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This article, based on materialist Discourse Analysis (DA), discusses the border space, focusing specifically on a reflection about the subjects and languages at work in the daily life of the border between Dionisio Cerqueira-SC, Barracao-PR (Brazil) and Bernardo de Irigoyen (Misiones, Argentina) during the covid-19 pandemic period. The corpus is composed of selected statements from an interview produced by the television channel Noticiasdel6 from Posadas (Argentina) and an announcement broadcast by Radio Provincial LT 46, from the Argentine city of Bernardo de Irigoyen. Thus, the main considerations made in this paper focus on the analysis of the statement Is the border closed or is something wrong, mayor? which, when put in dialogue with the radio announcement, makes it possible to observe an unequal relationship between organization and order of the border. This question also leads to question the functioning of the legal system in the border since, even with the official decrees published by Brazil and Argentina determining the closing of the borders, the daily and ordinary practices erupted, piercing the work of the legal system.
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Background: The coronavirus disease 2019 (COVID-19) pandemic has imposed several constrains in the medical practice, especially in hematologic patients (pts) where a higher mortality rate is expected. In our center strict measures were implemented earlier, with the use of personal protective equipment, hand wash at all times, internal separated circuits, frequent prophylactic tests, teleconsultation and rapid isolation of positive cases. However, data is still limited and risk factors for increased susceptibility remain unclear. Aims: Characterize our pts with COVID-19 regarding the type of hematologic disease, the respective treatment, infection severity and identification of any possible risk factors that may have impact in the outcome. Methods: Pts with a positive quantitative RT-PCR from nasopharyngeal swab between 18/03/2020 and 02/02/2021 were identified. Epidemiologic, laboratory, and clinical characteristics were retrospectively collected. Chi-square and Mann-Whitney-U tests were performed to identify statistical differences between groups and logistic binary regression to assess predictive risk factors. Severity of illness was defined by level of care [ambulatory, general inpatient wards and intensive care unit (ICU)], need for respiratory support, incidence of thrombotic events, acute kidney injury and/or death. Active hematologic treatment was defined as therapy within 6 months of COVID-19 diagnosis. Results: A total of 81 pts were identified, with a median age of 61 years (19-88), 52% were male, 63% had an ECOG PS 0 and 69% had at least one comorbidity (hypertension 36%, dyslipidemia 21%, cardiovascular disease 21%, diabetes mellitus 14% and pulmonary disease 11%). Regarding the hematologic disease, 83% had a neoplastic malignancy (non-Hodgkin lymphoma 30%, myeloproliferative neoplasms 16%, acute myeloid leukemia 11% and multiple myeloma 11%), 64% were in active treatment and 43% had active disease. Concerning the COVID-19 infection, 46% required hospital admission among which 65% needed respiratory support and 9% admitted to an ICU. Median overall survival (OS) was not reached (84% at 1 month) and the mortality rate was 17%, mainly in pts with active disease and neoplastic malignancy. Non-survival pts had a lower hemoglobin level (8,3g/dL vs 12g/dL;p-value 0,016), a higher CRP (218mg/L vs 22mg/L;p-value 0,041), acute renal failure (36% vs 6%;p-value 0,014), more need of respiratory support (71% vs 27%;p-value 0,004) and mechanical ventilation (21% vs 5%;p-value 0,022). There were no statistical differences regarding age, absolute lymphocyte count, platelet count and LDH. Regression analysis revealed hemoglobin level (p-value 0,026), CRP (p-value 0,05) and respiratory support (p-value 0,003) as predictive factors for death. In our pts there were no thrombotic events. Summary/Conclusion: Nearly half of the pts were admitted to the hospital and discharged. In our analysis low hemoglobin level, high CRP and respiratory support were associated with poorer survival, however, given our small sample, these findings need to be confirmed. Contrary to most of the published results, the number of confirmed COVID-19 positive cases was surprisingly low, with only 81 cases in 11 months, with a mortality rate similar to the general population and lower than expected. We believe that implementing early and rigorous protective measures as well as create self-awareness may be the key to improve mortality rate in this highly susceptible population.
