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BackgroundRheumatoid Arthritis (RA) patients are effectively treated with anti-TNF-α therapy. However, pharmacological non-adherence limits the achievement of the therapeutic objective. This is a multifactorial behavior where factors such as the route of administration, frequency, tolerance, perception of improvement, polypharmacy and social factors are involved [1,2].ObjectivesTo explore the factors associated with non-adherence to anti TNF-α in RA patients during the COVID-19 pandemic.MethodsThis is a cohort of RA patients treated with anti TNF-α in Medicarte SAS, a Colombian center for Immune-Mediated Diseases, between January to December 2021. The program implements strategies such as pharmacotherapeutic support, informed dispensing, phone calls, text messages and home care services to increase adherence. Adherence was defined as dispensing at least 10/12 (>0.80) prescribed monthly doses for 1 year. Sociodemographic characteristics, time in the program, DAS28-CRP, HAQ and treatment were included as exposure variables. For continuous variables, median and interquartile range (IQR) were calculated. Adjusted Odds Ratio (AOR) with logistic regression were calculated, and a p-value <0.05 was considered as statistically significant.Results565 patients were included, 85.8% (n=485) were women, median age 56 years (IQR: 49-65), disease evolution time 13.7 years (IQR: 7.7-20.8), 51% (n=288) had been in the program for more than 3 years, the median time in treatment with anti TNF-α was 3 years (IQR: 1-3) and DAS-28-CRP 2.4 (IQR: 1.6-3.4). The most frequently anti TNF-α prescribed was etanercept 46.0% (n=260), followed by adalimumab 23% (n=130), subcutaneous golimumab 13.3% (n=75), certolizumab 11.0% (n=62) and intravenous golimumab 6.7% (n=38). At the admission, 18.2% (n=103) of the patients had high activity, 38.6% (n=218) mild activity, 9.2% (n=52) low activity and 34% (n=192) were in remission. At the end of follow-up, 6.4% (n=36) of patients had high activity, 18.2% (n=103) mild activity, 14.3% (n= 81) low activity and 61.1% (n= 345) were in remission. The 51.5% (n=291) did not have pharmacological adherence. The use of etanercept (AOR 0.36 CI95% 0.23- 0.58, p < 0.001) and adequate functionality measured through HAQ (AOR 0.64 CI95% 0.42- 0.97, p < 0.04) were associated with a lower risk of non-adherence. Higher DAS28-CRP at the end of follow up was associated with non-adherence (AOR 1.29 CI95% 1.12 - 1.48, p < 0.001).ConclusionDuring COVID-19 pandemic, the implementation of strategies in the home care patient program guaranteed adherence close to 50% in our cohort. Higher values of DAS28-CRP were associated with non-adherence, whilst etanercept use and a normal HAQ value were associated with a higher probability of adherence.References[1]Marengo MF, Suarez-Almazor ME. Improving treatment adherence in patients with rheumatoid arthritis: what are the options? Int J Clin Rheumtol. 2015 Oct 1;10(5):345-356.[2]Smolen JS, Gladman D, McNeil HP, Mease PJ, Sieper J, Hojnik M, et al. Predicting adherence to therapy in rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis: a large cross-sectional study. RMD Open. 2019 Jan 11;5(1):e000585.Acknowledgements:NIL.Disclosure of InterestsWilmer Gerardo Rojas Zuleta Speakers bureau: Pfizer, Jannsen Cilag, Bristol Myers Squibb, Amgen, Eli lilly, Mario Barbosa: None declared, Oscar Jair Felipe Díaz Speakers bureau: Pfizer, Jannsen Cilag, Bristol Myers Squibb, Amgen, Eli lilly, Adelis Enrique Pantoja Marquez: None declared, Jeixa Canizales: None declared, Carolina Becerra-Arias: None declared, Jorge Hernando Donado Gómez: None declared, Natalia Duque Zapata: None declared.
