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Objective: The present investigation aims to understand the impact of providing care to people with suspected or confirmed SARS-CoV-2 infection on nurses' quality of life and psychosocial risk factors and to identify associations with their sociodemographic characteristics. Method(s): An exploratory-descriptive study was carried out through the World Health Organization Quality of Life Instruments - Bref and Copenhagen Psychosocial Questionnaire scales, with a total of 127 valid responses. Data were processed in SPSS, using descriptive statistics and crosstabs. Result(s): The mean values of quality of life did not reach 70 points and 22 psychosocial risk factors were identified in intermediate and high degree. Some sociodemographic characteristics seem to be associated with these results. Conclusion(s): The nurses of the sample were significantly affected by the provision of care in the context of the pandemic.Copyright © 2022, Fundacion Index. All rights reserved.
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Introduction: Breast cancer is the most common cancer in women and the leading cause of cancerrelated death in women worldwide. The high prevalence of physical and psychosocial suffering among breast cancer patients and their families justifies the need for an early interdisciplinary approach by a palliative care team. The effectiveness of early palliative care for patients with advanced cancer has been demonstrated in many studies. Early referral to outpatient palliative care services improves symptom control, reduces suffering and improves quality of end-of-life care. Aim(s): Evaluation of referral patterns of metastatic breast cancer patients to the outpatient embedded palliative care team. Method(s): We retrospectively retrieved data from electronic medical records of patients who were treated at a private community oncology practice in Brazil who died from metastatic breast cancer during the years of 2018 until 2021.We evaluated the patient's follow-up time by the palliative care team (follow-up > 12 weeks or not) and the year of referral to the service (pre-2020 vs 2020 and later) associated to the service referral type: Late referral (more than 8 weeks of metastatic diagnosis) or early referral. Each group was followed-up by cancer physicians and after referral was also followed-up by a palliative care multidisciplinary team who regularly evaluated cancer patients during their treatments at outpatient setting. During COVID-19 pandemic, some patients were evaluated by telemedicine appointments. We performed univariate comparisons analysis by Fisher's Exact Test. p < 0.1 was deemed as statistically significant. Result(s): Of the 211 patients whose data were assessed, 99 patients were referred to Palliative Care team before 2020 and 112 patients after 2020. 13.1% of patients pre-2020 received early palliative care versus 33.9% of patients in the post-2020 referral group, resulting in a 3.37-fold odds of an early palliative care integration after 2020 (OR 3.37, CI95: 1.61 - 7.45;p< 0.001). Overall, 30.4% of longer follow-up patients were an early referral versus 19.3% of the shorter follow-up, resulting in an 82% greater chance (OR 1.82, CI: 0.92-3.63;p< 0.1) of prolonged assistance with early referral. Conclusion(s): In this analysis, early palliative care integration for patients with metastatic breast cancer has increased after 2019 despite the COVID-19 pandemic, leading to prolonged time of accompaniment by the multidisciplinary palliative care team. This suggests that even in the face of this challenging moment, a mature and consolidated service is offered by the palliative care team. Also, according to previous data in literature, prematurely integration show signs of correlation with better quality of life and death, supporting early palliative care for this group of patients. However, further work is needed to examine the effect of this care model in our cohort.
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The disruption in the supply chain imposed by the COVID-19 pandemic has posed important challenges for companies. This study explores the consequences of the pandemic on the supply chain of companies, identifying the main problems and proposing solutions for future disruptive situations. The qualitative study presented is based on the study of multiple cases obtained through interviews with Portuguese companies. Exploring the multiple cases of companies revealed that companies with less resilient and more vulnerable supply chains, both upstream and downstream, were most affected by the pandemic. The supply chain that includes redundancies and adopting appropriate risk management tools by companies guarantees greater flexibility for supply chains to adapt more quickly to disruptive situations. This exploratory study contributes to the approach of the Complex Adaptive System theory and brings new insights into the consequences of the pandemic on supply chains. © 2022, Czestochowa University of Technology. All rights reserved.
