SUS funding in the face of the Covid-19 pandemic

The Brazilian Unified Health System (SUS), since its creation in 1988, has a history of insufficient resources to effectively guarantee universality and comprehensive care. Its underfunding, derived from the lack of support from part of society and neoliberal policies undertaken by various governments in the 1990s and 2000s, turned into effective reduction in real terms of funding resources after the approval of the "expenditure ceiling” in 2016, aggravating the structural system difficulty. The Covid-19 pandemic generated a preeminent need to expand the service capacity of the public health system and, with that, the resources for the SUS were expanded. However, this greater financial availability was the result of extraordinary measures and was restricted to the years 2020 and 2021. The ordinary budget for health in those years and the 2022 LOA demonstrate that the underfunding continues and that the pandemic did not change the lack of priority given to healthcare within the federal budget. © 2023, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.

Smoking on COVID-19 pandemic: neurobiological aspects of drug abuse in lasting stress conditions

One of the biggest global public health crisis began in Wuhan, China at the end of 2019. That emergency was the emergence of SARS-CoV-2 and the disease COVID-19, a highly transmissible acute respiratory syndrome. The pandemic declaration by the WHO in March 2020 caused the world to take on several measures to combat and contain the virus. Initially, social isolation and lockdown were the main initiatives, as there were no forms of treatment or prevention of the disease. These restrictive measures generate a change in the habit of the population that triggered serious physical and psychological impairments. One of the consequences was the increase in the use of substances of abuse and, consequently, substance use disorder, including tobacco. During the pandemic, cigarette consumption increased from 10 to 30% worldwide, whereas smoking is the main cause of preventable death and a risk factor for several diseases. Along with alcohol, nicotine has a greater addictive power than illicit drugs. Substance use disorders and COVID-19 have a synergistic effect, in this way, we seek to integrate neurochemical, cognitive and behavioral aspects that led to increased consumption and/or relapse in nicotine consumption and the used therapy.

Water Disconnection and Vital Flow Policies: International Practices in Medium- and High-Income Countries

Water access is recognized as a human right by the United Nations since 2010. However, even when piped water is available, the economic crisis has limited poorer households to afford those services on a regular basis. Users become debtors as utilities face growing service costs and shrinking national public funds, pushing tariffs as the main source of revenue for cost recovery. The COVID-19 pandemic lit up affordability issues and health consequences of disconnection policies. Countries worldwide banned water shutoffs during the last year, ensuring water and wastewater service access for all citizens. Although disconnection is a way to reduce the number of debtors, it is, at the same time, considered a threat to human rights statements. This study gathered information on water subsidies, disconnection and vital flow policies applied among several medium- and high-income countries, in order to analyze how utilities have dealt with default rates and if there is any difference between the approaches between medium- and high-income countries. Through case studies, this paper also aims to inspire other practitioners facing the same issues. Based on the eleven case studies presented here, we concluded that high-income countries use assistance programs over water disconnection policies when compared to medium-income ones. Water shutoffs are explicitly forbidden in the United Kingdom, Australia, and France. Although a humane alternative, water flow restrictors have limited application, especially considering the technical issues involved. © 2023 by the authors.

Manifestations musculosquelettiques du SRAS-CoV-2 dans une population pédiatrique – expérience d'une unité de rhumatologie pédiatrique