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Problematic Internet use by children and adolescents has increased in recent years, causing negative consequences in the psychoemotional, physical, social, and academic development of minors. However, few studies have examined the change in problematic Internet use by minors following the pandemic. Thus, the main objective of this research was to study whether there has been an increase in problematic Internet use after the lockdown due to COVID-19, analyze if this increase is related to parental supervision and explore its link with age, gender, and non-educative online activities. This was a retrospective study including 156 parents of children (aged 5 to 16 years), who answered a set of questionnaires with good reliability to assess their children's problematic Internet use, the frequency of use of the activities that children perform on the Internet and the supervision that they give to their children. These variables were compared before and after the lockdown due to COVID-19. The results showed that there has been an increase in problematic Internet use by minors after the lockdown. On the other hand, the findings did not show a significant relationship between parental supervision and less problematic Internet use at either time point. It is noteworthy that parental supervision remained unchanged despite the increase in problematic Internet use after the lockdown. © 2023. Psy, Soc & Educ.
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Background/Objectives: SARS-CoV2 causes the COVID-19 disease, capable of producing a severe acute respiratory syndrome. Several clinical variables and genetic variants have been related to a worse prognosis. The aim of this study is to measure if difference in the gene expression are associated with COVID-19 severity. Method(s): We performed RNA-seq Transcriptome in RNA extracted from lymphoblastoid cell line in 20 patients who require hospitalization (10 from the intensive care unit) in a GeneStudio S5 Plus Sequencer (Ion Torrent Technology). FASTQ files were obtained and trimmed using BBtools, BBduk for cutting, filtering and masking the data, and Dedupe for the elimination of duplicates. Mapping and counting matrix was done in bash using the Salmon program. Differential expression analysis and subsequent functional enrichment was performed using Rstudio (DESeq2, ClusterProfiler, GO and KEGG). Result(s): We observed that 2042 differentially expressed genes (1996 overexpressed, LFC>0 and 406 underexpressed, LFC<0) were obtained between patients who require hospitalization versus those in the intensive care unit. We found some genes previously SARS-CoV-2 associated (PGLYRP1, HDAC9 and FUT4). Furthermore, genes involved in the activity of the immune system and in inflammatory processes showed significant differences between cohorts (ABCF1 (LFC = -25.14, padj = 1.05e-13), ABHD16A (LFC = 25.00, padj = 1.05e-13) and IER3 (LFC = -24.45, padj = 2.43e-13)). Conclusion(s): We described differential expression in genes of the immune system and inflammatory processes that might be have a role in the risk of develop severe symptoms of COVID-19, including admission in the intensive care unit. This results should be validated by additional functional studies.
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Objectives: Pertussis, a highly contagious respiratory disease caused by Bordetella pertussis, is endemic in Brazil, but is underdiagnosed in adults due to atypical symptomatology and limited diagnosis time window. Brazil's Ministry of Health recommends decennial boosters in adults against diphtheria and tetanus, but not pertussis. After the COVID-19 pandemic, infectious diseases surged worldwide due to lack of natural exposure and reduced immunization coverage. Asthma and COPD populations are at increased risk of pertussis infection. This study assessed the cost-utility of decennial pertussis vaccination with Tdap vaccine versus no pertussis vaccination in Brazil's adult asthma and COPD populations in a high-incidence context. Method(s): A static cross-sectional population-based cost-utility model of decennial Tdap boosters in asthma patients >=50 years and COPD patients >=40 years was developed from the payer's perspective. Pertussis incidence from Sao Paulo's state surveillance system in the peak year 2014 was adjusted for underdiagnosis and relative risk of pertussis in asthma and COPD populations. Vaccine efficacy and coverage, and costs and outcomes discounted at 5%, were obtained from the literature and public databases. Deterministic and probabilistic sensitivity analyses, and scenario analyses were run, including alternative annual incidence. Result(s): In the asthma population, Tdap boosters would incur 7,065,788 Brazilian reais (BRL) direct costs and save 32.85 Life Years (LYs) and 262.13 Quality-Adjusted LYs (QALYs). In the COPD population, Tdap boosters would incur 41,102,844 BRL direct costs and save 157.47 LYs and 1,078.26 QALYs. Discounted incremental cost-utility ratios were 26,956 and 38,120 BRL/QALY in asthma and COPD populations, respectively. At a cost-effectiveness threshold of 1 Gross Domestic Product (GDP)/capita, 85.8% and 49.7% of simulations were cost-effective in asthma and COPD populations, respectively, while all simulations were cost-effective at a threshold of 3 GDP/capita. Conclusion(s): Implementing decennial Tdap boosters for adult asthma and COPD patients should be considered, given the favorable cost-utility profile in peak-incidence years.Copyright © 2023