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The covid-19 pandemic brought the opportunity to accelerate the acceptance and usage of existing behaviors and innovations by society and the market. Amongst these innovations, e-commerce food stands out, allowing food companies to redesign their models to face the demand during the pandemic. This research aims to recognize the profile of online food buyers within Portugal and understand the determinants of online food purchase intention in the context of the pandemic. The methodology applied is quantitative, using the Partial Least Squares method to test the hypotheses formulated by the proposed structural model. The data used resulted from applying an online questionnaire to 358 food consumers in Portugal. The results show that situational factors directly related to eating behavior positively impact the online food shopping experience, increasing the intention to purchase food online during covid-19. Concerning the profile of the e-consumer, it seems that owning a vehicle negatively influences the intention to purchase food in e-commerce, as opposed to the level of income, which is a positive factor. On the theoretical side, this research contributes to the literature by contributing on the theme of food e-commerce in a pandemic time, which is currently very scarce. As for practical contributions, through the identification of the trends in consumer behavior during and after the pandemic, companies can better anticipate and prepare for new consumer needs and profiles, consequently developing new strategies and increasing their e-commerce sales. Since Portugal has a small digital population and less than 35% of digital natives, the prominence of studies in this area is minor. The current research is original and innovative, as studies that analyze consumer behavior in food e-commerce in this country, specifically during a pandemic, are scarcer. © 2023, Universidad Nacional de Colombia. All rights reserved.
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From a case study of the State of Rio Grande do Norte, in Brazil, this article discusses the role of states in coordinating healthcare with its local governments in the context of the new coronavirus pandemic. The absence of federal government initiatives in responding to the pandemic in Brazil have been acknowledged by several specialists as an unprecedented event in the Brazilian federation, breaking with a recurrent pattern of national coordination and regulation by different governments since the 1988 Constitution. In this sense, states and municipalities had to adopt their own initiatives to respond to the pandemic. Qualitative research based on the collection of documents (local media, epidemiological reports, and state regulations) and in-depth interviews with state and municipal managers reveals significant changes in the state-municipal relationship throughout the pandemic period in Rio Grande do Norte, a state historically characterized by the lack of state coordination. The pandemic, thus, functioned as an exogenous shock, which induced changes in the pattern of state coordination in healthcare. It is unclear, however, whether these changes are one-off or permanent since the weight of increasing returns - a specification of a path dependency process - seem to work as a mechanism producing inertial dynamics of difficult disruption with the past. Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.
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Covid-19 pandemics has been affecting the educational systems and the universities, intervening in the organization of academic work in the undergraduate courses. In the context, Emergency Remote Teaching (ERT) has been adopted by the universities in order to minimize the losses on the teaching-learning process in the period of social isolation. Given that fact, this paper presents results of a research that aimed at analysing the teaching of didactics, in the period of social isolation, problematizing challenges, tensions and possibilities in face of the pedagogical work mediated by digital technology in the context of the pandemics. Regarding methodology, it if an exploratory study of quantitative and qualitative approach. The results indicated absence of effective interaction between students and teaches, caused by the lack of material conditions and by the limited access to quality internet. The students highlighted still the importance of presence teaching to preserve the quality of the teaching-learning process at the university.
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Background: During the COVID-19 pandemic, the accessibility of health services at community pharmacies for the management of minor ailments became even more relevant, particularly in the case of acute Upper Respiratory Infections (URI) for which symptoms are often similar. Purpose: To provide a clinical pharmacy service to assess and manage symptoms of acute URI and to reaffirm the role of community pharmacies, in these challenging times, as the first line of advice, treatment, and referral, preventing unnecessary visits to emergency rooms. Method: A literature review was carried out to define the appropriate pharmaceutical intervention to assist patients with symptoms of acute URI. Patients were identified by pharmacy teams based on the presence of symptoms suggestive of acute URI or when filling a prescription for an acute URI treatment. The service consisted of an initial assessment and two follow-up contacts (conducted either by phone or face-to-face) 2 and 10 days after initial assessment. A total of 110 pharmacies received training and educational resources to support the service, and surveys to collect data were designed for each contact. Patient registration, task scheduling and surveys were setup and made available through a computer application. Findings: From February 2020 to November 2021, a total of 2239 patients were enrolled in the programme, in 63 participating pharmacies. Most patient were between 31 and 70 years old (n = 1290;56.3%) and 1344 (60.0%) of them were female. At the initial assessment, the top 3 symptoms identified were: runny or itchy nose, and sneezing (23.0%), sore throat (22.9%), unusual cough or worsening of the usual pattern (16.6%). At the initial assessment and during follow-up, the counseling of non-pharmacological measures to alleviate symptoms, along with other pharmaceutical interventions, mostly focused on increasing health literacy, were 3.5 times more frequent than the dispensing of over-the-counter medicines. In addition, there were 346 referrals to the physician. At first follow-up contact, 90.4% of patients reported feeling better, and at the second follow-up contact this percentage was 97.1%. A total of 215 medical consultations were reported by the patients, during follow-up contacts (127 by the first follow-up contact and 88 by the second). As result of these medical appointments, patients were diagnosed with COVID-19 (n = 16), other respiratory illnesses (n = 75), chronic disease decompensation (n = 7), or other diseases (n = 39). Conclusion: During this challenging context for the health care sector, pharmacists play an important role in managing minor ailments, supporting patients throughout their journey, and cooperating with other health care professionals.
