms are persistent, even in mild cases, and the infection consequences include fatigue, dyspnea, tachycardia, muscle loss, and reduced functional capacity. Regarding cardiopulmonary rehabilitation, there seems to be an improvement in functional capacity, quality of life, and prognosis with the 6-Minute Walk Test used as a prognostic and therapeutic evaluator. Therefore, this case series report aims to present our experience with four cases of different severity levels, involved in a post-COVID-19 cardiopulmonary rehabilitation program. These patients were assessed with the 6-Minute Walk Test, peripheral muscle strength, and double product at rest, to assess the results after a three-month rehabilitation protocol of at least 300 minutes per week. The four patients had their distance covered during the walk test increased between 16% and 94%. Peripheral muscle strength was improved by 20% to six times the baseline values, and double product at rest was reduced by 8% to 42%. The cardiopulmonary rehabilitation program had a positive impact on these cases, improving functional capacity despite the different severity levels in these post-COVID-19 cases.

Narratives between science and politics in chloroquine activism

The current sanitary and pandemic crisis generated a set of global tensions, schemes and conflicts in different scientific, politic-party and economic spaces. The drugs hydroxychloroquine and chloroquine gained fame and expectations. What until then served only to treat malaria, now had a "cure possibility" for Covid-19. In this article we sought to understand the debate between science and politics that was generated through a research with chloroquine (Chlorocovid-19) and developed in Manaus, Amazonas. Through an ethnography woven with documents such as videos, notes, letters and messages broadcast on social media, we described and analyzed: (a) what we call chloroquine activity in Manaus and its offensive;(b) the consequent academic reaction to the attacks. Both poles-pro and contra-made efforts in the construction of a truth, in which science and politics cross-link. © 2020.