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After a full year of intermittent observation of pandemic conditions, this research analyzes the way street life of neighborhoods in two Southeast Asian cities has adapted to government-intensified sanitation measures, scarcity of essential goods and services, and movement restrictions that characterize the persistence of the COVID-19 influenza in selected sites in and around Manila, in the Philippines and in Hanoi, Vietnam. This study describes how citizens negotiate the morbid geography - the reshaping of public space as well as its encompassed social, institutional and economic processes in response to the pervasive state of pandemic - in relation to well-meaning but sometimes draconian government health regulations in the Global South. We draw on the dynamics of institutional strategy and citizen tactics as a theoretical lens, as informed by literature on coping and transgressive practices. Learning from comparable patterns of citizens' everyday life on the streets, even in countries with distinct administrative traditions, the study highlights the significance of agency under crisis and emphasizes the different meanings of public space for varied social groups. It suggests how urban planning and administration can be improved to prepare cities for future health emergencies and make them more resilient. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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The COVID-19 pandemic has greatly affected households' mobility habits and choices in the past two years. Scarce evidence is available concerning medium term decisions such as the purchase or sale of a private vehicle. This work aims to explore the factors that have influenced households' decisions to buy or sell a private car due to the pandemic and foresee how these decisions might influence their travel behaviour in the next few years. To achieve this goal, an EU-wide survey gathering information from 21 European cities was carried out during the second term of 2021, when lockdowns were no longer in place, but some mobility and sanitary restrictions were still maintained. The survey focuses on the impact of the pandemic and the consequent mobility restrictions on the transport habits and preferences of the respondents. The questionnaire collected socio-economic characteristics and mobility habits of 10,152 individuals. Interestingly, the analysis of the survey does not provide any evidence of a reduction of motorization rates for teleworkers. On the contrary, both partial and full-time teleworkers have bought significantly more cars than the rest of the groups. These findings greatly contrast with the fact that changes in daily habits resulting from the adoption of teleworking regimes are the main cause of reductions in car use among car buyers. This result suggests that further incentives for car ownership reduction are needed to harness the full potential of teleworking for decreasing car dependency. A positive relation between number of cars owned before COVID and car purchases has been found, pointing out that these purchases are probably not solving accessibility limitations for car-less households. Finally, a positive relation is also observed between car purchases and increased use of shared mobility services. © 2023 The Authors. Published by ELSEVIER B.V.
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BACKGROUND: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies. METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/ contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables. RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%). CONCLUSIONS: The context in which COVID-19 cases were infected is different according to social inequalities related to country of origin, gender and occupational social class.
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Introduction: Since March 2020, a number of SARS-CoV-2 patients have frequently required intensive care unit (ICU) admission, associated with moderate survival outcomes and an increasing economic burden. Elderly patients are among the most numerous, due to previous comorbidities and complications they develop during hospitalization [1]. For this reason, a reliable early risk stratification tool could help estimate an early prognosis and allow for an appropriate resources allocation in favour of the most vulnerable and critically ill patients. Method(s): This retrospective study includes data from two Spanish hospitals, HU12O (Madrid) and HCUV (Valencia), from 193 patients aged > 64 with COVID-19 between February and November 2020 who were admitted to the ICU. Variables include demographics, full-blood-count (FBC) tests and clinical outcomes. Machine learning applied a non-linear dimensionality reduction by t-distributed stochastic neighbor embedding (t-SNE) [2];then hierarchical clustering on the t-SNE output was performed. The number of clinically relevant subphenotypes was chosen by combining silhouette and elbow coefficients, and validated through exploratory analysis. Result(s): We identified five subphenotypes with heterogeneous interclustering age and FBC patterns (Fig. 1). Cluster 1 was the 'healthiest' phenotype, with 2% 30-day mortality and characterized by moderate leukocytes and eosinophils. Cluster 5, the severe phenotype, showed 44% 30-day mortality and was characterized by the highest leukocyte, neutrophil and platelet count and minimal monocytes and lymphocyte count. Clusters 2-4 displayed intermediate mortality rates (20-28%). Conclusion(s): The findings of this preliminary report of Eld-ICUCOV19 patients suggest the patient's FBC and age can display discriminative patterns associated with disparate 30-day ICU mortality rates.