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Current human research on COVID-19 - SARS-CoV-2 (Severe Acute Respiratory Syndrome-Corona Virus) showed that ACE2 (Angiotensin Converting Enzyme 2) is a functional receptor to which the spike proteins attach. Invertebrates have been exposed to a wide array of threats for millennia and their immune system has evolved to deal with these efficiently. The annelid Enchytraeus crypticus, a standard ecotoxicological species, is an invertebrate species where extensive mechanisms of response studies are available, covering all levels from gene to population responses. Nanomaterials (NMs) are often perceived as invaders (e.g. virus) and can enter the cell covered by a corona, triggering similar responses. We created a database on E. crypticus ACE gene expression, aiming to analyse the potential knowledge transfer between invertebrates and vertebrates. Total exposure experiments sum 87 stress conditions for 18 different nanomaterials (NMs). ACE expression following TiO2 NM exposure was clearly different from other NMs showing a clear (6-7 fold) ACE down-regulation, not observed for any other NMs. Other NMs, notably Ag NMs, and to some extent Cu NMs, caused ACE up-regulation (up to 4 fold). The extensive knowledge from response to NMs can support the immuno-research community, especially to develop therapies for virus that trigger the innate immune system.
Subject(s)
COVID-19 , Nanostructures , Oligochaeta , Animals , Humans , Immune System , Nanostructures/toxicity , Oligochaeta/metabolism , SARS-CoV-2ABSTRACT
The current pandemic scenario, which has affected the entire world since the beginning of 2020, has had important and significant impacts in all areas of society, with particular emphasis on education. It is about some of these impacts that we will reflect in this text. The proposed study aims to reflect on the effects of the pandemic on higher education, with specificity in Brazil and as a research question: “what are the opinions of students of a Pedagogy course on emergency remote teaching”? We will make some reflections based on the literature published in 2020-2021 and we will complete this reflection based on empirical data collected through a questionnaire applied to students of a Pedagogy course at a particular HEI. Uncertainty, perplexity, volatility, complexity and ambiguity are an integral part of the daily lives of students, their families and teachers and administrators. The virtual has become the only reality in which choices and decisions have to be made. The need for adaptations in education systems with the use of new technologies had the effect of adopting a simple path, that is, by the mere use of technologies, the effects on student learning/training are not yet known. This path, which consists of the mere replacement of in-person classes with online classes, does not guarantee, a priori, the quality of teaching. As there is no known empirical data that allow us to reflect on the effects on students of replacing face-to-face classes with online classes, we intend to know, from the data collected, what are the negative and positive impacts of the on going changes. © 2021, Edicoes Universitarias Lusofonas. All rights reserved.
