Inclusive Education of Children and Youth in the First Year of Covid-19 Pandemic: Integrative Review

In order to identify the knowledge produced on inclusive education and the COVID-19 pandemic, we carried out an integrative literature review, with 22 articles, from 23 databases such as OneFile, PubMed, Web of Science, Sage Journals and Medline, published from January 2020 to January 2021. The pandemic revealed challenges such as lack of internet access, use of technologies, adapting activities to students with disabilities and limited support for children and caregivers. Negative impacts of isolation and lack of school environment reflect on future psychological and social problems. Adaptations in education systems and the development of pedagogical responses must be urgent due to the impacts on the learning and health of children and their caregivers.

Leaving No One Behind: Involving Users in Creating Inclusive Digital Mobility

With a shift towards the digitisation of mobility services, user involvement is vital for success. Especially critical is the inclusion of groups vulnerable to exclusion, so they can equally benefit from such services. In this respect, the Inclusive Digital Mobility Solutions (INDIMO) project established a multidisciplinary perspective on digital mobility services by considering the needs and concerns of vulnerable-to exclusion groups such as those who lack digital skills, belong to an ethnic minority or have reduced mobility. Using data collection methods such as interviews and surveys targeted at vulnerable persons in five pilot locations, we collected information about user needs, intentions and preferences when using a digital mobility service. In this paper, we provide insights into the user recruitment process for this study and share tips for working with groups vulnerable to exclusion. Not to be forgotten are the lessons learnt from conducting this research during the COVID-19 pandemic. © 2023, The Author(s).

Impact Of The COVID-19 Pandemic In The Brazilian National Committee for Health Technology Incorporation (Conitec) Recommendation Process

Introduction. Health Technology Assessment (HTA) Process assists decision-making in health policies. The COVID-19 pandemic caused a high demand on protocol or guideline updates and incorporation of new drugs or therapies, overwhelming local agencies. A recent study reported that major HTA bodies in England, Scotland, Germany, and Canada reduced their number of drug recommendations in 2020, due to reprioritization of resources and COVID-related challenges. The present study aimed to evaluate the impact of the COVID-19 pandemic at the Brazilian National Committee for Health Technology Incorporation (Conitec) recommendation process. Methods. This descriptive study evaluated all official recommendation reports available on the Government website in 2020 and 2021, extracting the data of disease category, technology type, the aim of the report, Public Involvement, and final result for the recommendation. The results were presented in tabular and graphical form using the machine learning, through the software R studio and excel. Results. A total of 168 documents were evaluated, including guidelines and recommendation reports, with no reduction in the number of evaluations considering 2019. In 2020, there was a more significant evaluation of guidelines, and in 2021, a report on the nonincorporation of technologies. There were four specific documents about COVID 19, including vaccines and hospital care guidelines. The most incorporated and non-incorporated technologies were medication, targeting rare and highly prevalent diseases in balance. The Brazilian government was the main proposer. These results are part of the study A Survey about the core methods of the recommendation reports for Brazilian Ministry of Health carried out by Brazilian Health Technology Assessment Centers, which will characterize and analyze the core methods of the recommendation reports conducted by the Brazilian HTA Centers. Conclusions. The pandemic had a low impact on demands in the routine of the Conitec. Establish indicators and technological norms applicable to health services, contribute to the identification of possible new practices, methods or criteria.

Emotions in a Brazilian teacher’s experience report on remote English teaching during the COVID-19 pandemic

Grounded on the dialogical perspective of language and the critical approach to the study of language teacher emotions, this paper aims to discuss the emotions of an English teacher in her remote teaching experience in the context of the COVID-19 pandemic. We present a case study based on the discourse analysis of the teacher’s experience report during her participation in a roundtable discussion about English teaching in pandemic times. The online event took place in the first semester of 2020, during the University Week of a college located in the countryside of Ceará State, Brazil. Considering the concrete context and the broader contexts of discursive production, our analysis of the teacher’s utterance indicates the predominance of emotional distress in power relations, especially, with academic, pedagogical, and legislative discourses. Notwithstanding, she reveals self-confidence in face of the demand for frequently using the computer and WhatsApp in remote language teaching. © 2022, Universidade Federal de Minas Gerais, Faculdade de Letras. All rights reserved.