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In Cuba, the implementation of telework and distance work has expanded with the arrival of the Covid-19 pandemic. This happened in atypical confinement conditions in the family home, that leads to greater overload for women remote workers, due to the traditional gender roles. This paper discusses the results of the national study on distance work / telework seen from a gender perspective, that show the inequalities that these modalities have on men and women. The need of this approach is confirmed if a more equitable, inclusive and healthy work environment is to achieved for all.
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Background: Myocarditis after SARS-CoV2 infection or vaccination is rare, but seems to be relatively more frequent in young population. Cardiac magnetic resonance (CMR) T2 weighted sequences have the potential to detect subclinical myocarditis. However, there is paucity of data on the potential myocardial involvement after SARS-CoV2 infection or vaccination in asymptomatic adolescents. Purpose(s): To evaluate the presence of subclinical myocardial damage in adolescents who were infected with SARS-CoV2 or vaccinated against SARS-CoV2 using non-contrast CMR imaging. Method(s): Asymptomatic adolescents enrolled in the Early ImaginG Markers of unhealthy lifestyles in Adolescents (EnIGMA) project were scanned using a 3-Tesla CMR scanner between March 2021 and October 2021. CMR scans included CINE imaging and myocardial T2-mapping sequences. SARS-CoV2 IgG antibody testing was performed in capillary blood samples, and date of confirmed SARS-CoV2 infection and/or vaccination if any was collected. Participants were assigned to three different groups according to SARS-CoV2 status: Group 1 (non-infected and nonvaccinated), Group 2 (infected and non-vaccinated), and Group 3 (vaccinated, independently of past infection status). CMR images were analyzed by experienced observers blinded to adolescent's SARS-CoV2 status. ANOVA and multiple regression analysis, together with correlation coefficients, were used to study between-group differences and associations among variables of interest. Result(s): A total of 115 adolescents with a mean age of 16.0 years (standard deviation (SD)=0.4), 54% girls, completed the CMR study and SARSCoV2 data successfully, and were assigned to Group 1 (n=72), Group 2 (n=22), and Group 3 (n=21). Left and right ventricular ejection fraction (LVEF/RVEF) did not significantly differ among groups: Mean LVEF was 62.8% (SD=4.1), 63.0% (SD=3.7) and 60.9% (SD=3.9) [p=0.12] and mean RVEF was 56.5% (SD=4.2), 56.5% (SD=5.5) and 54.5% (SD=5.1) [p=0.23] in Groups 1, 2 and 3, respectively. Similarly, there were no between-group significant differences in myocardial T2 relaxation values: Mean T2 values were 44.1 ms (SD=2.2), 44.1 ms (SD=1.8) and 44.4 ms (SD=1.9) in Groups 1, 2, and 3, respectively (p=0.63) (Figure 1). No differences were found either after adjusting for age and gender. Median time (interquartile range) from date of infection or vaccination to CMR acquisition was 133 (121) days and 28 (38) days in Group 2 and Group 3, respectively. No correlation between time from infection/vaccination to CMR acquisition and T2 values was detected (Figure 2). Conclusion(s): This observational study did not find evidence of subclinical myocardial involvement after SARS-CoV2 infection or vaccination in asymptomatic adolescents, as assessed with T2-mapping magnetic resonance imaging.
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This chapter introduces the state's duty to protect human rights and to compel business organisations to respect fundamental rights and freedoms. It outlines the emergence of the United Nations Guiding Principles (UNGPs) on Business and Human Rights, the emergence of which has taken place in a very complex international system today. Business organisations exert tremendous influence over countries and societies across the world, alongside states. There has been increasing interest in the UNGPs in Asia as governments explore the development of national action plans to give effect to their duty to protect. The chapter surveys the rich multi-disciplinary literature on BHR and fills a gap in scholarship on Asia. The BHR agenda post-COVID-19 crisis needs to be examined as part of this scholarship. © Asia Centre 2021.