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Background: Hydroxyurea (HU) is the primary medication used to prevent the significant medical and neurologic morbidities of pediatric sickle cell disease (SCD;HbSS or HbSB0 thalassemia). Despite the benefits of HU, it remains under-utilized likely due to lack of clinician knowledge/training and negative caregiver perceptions. Thus, we developed the Engage-HU randomized controlled trial (NCT03442114) as a novel approach to address HU utilization barriers. Engage-HU is designed to assess how clinicians can engage caregivers in a shared discussion that considers their values, preferences, and scientific evidence about HU. The COVID-19 pandemic has resulted in significant changes to healthcare delivery for children with SCD, as they are at increased risk of severe illness from COVID-19 infection. Given their risk status, it was recommended that patients with SCD complete telehealth visits when possible. Some families also chose to delay care because they feared their child would get infected at hospitals/healthcare clinics that care for COVID-19 positive patients. Since the lives of all families enrolled in the Engage-HU trial have been affected to some extent, we incorporated measures to capture the impact of the COVID-19 pandemic and the usability of telemedicine implementation and services. Methods: Engage-HU is a randomized control trial comparing two dissemination methods for clinicians to facilitate shared decision-making with caregivers of young children with SCD. Study outcomes include caregiver confidence in decision-making and perceptions of experiencing shared decision-making as well as HU uptake and child health outcomes. Eligible children are 0 to 5 years, candidates for HU, and their caregiver has not decided about HU in the past 3 months. The trial is being conducted at 9 sites in the United States and uses a unidirectional crossover design. The primary endpoints are caregiver decisional uncertainty and caregiver perception of shared decision-making measured using validated tools. Data will be analyzed using the intent-to-treat principle, and all participants will remain in the arm to which they were randomized. A multiple group comparison analysis will be performed to assess significant response variable differences by group randomization. The Engage-HU study aims to recruit 174 caregivers who are considering initiating HU. The trial is being conducted at 9 sites in the United States. Data collection is ongoing, and 160 caregiver-participants have been enrolled to date. Since May 2020, caregiver-participants have completed the COVID-19 Exposure and Family Impact Scales (CEFIS), which contain 2 subscales (exposure to potentially traumatic aspects of the pandemic, impact on families), and the COVID-19 telemedicine use survey during a study visit. Results: Currently, 8 of the 9 sites have collected data from 48 caregivers (93.8% mothers), most of whom (93.8%) identify as African American/Black (see Figure 1). Correlations indicated that older caregivers experienced greater exposure (Mean = 7.0, SD = 4.1, range = 1-19) to potentially traumatic aspects of the pandemic (r =.31, p =.04). Distress related to COVID-19 varied widely across the sample, for both caregivers (Mean = 5.9, SD = 2.9, range = 1-10) and children (Mean = 4.1, SD = 3.4, range = 1-10). Scores on the telemedicine usability survey were generally high, indicating that caregivers are happy with the quality of care delivered via telehealth. However, caregivers (r =.30, p =.09) and children (r =.32, p =.07) experiencing more pandemic-related distress reported less satisfaction with telehealth. Conclusion: Although Engage-HU has resumed research operations, recruitment has not reached pre-pandemic targets, as fewer eligible patients are scheduled for routine care visits at SCD clinics. Our preliminary analyses suggest a significant continued impact of the pandemic on families and general satisfaction with the quality of healthcare delivered via telemedicine. These findings indicate that targeted screenings to identify and intervene for those who emonstrate more COVID-19 pandemic-related distress are needed. [Formula presented] Disclosures: Quinn: Forma Therapeutics: Consultancy;Aruvant: Research Funding;Novo Nordisk: Consultancy;Emmaus Medical: Research Funding. Yates: Agios Pharmaceuticals: Current Employment. Badawy: Sanofi Genzyme: Consultancy;Vertex Pharmaceuticals Inc: Consultancy;Bluebird Bio Inc: Consultancy. Thompson: bluebird bio, Inc.: Consultancy, Research Funding;Baxalta: Research Funding;Biomarin: Research Funding;Celgene/BMS: Consultancy, Research Funding;CRISPR Therapeutics: Research Funding;Vertex: Research Funding;Editas: Research Funding;Graphite Bio: Research Funding;Novartis: Research Funding;Agios: Consultancy;Beam: Consultancy;Global Blood Therapeutics: Current equity holder in publicly-traded company. Smith-Whitley: Global Blood Therapeutics: Current Employment. King: National Cancer Institute: Research Funding;National Heart, Lung, and Blood Institute: Research Funding;Health Resources and Services Administration: Research Funding;Global Blood Therapeutics: Research Funding. Meier: CVS Caremark: Consultancy;Forma Therapeutic: Membership on an entity's Board of Directors or advisory committees;NovoNordisk: Membership on an entity's Board of Directors or advisory committees;Novartis,: Other: Data Safety Monitoring Board membership;NHLBI: Other: Data Safety Monitoring Board membership;Global Blood Therapeutics: Other: Steering Committee membership, grant funding;CDC,: Other: grant funding;Indiana Department of Health: Other: grant funding. Tubman: Global Blood Therapeutics: Consultancy, Research Funding;Novartis Pharmaceuticals: Honoraria, Research Funding;Forma Pharmaceuticals: Consultancy;Perkin Elmer: Honoraria. Crosby: Forma Therapeutics: Honoraria;PCORI: Research Funding;HRSA: Research Funding;Global Blood Therapeutics Panel: Honoraria;Children's Hospital of Philadelphia: Honoraria;Professional Resource Exchange: Patents & Royalties: $30-$60 every other year;SCDAA: Honoraria;NHLBI: Other: Payment for review of LRP Proposals, Research Funding. OffLabel Disclosure: Hydroxyurea has been FDA approved for the treatment of sickle cell disease for patients ages 2 years and above but NHLBI and ASH Guidelines recommend it be offered to children as young as age 9 months.
