Repercussions of the COVID-19 pandemic on nursing education: Scoping Review

Objetivo: mapear o conhecimento produzido sobre as repercussoes da pandemia COVID-19 na formacao em Enfermagem. Metodo: trata-se de uma scoping review, guiada pelas recomendacoes da Joanna Briggs Institute Reviewer's Manual realizada em 15 bases de dados eletronicas e repositorios de teses e dissertacoes. O protocolo desta revisao foi registrado em Open Science Framework. Os dados foram analisados e sintetizados em duas categorias de analise estabelecidas: aspectos positivos e negativos e estatistica descritiva. Resultados: 33 publicacoes identificadas, os aspectos positivos mais citados foram o desenvolvimento de novas estrategias de ensino adaptadas ao meio virtual e a capacitacao dos futuros profissionais na pratica clinica do contexto de crise sanitaria. Os aspectos negativos estao relacionados as questoes psicologicas, como aumento de casos de ansiedade, estresse e solidao entre os estudantes. Conclusao: as evidencias sugerem que o ensino remoto foi uma saida emergencial oportuna para a continuidade da formacao academica, contudo, esta modalidade educacional apresentou aspectos positivos e negativos que precisam ser repensados para uma melhor sistematizacao do ensino-aprendizagem em outros contextos que se assemelhem ao da pandemia da COVID-19.

COVID-19 WAS NOT TRIGGER FOR RHEUMATIC DISEASE ACTIVITY AFTER 6 MONTHS FOLLOW-UP: RESULTS FROM REUMACOV BRASIL REGISTER

BackgroundThe COVID-19 pandemic has brought uncertainties to rheumatology practice, mainly related to the possibility of triggering disease activity after infection in immune mediated rheumatic diseases (IMRD). To date, there are few data in the literature specifically evaluating this issue.ObjectivesEvaluate the disease activity in IMRD patients after 6 months of the infection, compared to pre infection status.MethodsReumaCoV Brasil is a longitudinal study performed at 35 study centers designed to follow-up IMRD patients for 6 months after clinical or laboratorial COVID-19 diagnosis (cases), comparing with patients with IMRD who had not had the infection at the time of inclusion (controls). Demographic data such as age, sex, comorbidities, clinical characteristics, treatment, evolution of COVID-19 and disease activity status were collected using a Research Eletronic Data Capture (REDCap) database on three consecutive visits (inclusion and 6 months). The analysis was carried out on the four diseases with the highest inclusion number in the study: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). In addition to specific disease activity assessment metrics, we used patient's global assessment of disease activity (PGA), ranging from 0 to 10, at all visits, with 0 being no activity and 10 being intense activity. All conclusions were drawn considering the significance level of 5%. This study was registered at the Brazilian Registry of Clinical Trials—REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.ResultsBetween May 2020 and January 2021, 2032 patients were included in the registry, and of these, 1322 patients (721 cases and 601 controls), completed 6 months of follow-up, being 550 SLE (42.0%), 497 RA (37.6%) and 176 SpA (13.3%) and 99 (7.4%) PsA. Most patients were female (82.0%);the median age was 46.7 (13.8). Disease activity at the time of enrollment, according to the PGA, was similar between cases and controls, except for patients with RA and AS, where it was higher in controls. After the follow up time, no worsening of activity was observed in any of the diseases evaluated in the case group (Table 1). Despite this, worsening of disease symptoms after COVID-19 was reported by 23.3%, 24.6%, 25.0% and 25.8% of patients with SLE, RA, AS and PsA respectively, not related with disease activity.ConclusionIn patients with IMRD, no worsening of disease activity was observed after COVID-19 in this cohort of Brazilian patients. Despite this, many patients noticed worsening of symptoms, possibly associated not with the triggering of the activity, but with the so-called long COVID syndrome.Table 1.Comparison of disease activity, according to PGA, comparing disease activity status at inclusion and after 6 months of follow up, in cases and controlsINCLUSIONAFTER 6 MONTHSCasesControlsp-valueCasesControlsp-valueSLE2 (0-4,5)2 (0-4)0,8102 (0-5)2 (0-4)0,172RA3 (1-5)4 (2-6)0.0013 (1-5)3 (1-5,5)0,731AS2 (0-5)4 (1-6)0,0022 (0-5)3,5 (1-6)0,044PsA2 (0-4)2 (0-5)0,8162 (0-5)2 (0-5)0,939*Median and interquatile range;Student t test;CI 95%AcknowledgementsReumaCoV Brasil researchers, Brazilian Society of Rheumatology and National Council for Ccientific and Technological Development.Disclosure of InterestsNone Declared.