Clinical-epidemiological profile of COVID-19 patients during the first wave of the disease in the state of Para, Brazil

December 2019 saw several cases of pneumonia of unknown origin reported in Wuhan, China;the cause of this unknown disease was later identified as the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The purpose of the present study was to evaluate the epidemiological profile of coronavirus disease 2019 (COVID-19) in the North Region of Brazil to assess possible correlations between demographic, social and health factors as well as adherence to safety protocols and the epidemiological profile of COVID-19. Information was obtained via a socio epidemiological survey carried out using Google Forms shared on various social media platforms from May 13 to 20, 2020.6,781 people, living in the State of Para, participated in the study of which only 682 (10.1%) had been diagnosed with COVID-19. Of these, 43 (6.3%) required hospitalization. 155 (23.5%) tested positive by RT-PCR associated with computed tomography. The RT-PCR test, with no association with other methods, was performed in 77 (11.6%) cases and serology performed in 360 cases (54.6%). There was a higher prevalence of confirmed cases (457, 67.0%) in females than in males, and the predominant age group was 30 to 40 years of age (214 participants, 31.4%). Considering the relatively homogeneous demographic profile of the sample, continued research is vital, preferably multi-centric studies, to obtain relevant data regarding the epidemiological dynamics of COVID-19;this data will allow the development of pandemic-prevention strategies that consider the social, cultural and political aspects of specific locations.

Vulnerability to COVID-19 in Pernambuco, Brazil: a geospatial evaluation supported by multiple-criteria decision aid methodology. (Special issue on COVID-19.)

The paper presents an innovative application to identify areas vulnerable to coronavirus disease 2019 (COVID-19) considering a combination of spatial analysis and a multi-criteria learning approach. We applied this methodology in the state of Pernambuco, Brazil identifying vulnerable areas by considering a set of determinants and risk factors for COVID-19, including demographic, economic and spatial characteristics and the number of human COVID-19 infections. Examining possible patterns over a set number of days taking the number of cases recorded, we arrived at a set of compatible decision rules to explain the relation between risk factors and COVID-19 cases. The results reveal why certain municipalities are critically vulnerable to COVID-19 highlighting locations for which knowledge can be gained about environmental factors.

Newborn in the Pediatric Emergency Department: A Reality During the COVID-19 Pandemic

Introduction: We aimed to characterize newborns admitted to the pediatric emergency department in the first months of the coronavirus disease 2019 (COVID-19) pandemic. Methods: We conducted a retrospective observational study regarding newborns who presented to the pediatric emergency department during the pandemic period in comparison with the same period of the previous year. Data gathered concerning the neonatal characteristics included the length of postpartum stay in the nursery, age at presentation to the pediatric emergency department, source of referral to the pediatric emergency department, presenting complaint, need for complementary exams, diagnosis, final destination, and hospital readmission. Results: The number of births was 591 in the pandemic period and 709 in the homologous period. We analyzed 72 pediatric emergency department admissions in the pandemic period and 123 pediatric emergency department admissions in the homologous period. During the pandemic period, there was a decreased rate of neonatal admissions to the pediatric emergency department, but not as pronounced as for the total number of children. We found an increased rate of patients visiting the pediatric emergency department and without disease during the first 2 weeks of life. There were higher referral rates to the pediatric emergency department and to an ambulatory pediatrics appointment. No differences were found concerning the presenting complaints, need for complementary exams, diagnoses, and admission rates. Discussion: Although there was a decreased rate of neonatal admissions during the pandemic period, it was not as pronounced as for the total number of children, denotating a greater need to attend to the pediatric emergency department compared to the other age categories. The reduced access to primary care during the pandemic period and the decreased time of parental education in the nursery might have contributed to these findings. © Author(s) (or their employer(s)) and Portuguese Journal of Pediatrics 2022.

Cough and Dyspnea in 2021: A Case of Asthma, COVID-19, or.?

Background: COVID-19 has changed the perspective through which medical staff look at dyspnea and hypoxemia cases. Epidemiological links are frequently missing, and clinical and imagological findings are often unspecific, overlapping substantially with other respiratory infections. Case summary: We report the case of an 11-year-old girl with a known history of asthma who had recently moved from Guinea-Bissau with her mother. Although the mother reported being Ag HBs positive, no serologic studies had ever been performed on the child. The patient was admitted to the Emergency Room after 4 days of cough and the feeling of thoracic oppression, without fever. No contact with suspected or confirmed individuals infected with SARS-CoV-2 or other respiratory viruses was reported. She presented with peripheral oxygen saturation of 90%, costal retractions and a prolonged expiratory phase. After an unsuccessful course of bronchodilators and prednisolone, she was admitted to the Pediatric Intermediate Care Unit because of a sustained need for oxygen therapy. Polymerase chain reaction analysis for SARS CoV-2 came back negative. A chest radiograph displayed a bilateral reticular infiltrate, and therapy with azithromycin was started. Due to a deterioration of the dyspnea, a chest tomography was eventually performed, revealing an exuberant and bilateral ground glass-like densification suggestive of alveolar injury. Echocardiogram and e electrocardiogram were both normal. After a positive serologic result for HIV, the patient was transferred to a Level III hospital, and Pneumocystis jirovecii was identified in bronchoalveolar lavage. T cell count was 12/mm3. Highly active antiretroviral therapy and cotrimoxazole were started, prompting clinical and analytical recovery. Discussion: Pneumocystis jirovecii can cause fatal pneumonia in immunocompromised children. Even though an asthma exacerbation and atypical bacterial or viral infections, namely COVID-19, present as more usual causes of dyspnea, a low suspicion index is warranted in children coming from HIV-endemic countries, particularly those who are unresponsive to conventional bronchodilator and antibiotic therapy.