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The Covid-19 pandemic caused sudden changes in the social, political, economic, and educational fields in Brazil and worldwide. One of the measures implemented is the shutdown of schools during physical isolation, which challenged them to assume distance learning on an emergency basis, mediated by digital technologies. In this sense, this article aimed to analyze how the school can fulfill its political and social function in the context of the pandemic crisis. From the methodological point of view, it is an exploratory study with a qualitative approach with secondary and empirical data from UNESCO. There was also a mapping of Brazilian states on the conduct of education during the coronavirus pandemic. The results indicate that the new coronavirus pandemic has had different implications for social life;emergency remote education implemented in most Brazilian states did not count on the participation of the school community.
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Background: The COVID-19 pandemic brings sudden changes in health care. During the period of social distance and restricted contact, it was necessary to restore the communication between inpatients and their relatives in the oncology setting. Even though we did not find publications about psychosocial virtual visits (VVs) in this context, these video interactions have emerged as an innovative and necessary alternative to support advanced cancer care patients (ACCP). Aim: Identify and describe the implementation of psychosocial virtual visits used in an Oncology Institute. Methods: A quantitative, descriptive, exploratory study Research question: What are the characteristics of virtual visits made with advanced cancer care patients? Data Collection: a retrospective, consultation of clinical files, March to December 2020. Non-probabilistic sample, random type. Participants: ACCP over 18 years old. Data analysis: Descriptive statistics software. This study complied with the ethical norms. Results: The psychosocial VVs directly benefited 707 persons, 145 patients (average age 70) and 562 (with emphasis on 519 relatives and 43 significant others). All visits were carried out by a psychosocial support team. The majority of VVs happened in the oncology service and in the PC services. Of all the patients who were integrated into VVs, 49 were PC service inpatient and 37 of whom died. The VVs allowed us to keep providing holistic care in an advanced disease context. Two brochures were developed related to good practices in VVs, which were disseminated nationwide. Conclusion: The pandemic was a powerful motivator for systemic change and made professionals search for new ways to provide care and connection between patients and their relatives. Although technology does not replace face-to-face visits, it can offer meaningful interactions and contribute to the wellbeing of everyone involved. In the field of advanced disease, we continue to provide PCs to those who need them.
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Objective: to identify negative repercussions and the psychological impact on health professionals who work in the care of patients with coronavirus and strategies to minimize its effects. Method: integrative review of publications from 2010 to 2020, in the Public Medline databases, Journal Portal of the Coordination for the Improvement of Higher Education Personnel, Cumulative Index to Nursing and Allied Health Literature and TRIP DATABASE. Results: the analysis of 12 studies related to psychological impacts on workers resulted in three categories: perceived stressors;negative repercussions and psychological implications;and supporting factors for reducing stressors. Conclusion: the coronavirus pandemic can cause psychological distress and the results indicate the need for attention to the mental health of health workers. Assessing psychic overload, offering psychological support and implementing protocols for a safe environment make up the complex network of actions that determine success in coping with COVID-19.