Leisure and COVID-19: reflections on Brazilian older adults who frequent urban public parks. (Leisure and aging in difficult times.)

This qualitative research analysed how the pandemic caused by COVID-19 influenced the leisure of older adults who frequent urban public parks in a city in southern Brazil. Semi-structured interviews were conducted by telephone with 23 older adults, 16 women and 7 men (60 years old), who frequented urban parks before the beginning of the pandemic. The interviews were specifically designed for this research and addressed (a) the participants' perspectives on the concept of leisure;(b) the influence of COVID-19 on leisure and (c) leisure events and activities during the pandemic. The data was analysed using the content analysis technique. The participants reported that their leisure was affected by COVID-19, mainly due to pandemic-related restrictions which make social, cultural, touristic and physical activities unfeasible and reduced their leisure participation in urban public parks. Furthermore, findings suggest that the COVID-19 pandemic reduced the freedom and autonomy of older adults, and increased inequality, fear and lack of time, resulting in greater leisure constraints. With more time at home and in contact with friends and family, albeit virtually, leisure has been re-defined, denoting different and important configurations for older adults. Esta pesquisa qualitativa analisou como a pandemia causada pela COVID-19 influenciou o lazer de idosos frequentadores de parques p..blicos urbanos em uma cidade do sul do Brasil. Entrevistas semiestruturadas foram realizadas por telefone com 23 idosos, 16 mulheres e sete homens (60 anos), que frequentavam parques urbanos antes do in..cio da pandemia. As entrevistas foram elaboradas especificamente para esta pesquisa e abordaram: (a) as perspectivas dos participantes sobre o conceito de lazer;(b) a influ..ncia da COVID-19 no lazer;e (c) eventos e atividades de lazer durante a pandemia. Os dados foram analisados por meio da t..cnica de an..lise de conte..do. Os participantes relataram que seu lazer foi afetado pela COVID-19, principalmente devido ..s restri....es relacionadas .. pandemia que inviabilizam as atividades sociais, culturais, tur..sticas e f..sicas e reduzem a participa....o no lazer em parques p..blicos urbanos. Al..m disso, os resultados sugerem que a pandemia da COVID-19 reduziu a liberdade e a autonomia dos idosos e aumentou a desigualdade, o medo e a falta de tempo, resultando em maiores restri....es de lazer. Com mais tempo em casa e no contato com amigos e familiares, ainda que virtualmente, o lazer foi redefinido, denotando configura....es diferentes e importantes para os idosos.

COVID-19 cancer patients outcomes in an intensive care setting: A case-control study