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This chapter reiterates the central point made collectively in this work, namely that states have a duty to protect human rights and that they must hold business organisations to account. It also identifies some new issues that need to be analysed in relation to BHR, which include: the drafting of an international treaty on BHR, indigenous peoples rights, the notion that corporations have human rights, state action to eliminate escape clauses parallel legal regimes that allow states to escape responsibility, the business case for access to justice and the impact of the COVID-19 crisis on the implementation of the UNGPs in Asia. BHR will continue to be an important part of Asia Centre's human rights programme. © Asia Centre 2021.
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This book examines the State's duty to protect human rights in Asia amidst rising concern over the human rights impact of business organisations in the region, a topic which has hitherto been understudied. It analyses a range of inter-connected issues: the advent of international standards, the UN Guiding Principles on Business and Human Rights, the challenges inherent in the formulation of National Action Plans on business and human rights, the need for improved legislation and policies, access to remedies, and conflicts with indigenous peoples over business activities. The book also covers innovative themes such as BHR in the era of smart cities, ethical consumer behavior, and a human rights management system, which are emerging areas of enquiry in this field concluding with a range of critical issues to be addressed, including the need for an assessment of COVID-19 pandemic's impact on BHR in Asia and beyond. This book is part of Asia Centre's exploration of the nascent regional human rights architecture that is facing significant obstacles in protecting human rights and showcases the progress achieved and the ongoing challenges across Asia. © Asia Centre 2021.
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We find evidence that markets anticipate the potential loss of firm value in the event of the CEO falling sick and eventually dying of COVID-19 in a sample of almost 3000 listed firms from across 137 regions in 10 European countries. First, we use soccer games as "super-spreader"events. The instrumented number of infected cases per capita in the region where company headquarters are located predicts a significant drop in stock returns during March and April 2020 for firms managed by CEOs with a higher probability of dying from COVID-19. Second, we show that the stock price of these firms increases significantly the day on which positive news on the development of COVID-19 vaccines are released in the market. © 2022 World Scientific Publishing Company. Midwest Finance Association.
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PURPOSE: To assess the efficacy of lung low-dose radiotherapy (LD-RT) in the treatment of patients with COVID-19 pneumonia. MATERIALS AND METHODS: Ambispective study with two cohorts to compare treatment with standard of care (SoC) plus a single dose of 0.5â¯Gy to the whole thorax (experimental prospective cohort) with SoC alone (control retrospective cohort) for patients with COVID-19 pneumonia not candidates for admission to the intensive care unit (ICU) for mechanical ventilation. RESULTS: Fifty patients treated with LD-RT were compared with 50 matched controls. Mean age was 85 years in both groups. An increase in arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (PAFI) in the experimental LD-RT-treated group compared to the control group could not be found at 48â¯h after LD-RT, which was the primary endpoint of the study. However, PAFI values significantly improved after 1 month (473 vs. 302â¯mmâ¯Hg; pâ¯< 0.0001). Pulse oxymetric saturation/fraction of inspired oxygen (SAFI) values were also significantly higher in LD-RT-treated patients than in control patients at 1 week (405 vs. 334â¯mmâ¯Hg; pâ¯= 0.0157) and 1 month after LD-RT (462 vs. 326â¯mmâ¯Hg; pâ¯< 0.0001). All other timepoint measurements of the respiratory parameters were similar across groups. Patients in the experimental group were discharged from the hospital significantly earlier (23 vs. 31 days; pâ¯= 0.047). Fifteen and 26 patients died due to COVID-19 pneumonia in the experimental and control cohorts, respectively (30% vs. 48%; pâ¯= 0.1). LD-RT was associated with a decreased odds ratio (OR) for 1month COVID-19 mortality (ORâ¯= 0.302 [0.106-0.859]; pâ¯= 0.025) when adjusted for potentially confounding factors. Overall survival was significantly prolonged in the LD-RT group compared to the control group (log-rank pâ¯= 0.027). No adverse events related to radiation treatment were observed. CONCLUSION: Treatment of frail patients with COVID-19 pneumonia with SoC plus single-dose LD-RT of 0.5â¯Gy improved respiratory parameters, reduced the period of hospitalization, decreased the rate of 1month mortality, and prolonged actuarial overall survival compared to SoC alone.