Implementing a patient navigation program to improve adherence with cancer treatment for community health center patients newly diagnosed with cancer

Background: Community health centers' (CHCs) patients newly diagnosed with cancer often experience barriers to accessing timely treatment. Patient navigation decreases barriers to cancer screening and diagnostic care, but the exact impact on cancer treatment is unclear. We implemented patient navigation to provide underserved patients with support to access and adhere to cancer treatment. The goal of our study is to determine the effect of patient navigation on missed appointment rates, treatment adherence, and health outcomes among an underserved patient population. Here, we present preliminary data about program implementation. Methods: Utilizing a population health registry, TopCare, and referrals from CHCs physician champions, newly diagnosed cancer patients from Massachusetts General Hospital CHCs were referred to the Cancer Center, identified and verbally consented to participate in the study's intervention. Patients are randomized either to receive in-person patient navigation or enhanced usual care, which consists of two reminder phone calls prior to each oncology appointment. Adherence to treatment, healthcare utilization, patient satisfaction with cancer care and patient navigation, patient engagement, financial burden, symptom burden, health-related quality of life, and psychosocial care are longitudinally assessed. Our primary outcome is missed appointment rate to oncology appointments. Results: The trial started in November 2017 and as of April 2021, we have identified 349 eligible patients and enrolled 261 (82% consent rate for reached patients). Of 261 enrolled patients, 50% were women, 38% identified as non-White, 25% identified as Hispanic or Latino, and 28% did not speak English. The most frequent cancer types enrolled include genitourinary (n=67), thoracic (n=47), gastrointestinal (n=47), and breast (n=46). Patients had 6257 visits and 195 were missed (3.1%). Navigators performed 4553 interventions. There were 152 emergency department visits and 127 unplanned hospital admissions. Of 120 referrals to supportive care, 54 were to social work, 38 to palliative care and 28 to Psychiatric Oncology or behavioral health. Conclusions: Patient navigation is feasible for underserved CHC patients newly diagnosed with cancer. Our current missed appointment rate is 3.1%, including the time period of the COVID-19 pandemic. After trial completion in July 2021, we will compare the outcomes in patients who received in-person patient navigation to patients who were randomized to enhanced usual care.

Essential activities, social distancing and adi nº 6.341: Consequences of covid-19

Objective: The article aims to reflect on the existing correction between the definition of essential activities and social distance and, from them, to point out reflexes of this decision in relation to the federative pact, resulting from the judgment of ADI nº 6341, at the time of COVID-19. Methodology: The research will be analyzed through the bibliographic review of arti-cles and doctrinal material raised, including, from health protocols adopted by European countries, regarding issues related to social distance, as well as the Supreme Court's own decision in ADI nº 6341. Results: Under the formal aspect, the social distancing health measure, like the oth-er measures, could, in theory, be carried out by the health authorities of the federated entities, however, as it was not expressly listed in law, having its validity basis in an infra-legal act (epidemiological bulletins from the Health Ministry), so that, as a measure that restricts rights, it could not be conveyed through regulatory decree of states and municipalities. Conclusions: From the study it is concluded that the adoption of autonomous decrees to implement the measure of social distance is inadequate, with no legal basis. © 2021, Centro Universitário Curitiba - UNICURITIBA. All rights reserved.