Introduction Les infections à coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) peuvent provoquer une inflammation sévère et déclencher des manifestations auto-immunes. Plusieurs rapports de cas chez des adultes ont décrit la production d'autoanticorps et manifestations musculosquelettiques (MMS) après une infection par le SRAS-CoV-2 (chez environ 27 %), mais les informations chez les enfants sont rares. Objectif Décrire les MMS, après infection par le SRAS-CoV-2, dans une population pédiatrique sans maladie rhumatismale (MR) connue antérieurement adressée à unité de rhumatologie pédiatrique. Patients et méthodes Les dossiers cliniques de tous les nouveaux patients en rhumatologie pédiatrique (RP), entre avril 2020 et août 2022, présentant MMS et/ou résultats sérologiques liés à des MR après une infection par le SRAS-CoV-2, ont été examinés. Les patients avec des antécédents de MR connus ont été exclus. Résultats Pendant la période d'études, 325 nouveaux patients ont été référés à unité de RP, dont 20 (6,2 %) présentaient MMS et/ou résultats sérologiques liés à des MR après infection. Sur les 20 patients (60 % femmes), l'âge moyen au moment du diagnostic d'infection était de 12,6 ± 4,2 [2–17] ans et le délai moyen pour les MMS ou sérologiques après l'infection était de 21,6 ± 10,8 [9–49] jours. Tous les patients avaient une infection asymptomatique ou légère. Après infection, les principaux MMS étaient : arthralgies (12/20, 60 %), myalgies (8/20, 40 %) et acrocyanose (5/20, 25 %). Les MR les plus fréquemment identifiés étaient : myosite (3/20, 15 %), maladies du tissu conjonctif (3/20, 15 %), perniose (3/20, 15 %) et douleurs musculosquelettiques non spécifiques (DMNS : 5/20, 25 %). Un garçon de 12 ans a eu deux infections enregistrées par le SRAS-CoV-2 avec différentes manifestations cliniques : suite à la première infection, il a développé une DMNS et six mois plus tard, après la seconde, il a présenté une arthrite qui a ensuite été diagnostiquée comme une arthrite juvénile idiopathique. 2 patients (0,6 %) ont été référés en raison de résultats sérologiques positifs (un avec ANCA-PR3 et un avec anticoagulant lupique), malgré l'absence de manifestations cliniques évocatrices de MR. Cinq patients (25 %) ont été hospitalisés en raison de la gravité du MR : 2 lupus érythémateux disséminés (10 %) et 3 myositis (15 %), 3 ont nécessité injections d'immunoglobuline et méthylprednisolone. Au cours du suivi, les patients atteints de MR inflammatoire ont été majoritairement traités par prednisolone orale (n = 6), hydroxychloroquine (n = 3) et anti-inflammatoire oral (n = 3). Les autres avaient des symptômes contrôlés par la physiothérapie (n = 4), myorelaxant (n = 4) ou traitement topique (n = 2). Après un suivi moyen de 8,9 ± 6,0 [1–20] mois, tous les patients ont présenté une évolution favorable : 16 (80 %) avaient une maladie contrôlée et 4 (20 %) avaient une rémission complète. Discussion À notre connaissance, il s'agit de l'une des rares études analysant l'atteinte MMS induite par SRAS-CoV-2 dans une population pédiatrique. Dans notre cohorte, les MMS étaient peu fréquents (6,2 %), par rapport aux adultes, et les plus fréquents étaient myositis, maladies du tissu conjonctif, perniose et DMNS. Toutes ont été identifiées, traitées et 20 % ont atteint une rémission complète. Conclusion Les MMS induites par SRAS-CoV-2 dans la population pédiatrique de notre unité étaient rares et présentaient un large spectre de gravité, allant de légères à potentiellement mortelles.

An Artificial Intelligence System Focused on COVID-19 Pandemic: Results and Impacts