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Due to the COVID-19 pandemic, rethinking lifestyle and quality of life through the appropriate use of public space is necessary. This study aims to verify the measures of social distancing in Chapinero Centro, which, according to the mobility survey 2019 of Bogota, has an average of 4,633 trips on foot between 10 and 20 minutes according to the travel patterns in the areas of transportation analysis studied. Despite having great social and economic dynamics, this area has small sidewalks that hinder compliance with social distancing, which is necessary to mitigate the coronavirus pandemic. Therefore, geographic analysis of this area was performed using data provided by the vulnerability map of the Coronavirus web in Colombia by the National Planning Department, the Institute for Health Technology Assessment, and the National Administrative Department of Statistics. This geographic analysis made it possible to calculate the variables of population indicator per block, maximum population per sidewalk, and the criterion of compliance with social distancing. When developing the vulnerability and social distancing maps, it became evident that 37% of the sidewalks do not comply with the 2 meters of social distancing between people, so we propose extending them to 3.5 meters and reducing this same value in the vehicular space to design an effective social distancing map. We concluded that the widening of the sidewalks allows flexible use of the streets oriented to a healthy distance, which could be complemented with an accessibility study and a study of vehicular traffic to measure the impact of this intervention. © 2022, Pontificia Universidad Javeriana. All rights reserved.
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Introduction: Viral infections in pregnant mothers can result in neurological disorders. Because of this, it is important to establish that there is fetal brain affectation due to COVID-19. Objective: To establish a direct and indirect relationship between SARS-CoV-2 infection during pregnancy, and adverse results on perinatalneurologicaldevelopment, as much as psychological long-term results. Material and methods: A narrative review of available evidence linked to the placenta and SARS-CoV-2 relationship, fetal brain physiopathology, and neuropsychiatric affectation was performed using PubMed, LILACS, and Google Scholar databases, on the time lapse between January 1997 to June 2022. Results: 66 studies with methodology, qualitative representability, and citation impact, according to the present research´s objective, were reviewed. Evidence review over COVID-19 and fetal central nervous system (CNS), establishes that chronic histiocytic intervillositis and trophoblast necrosis are risk factors for placental infection by SARS-CoV-2, viral vertical transmission, and breach of the maternal barrier-fetal. Fetal brain expression of protein S receptors suggests fetal brain incursion of SARS-CoV-2 in infected pregnancies, especially during the second and third trimesters of pregnancy. Infections during critical periods of early fetal neurodevelopment have been shown to increase the likelihood of neurodegenerative and neurobehavioral disorders, including autism or autism spectrum disorders (ASDs), and psychiatric illnesses in offspring. Conclusion: Evidence supports the possibility to establish a direct and indirect relationship between SARS-CoV-2 infection during pregnancy, and adverse results on perinatalneurologicaldevelopment, as much as psychological long-term results. © 2022 Academia Nacional de Medicina. All rights reserved.
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Introduction: During the COVID-19 pandemic and the cases of shortages of personal protective equipment (PPE), the utilization of modified snorkel masks has been documented, seeking to provide respiratory and facial pro-tection against SARS-CoV-2 aerosols. However, there is no report of changes in vital signs that can occur with its use, along with the perception of its wear by health personnel. Method(s): A case series was performed. Equipment: Snorkel mask, 3D adapter, and antimicrobial filter. CO2 level, respiratory rate, oximetry, pulse, and blood pressure were monitored for one hour. During the time of use, activities related to patient care were simulated. At the end, the usage characteristics were evaluated through a survey. Result(s): 14 volunteers were included in the study. After one hour of conti-nuous use, the clinical parameters were predominantly normal. 85% of the participants preferred this modified snorkel mask instead of personal protective equipment established for COVID-19 (goggles, N95 mask and visor). Conclusion(s): The adapted snorkel mask could be an alternative to PPE equipment in situations of scarce resources. This is only considered within the framework of its acceptability by a group of health professionals, in addition to the few effects on the vital signs evaluated in this case series. Further objective evaluations of usability and effectiveness are required. Copyright © 2023 Universidad de Antioquia.
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BACKGROUND // Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies. METHODS // A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/ contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables. RESULTS //The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%). CONCLUSIONS // The context in which COVID-19 cases were infected is different according to social inequalities related to country of origin, gender and occupational social class.