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The term "climate emergency" represents a new phase in climate change framing that many hope will invigorate more climate action. Yet there has been relatively little discussion of how the new emergency framing might shape broader governance and policy. In this advanced review, we critically review and synthesize existing literature on crisis and emergency to inform our understanding of how this new shift might affect governance and policy. Specifically, we explore the literature on crisis governance and policy to argue that there is no simple answer to whether the "climate emergency" framing will be supportive of climate governance and policy;rather, more work needs to be done to understand how different political actors respond according to their perceptions, interests and values. To assist this endeavor, we develop a typology of four policy pathways, ranging from "no emergency," to "no emergency, but recognize risk," "emergency as a threat" and "emergency as an opportunity." We highlight the need to consider the effects of multiple and overlapping emergency frames, using the example of the intersection of climate change and COVID-19. Finally, we suggest new interdisciplinary research directions for critically analyzing and refining this new phase of climate change framing. This article is categorized under: Policy and Governance > Governing Climate Change in Communities, Cities, and Regions Policy and Governance > Multilevel and Transnational Climate Change Governance
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IntroductionDelirium is characterized by fluctuating disturbance of consciousness, inattention, reduced awareness, hallucinations or delusions, occurring in 20% of hospital admissions. Central nervous system symptoms are the main form of neurologic injury in patients with COVID-19 and a significant portion of these patients presents with delirium. COVID-19 infection’s course and symptoms, as well as patient comorbidities can facilitate its onset, which is exacerbated by the frequent need for higher doses of sedation to suppress severe cough.ObjectivesTo summarize the most recent practices for management of delirium in COVID-19 infected patients, with emphasis on the psychopharmacology approach.MethodsSelective literature review via PubMed search, using the terms “delirium, neurological disorders, psychopharmacology and COVID-19”.ResultsCOVID-19 associated delirium can be presented in its hyperactive type with exuberant agitation, but also with additional clinical features such as rigidity, akinetic mutism, abulia and alogia. Psychopharmacological approaches may be needed for patients with agitation when there’s intractable stress or risk to self or others. In this group of patients, melatonin, alfa-2 agonists and low potency antipsychotics have been used as first line treatment. Trazodone, valproate, dopamine agonists, amantadine can be used. Other approaches such as correction of vitamin deficiencies and remdesivir can also play a role.ConclusionsDelirium remains frequently unrecognized. In the pandemic context of COVID-19 it is important to consider this infection as a cause of delirium and mind the misdiagnosis as a psychiatric condition. One should look for atypical features and be more thoughtful about the psychopharmacological approach.
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The purpose of the current study was to explore the delivery of the Group Lifestyle Triple P (GLTP) parent group programme through digital practice. Eight mothers of obese children aged 6–11 were recruited from a university hospital. Using a mixed-methods approach, the study sought to characterise the perceived changes throughout the intervention and explore the outcome measures on children’s BMI z-score, weight-related behaviour problems, parents’ self-efficacy, interparental conflict and parenting styles assessed pre- and post-intervention. Participants identified changes in themselves, in positive parenting, and in their ability to manage children’s nutrition and physical activity, contributing to improve children’s lifestyle behaviours. The clinical results were similar to the findings of studies in which GLTP was delivered in-person. Delivering GLTP through digital practice seems to be a possible way of implementing the intervention, particularly during the COVID-19 pandemic. Practitioner points: GLTP sessions’ contents and activities were adapted for digital delivery without compromising the programme’s implementation fidelity. Parents perceived an increase in positive parenting behaviours and their ability to manage children’s nutrition and physical activity. The clinical results of the GLTP delivered through digital practice were similar to those of studies in which the programme was delivered in-person. © 2021 The Association for Family Therapy and Systemic Practice