Background: Cancer patients appear to be a vulnerable group in COVID-19 pandemic. We aimed to compare clinical characteristics and outcomes of cancer and non-cancer patients with COVID-19 admitted to an intensive care unit (ICU). Methods: We conducted a retrospective case-control study in patients with laboratory-confirmed COVID-19, with and without cancer, admitted to the ICU of “Centro Hospitalar Universitário do Porto” from 2nd March 2020 to 31st January 2021. Patients were matched according to age, gender and underlying comorbidities. Clinical, laboratory and radiological findings were obtained from medical records. COVID-19 related outcomes of both groups were compared using logistic regression. Results: 29 critical COVID-19 cancer patients (cases) and 29 critical COVID-19 non-cancer patients (controls) were enrolled. Fever, dyspnea and cough were the most common presenting symptoms in both groups. Lymphopenia and elevated lactate dehydrogenase were the most common laboratory findings in both groups and anemia was observed significantly more often in cancer patients (75.9% vs 44.8%;p=0.031). Ground glass opacities were more frequently seen in controls (100% vs 67%;p=0.018). Univariate regression revealed that invasive mechanical ventilation (IMV) need on ICU admission was significantly higher among cancer patients [48% vs 7%;odds ratio (OR)= 12.600, 95% confidence interval (CI) 2.517-63.063, p=0.002] but there was no significant impact either on global need of IMV during all-length ICU stay (76% vs 55%;OR= 2.554, 95% CI 0.831-7.842, p=0.102) or on mortality rates (59% vs 38%;OR= 2.318, 95% CI 0.809-6.644, p=0.118). A multivariate model showed an increase in the adjusted risk of IMV need at ICU admission (adjusted OR= 14.036, 95% CI 1.337-153.111, p=0.028). The length of ICU stay, time to death and rate of complications were not impacted by the presence of cancer. Conclusions: In this study critical cancer patients with COVID-19 had an increased risk for IMV need at ICU admission but not for IMV need during all-length ICU stay or mortality rates. Despite evolving more rapidly to respiratory failure (RF) cancer patients did not have significant increase on mortality, stressing the importance of aggressive treatment in this group of patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Lupus patients infected by sars-cov2 performed less social isolation with higher hospitalization associated with hypertensionand cyclophosphamide pulsotherapy-data from reumacov Brazil

Objectives: To determine the main risk factors associated with COVID-19 in SLE patients. Methods: The Reuma CoV Brazil is a multicenter, observational, prospective cohort designed to monitor immune-mediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. SLE adult patients according to SLE SLICC criteria classification (2012), with and without (control group-CG) COVID-19 diagnosis were matched. Demographic data, managing of COVID-19, comorbidities, clinical characteristics (disease activity: Patient Report Outcomes-PROs, Physician Global Assessment and SLEDAI-2 K)were collected. Results: From May 2020 to January 2021, 604 SLE patients were included, 317 (52.4%) with COVID-19 and 287 (47.6%) in the CG. Both groups were homogeneous and comparable regarding sex and comorbidities. SLE patients with COVID-19 declared a lower level of social isolation (49.5% vs. 61.9%;p = 0.002), worked more commonly in health professions (10.4% vs. 3.5%;p = 0.002), presented more frequently joint (32.5% vs. 22.0%;p = 0.004) and hematological manifestations (18.0% vs. 11.5%;p = 0.025). SLEDAI-2 K did not differ among groups prior and after COVID-19 infection. However, considering the mean duration of COVID-19 symptoms (12.1 ± 8.8 days), infected patients had more severe disease activity's PROs after resolution of COVID-19 symptoms (2.9 ± 2.9 vs. 2.3 ± 2.6;p = 0.031). The hospitalization rate was 20.5% (n = 65), of whom 23 (7.2%) needed intensive care unit and 14 (4.4%) patients died. Hypertension [5,26 (1,9714,07);p = 0.001] and recently cyclophosphamide pulses [39,21 (4,17-368,53);p = 0.001] were associated with hospitalization and patients who received telemedicine medical care presented 72% less chance of hospitalization [0.28 (0.09-0.83);p = 0.023). Conclusion: COVID-19 was associated with a lower level of declared social isolation and more severe disease activity perception after SARS-CoV-2 infection according to PROs. Hypertension and cyclophosphamide were associated with hospitalization and telemedicine can be a useful tool for SLE patients with COVID-19. These data should be considered to perform public health policy and national guidelines to manage SLE patients during the pandemic, as well as to prioritize some special groups for the immunization program.