Impacts of the COVID-19 pandemic on the Brazilian hydrothermal system

Hydropower has been the predominant source of electrical energy supply in Brazil, with significant increasing participation share of thermal and wind power plants. From 2000 to 2012, on average, 91% of Brazilian effective electric generation was provided by hydropower, while the reservoir system operated, on average, at 68% of the active storage. From 2013 to 2020, 73% was supplied by hydropower plants, with only 39% of active storage. Demand increase, delays in expanding the system, and a series of moderate to severe droughts occurred in Brazil over the last eight years have contributed to bringing the power system to its current state of low storage levels and intense dispatch of the thermal plants. The COVID-19 pandemic in 2020 hit the country hard and brought an abrupt reduction in energy demand, with persistent impacts expected for the coming years. On average, 7.5 GW or 9.7% reduction is expected for the next three years in power demand. To deal with the reduction in demand, a well-planned adaptation strategy is urgently needed. It is important to plan how to efficiently combine reduction of dispatching the most expensive thermal plants and recover water levels of reservoir storage and productivity in the complex hydrosystem with over 150 reservoirs. To determine the tradeoff and adaptation strategy, we use the HIDROTERM model, a nonlinear programming optimization model previously developed for planning the operation of the Brazilian hydrothermal system for analysis by comparing results with demand forecasts before and during the pandemic and under different hydrological scenarios. © ASCE.

The COVID-19 mirror: reflecting science-society relationships across 11 countries

Twelve researchers from 11 countries used autoethnographic techniques, keeping diaries over 10 weeks of the COVID-19 crisis, to observe and reflect on changes in the role and cultural authority of science during important stages of viral activity and government action in their respective countries. We followed arguments, discussions and ideas generated by mass and social media about science and scientific expertise, observed patterns and shifts in narratives, and made international comparisons. During regular meetings via video conference, the participating researchers discussed theoretical approaches and our joint methodology for reflecting on our observations. This project is informed by social representations theory, agenda-setting, and frames of meaning associated with the rise and fall of expertise and trust. This paper presents our observations and reflections on the role and authority of science in our countries from March 10 to May 31, 2020. This is the first stage of a longer-term project that aims to identify, analyse and compare changes in science-society relationships over the course of the ongoing COVID-19 pandemic.

COVID-19 mortality in an area of northeast Brazil: epidemiological characteristics and prospective spatiotemporal modelling.

This study aimed to analyse the spatial-temporal distribution of COVID-19 mortality in Sergipe, Northeast, Brazil. It was an ecological study utilising spatiotemporal analysis techniques that included all deaths confirmed by COVID-19 in Sergipe, from 2 April to 14 June 2020. Mortality rates were calculated per 100 000 inhabitants and the temporal trends were analysed using a segmented log-linear model. For spatial analysis, the Kernel estimator was used and the crude mortality rates were smoothed by the empirical Bayesian method. The space-time prospective scan statistics applied the Poisson's probability distribution model. There were 391 COVID-19 registered deaths, with the majority among ⩾60 years old (62%) and males (53%). The most prevalent comorbidities were hypertension (40%), diabetes (31%) and cardiovascular disease (15%). An increasing mortality trend across the state was observed, with a higher increase in the countryside. An active spatiotemporal cluster of mortality comprising the metropolitan area and neighbouring cities was identified. The trend of COVID-19 mortality in Sergipe was increasing and the spatial distribution of deaths was heterogeneous with progression towards the countryside. Therefore, the use of spatial analysis techniques may contribute to surveillance and control of COVID-19 pandemic.

Angioedema, endothelium, ACE2, and bradykinin - interrelationships in COVID-19: A case report

COVID-19 is a new disease, whose several atypical clinical manifestations began to be observed with the evolution of the pandemic, and have been investigated to understand the pathophysiology of the disease. In this article, the objective is to describe a case of angioedema in COVID-19, considered an atypical manifestation, and rarely described in the literature. The case is of a 55-year-old patient who sought medical attention for a complaint of intermittent fever for four days. On the seventh day, he manifested angioedema in the left zygomatic projection and the right subpalpebral region. The patient had no history of angioedema earlier in life. The following day, he presented a regression of the angioedema concerning the previous day. After this period, the patient progressed well and became asymptomatic. The RT-PCR laboratory test performed on the first days of manifesting symptoms was positive for SARS-CoV-2. We correlate the onset of angioedema with the possible endotheliitis present in the disease, which has been evidenced by the observation of severe endothelial injury associated with the intracellular presence of the virus in several histopathological studies of patients with COVID-19. Also, possible deregulation of the Kininogen-Kallikrein-Kinin System (KKKS) could explain this manifestation, as SARS-CoV-2 binds to the ACE2 receptor, which is responsible for degrading kinins, such as bradykinin. © 2020 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.

Risk clusters of COVID-19 transmission in northeastern Brazil: prospective space-time modelling.

This study aimed to analyse the trend and spatial-temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space-time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.