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Background/Case Studies: Available scientific evidence of transmission, incubation, clinical and laboratory evolution of COVID-19 from other countries was very worrisome. This virus has an unknown, potential, or confirmed risk of blood transfusion transmission and there is a lack of information if cancer patients are at higher risk. Therefore, we decided to implement more restrictive rules for clinical screening of blood donors, trigger retrospective screening tests after post-donation notification of infection, and perform the transfused patients follow up. Here we evaluate results from 140 days period of implemented actions in a cancer center blood bank in Brazil. Study Design/Methods: Number of blood donation candidates, non-eligible donors due to risk of COVID-19, post-donation notifications and impact in receipt patients were retrospectively evaluated. Clinical screening included questions if candidates were in regions with local transmission of disease, contact with people with COVID-19 and if they had clinical or laboratory diagnosis of COVID-19. Donors were instructed to report any signs or symptoms of infections within fourteen days after donation. After any post-donation notification, all blood products from last donation were immediately traced: if still in stock, they were segregated;if any was transfused, frozen blood sample from these donors, collected on the same day of blood donation, were tested for SARS-COV2RT-PCR and patients were submitted to a close clinical follow up. Results/Findings: Data from Feb 27 to Jul 15, 2020 included 6288 blood donation candidates. Out of them, 31 (0.49%) were non-eligible to blood donation due to COVID-19 risk at screening. Post-donation notifications had one of contact with people with COVID-19, and nine notifications of flu-like symptoms within less than two weeks from donation, with six confirmed RT-PCR positive (0.09%). All blood products were traced and eight were transfused - two platelet apheresis, one red blood cell, and five random platelets. Available frozen blood samples from these donors were tested negative for SARS-CoV-2 RT-PCR and, due to these negative results, not all patients were tested for COVID-19 but had close clinical follow up. One patient had RT-PCR positive 5 days after transfusion, but no correlation to blood transfusion was confirmed. Conclusions: Further investigation is needed to better understand the potential risk of blood transfusion transmission of COVID-19, mainly for cancer patients. Clinical screening of blood donation candidates is the main tool at this moment to reduce risk of virus transmission since there is no regulation for testing all blood donors. In addition, donors' commitment to post-donation information is very important, reducing the risk of transfusion transmission of COVID-19.
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Background/Case Studies: The COVID-19 virus outbreak is primarily transmitted by the respiratory route and this virus has an unknown potential or confirmed risk of blood transfusion transmission. Social distancing to protect against the coronavirus pandemic was implemented as obligatory in our region. The epidemic has the potential to reduce supply of blood components and adversely affect blood system activities, mainly for an oncology hospital. The aim of this study is to evaluate results from 140 days period of implemented actions in a cancer center blood bank in Brazil, how to address the need of blood components with protection of donor health and provide safe blood supply for patients. Study Design/Methods: Actions were implemented to maintain adequate blood supplies during the COVID-19 pandemic with focus on donor and patient safety. For donors protection, scheduled blood donations were implemented in groups with no more than five people/ hour to avoid agglomerations and guarantee quality of care for donors, contact and agreement with local Companies to allow employees to schedule blood donation during work time, communication to community about the need of blood supply and how to schedule a donation, increased number of blood bank staff for a more agile service, committed with standards of safety and infection control, and following social distancing practices between donors. For patient protection, more restrictive rules for clinical screening of blood donors, collecting blood only from individuals who were at no risk of COVID-19. Also, donors were instructed to report any signs or symptoms of infectious process within fourteen days after donation. Results/Findings: Data from Feb. 27 to July 15, 2020 included 6288 blood donation candidates. Out of them, 31 (0.49%) were non-eligible to blood donation due to COVID-19 risk at screening. Ten (0.16%) post-donation notifications included one contact with people with COVID-19, and nine notifications of flu-like symptoms with six confirmed positive to COVID-19 (0.09%). Traced blood products from these donations were discarded except eight that had already been transfused. Comparing data with the same period from 2019, there was a 40% decrease of blood donation candidates and 34.2% decrease of total of collected bags. The proportion of deferrals at clinical screening due to flu-like symptoms decrease from 0.71% to 0.49%. No impact on blood transfusion occurred in this period. Conclusions: We are facing a very different scenario of reclusion, social distancing and even hospitals with fewer elective procedures being scheduled due to COVID-19 pandemic. However, for a cancer institution with lower or no decrease in oncology patients' care, it is very important to adapt to the new environment to guarantee protection of blood donors and a safe blood supply for patients.