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The Brazilian Federal Savings Bank (Caixa Econômica Federal—CEF) is the biggest government-owned bank in Latin America and the fourth globally in terms of assets. This work reports an empirical assessment of best practices conducted in one of the bank's units situated in Pernambuco. This empirical investigation is developed with a combination of Time-Series Data Envelopment Analysis for efficient (time) peers, human interactions, and the PROMETHEE methodology for outranking the best practices and strategies in accordance with the support of employees, sustainability impact and response to minimizing COVID-19 propagation during open hours. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: Early palliative care has shown an improvement in the quality of life of cancer patients by reducing overtreatment at the end of life and improving symptomatic control. Little is known about the quality of death in developing countries. End-of-life cancer care varies widely, and very few centers evaluate it systematically. The aim of the present study is to analyze the impact of follow-up of cancer patients by an outpatient palliative care team (OPCT) on the end-of-life outcomes at a Cancer Center in Brazil. Methods: We retrospectively retrieved data from electronic medical records of cancer patients who were treated at a Cancer Center in Brazil and who died from cancer or associated complications during the year of 2020. They were divided into two groups: OPCT and No-OPCT. OPCT group was followedup by a multidisciplinary team composed of physician, nurse, physiotherapist, psychologist, nutritionist, social worker, speech-language therapist, and pharmacist, who regularly evaluated cancer patients during their treatments at outpatient setting. During COVID-19 pandemic, some patients were evaluated by telemedicine appointments. No-OPCT group was followed-up by cancer physicians exclusively. We performed univariate comparisons and multivariate analysis by Cox proportional hazards model. p < 0.05 was deemed as statistically significant. Results: A total of 315 patients were included in the study: OPCT (N=122) and No-OPCT (N=193). The groups were well balanced in relation to median age (61yo vs 63yo), gender (women: 51% vs 54%), and TNM stage (stage IV: 69% vs 65%). Gastrointestinal and breast cancers were the most prevalent. The rate of home death was 44% in the OPCT group, compared to 16% in the No-OPCT group (p<0.001). The rate of admission in intensive care unit in the last 30 days of life (ICU30) was 13% vs 10%, respectively (p=0.413). Likewise, the rate of patients treated with chemotherapy in the last 30 days of life (CT30) was 42% vs 51% (p=0.146). In multivariate analysis, follow-up by the OPCT was the strongest independent predictor of home death (Table). In contrast, ICU30 and CT30 were inversely correlated with this outcome. Age, gender, and TNM stage did not have influence on the place of death. Conclusions: Follow-up by an OPCT had a strong positive impact on end-of-life care of cancer patients in a country which does not have Hospice culture. The OPCT was able to offer home death to a greater number of patients, with proximity to caregivers, and respect to their beliefs and values. Our data highlight the importance of early conversations about goals of care, prognostic awareness, and end-of-life preferences, while also reinforcing the need of early referral to a palliative care team. (Table Presented).
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Objectives: Efficiency analyses of health systems are often limited to hospital applications or macroeconomic evaluations considering a single production process. This application using a two-stage prevention and cure network perspective highlights nonparametric frontier estimations more coherently with the current COVID-19 pandemic scenario. Methods: This two-stage Data Envelopment Analysis methodology estimates cost efficiencies of preventing an increasing propagation of COVID-19 using the Federal Government COVID-19 expenditures as input and the inverse rate of cases as output (standardized by population) in the first stage. The second stage for the technical efficiency (cure model) has the number of ICUs, ventilators and medical staff (nurses, assistants and physicians) as input and success rate (the difference between the number of infected and deaths) as output. Results: Two efficient states on both prevention and cure models (Acre and Roraima). Pernambuco is deemed efficient in preventing COVID-19 (3 states total), and São Paulo, Mato Grosso, Amapá, Santa Catarina and Rio Grande do Sul (7 states) in cure. About 1400 ICU admissions, 590 ventilators and more than 100 thousand medical staff can be spared directed by best practices from these seven efficient states. The most inefficient states in preventing the pandemic are São Paulo (0.028), Bahia (0.076), Rio Grande do Sul (0.087) and Paraná (0.098), also reporting low social isolation. The most inefficient states in cure are Rio de Janeiro (0.231), Pernambuco (0.277), and Rio Grande do Norte (0.439). Conclusions: The proposed methodology offers an interesting framework combining both public health perspectives as responses to the COVID-19 pandemic. Brief comments can be made on Pernambuco's mapping technologies available for the general population;the cooperation between the government and NGOs in Roraima for providing EPIs, tests, food and hygiene items for indigenous districts (reducing potential propagations without expanding governments expenditures);and Acre's campaigns for basic hygiene, and pandemic control.