Artificial intelligence (AI) is rapidly becoming fundamental in our society, reaching from industry to our homes. AI benefits for human being lives are undoubtful, especially in its application on Health and Safety at Work. Specifically, when there is a high degree of uncertainty in preventive measures and protocols definition, such as the case of COVID-19, AI may enlighten and anticipate decisions saving lives. Therefore, this paper aims to discuss the success factors and the results of an AI application related to Covid-19 prevention in workplaces, named CyberLabs KeyApp. It presents a case study in the Brazilian energy sector applied to approximately 3000 employees located in more than 30 different cities. The system was composed by an application including Control Facial Recognition when employees reach the electric power plants, substations, and offices, conjugated with temperature control;a daily COVID-19 self-assessment form fulfilment gathering personal habits related to Covid-19 furthering the artificial intelligence processing;and surveillance cameras for agglomerations detecting on facilities. As a result, there is an AI COVID score calculation that classifies the employee's risk into four categories. Medical staff is notified with warns reporting each employee with High or Very High classification. The four categories are listed: Low - user pre-access to the facility is granted. Medium - user pre-access to the facility is granted and AI prescribes individual COVID avoidance good practices that are informed to the user by notification;High - user preaccess to the facility is conditioned to a prior individual medical staff evaluation and medical staff is notified for proceed to contact with the user;and Very High - user pre-access to the facility is not granted and the AI application notifies medical staff to contact immediately with the user. A set of operational, tactical, and strategic panels are available for managers and doctors for daily consulting. Through these AI dashboards, the variables - habits, symptoms, and preventive measures - that influences employees' Covid high risk are detected. Innovative Protocols were elaborated to diminish this risk rates as well as specific communication campaigns. Consequently, the company has reached the lowest Covid-19 rates among the Brazilian public energy sector institutions.

LINFOMA PRIMÁRIO DE SISTEMA NERVOSO CENTRAL EM PACIENTE PEDIÁTRICO HIV POSITIVO: RELATO DE CASO

Relato: Paciente de 6 anos, HIV+, iniciou quadro com crise de ausência em jan/2021. Recebeu tratamento para encefalite com melhora clínica temporária. Evoluiu com cefaleia frontal de forma progressiva, desenvolvendo ataxia, afasia, vômitos em jato e novo episódio convulsivo após 1 mês da alta. RNM de crânio evidenciou lesão expansiva em hemisfério cerebral direito com compressão do 4° ventrículo e pequenas imagens nodulares difusas com edema cerebral. Realizou cirurgia para derivação ventricular externa e biópsia das lesões. Descartadas causas infecciosas, foi diagnosticado em mar/2021 com linfoma de células B de alto grau através de exame histopatológico. Estadiamento não evidenciou doença em outros sítios. Iniciou tratamento em mar/2021 com o protocolo NHL BFM 2012 associado a rituximabe. Após o bloco AAZ1 apresentou mucosite grau IV. Após BBZ1, evoluiu com mucosite grau III precoce, íleo paralítico, tiflite e infecção leve pelo SARS-CoV-2. RNM após 2 blocos de tratamento apresentando expressiva redução das lesões previamente identificadas. Após CCZ1 apresentou íleo paralítico e pneumonia, evoluindo com quadro de insuficiência respiratória grave e óbito. Discussão: Linfoma primário do SNC (LPSNC) é um tipo raro e agressivo de LNH, mais comum em pacientes imunodeficientes, que corresponde a 0,5–2% dos tumores primários de SNC e 0,7–0,8% de todos os linfomas. A incidência desse tipo de neoplasia na população pediátrica é desconhecida devido a raridade de casos reportados. Seu subtipo mais frequente é o linfoma difuso de grandes células B. O paciente em questão foi diagnosticado com Linfoma de células B de alto grau estádio IV, duplo expressor (myc e bcl2) através do histopatológico e imuno-histoquímica com Ki67 >95%, padrão menos comum em crianças. A co-expressão das proteínas MYC e BCL2 está associada a um pior prognóstico. Pacientes duplo-expressores têm idade média de 71 anos, apresentam pior performance-status, doença mais avançada e maior índice de proliferação Ki-67. O cenário ideal seria o rastreio de MYC, BCL2 e BCL6 em todos os pacientes com linfoma de alto grau no diagnóstico e, se positivo, a complementação por FISH para avaliação de double-hit, que já confere novas abordagens prognósticas e terapêuticas em adultos. Os principais fatores prognósticos do LPSNC são idade e performance status. O tratamento de primeira linha em crianças é baseado em quimioterapia (QT) com HD-MTX. O papel da radioterapia (RT) nesses pacientes é questionável. O estudo com maior número de casos pediátricos (29) mostrou sobrevida de 82% em 3 anos, apresentando melhores taxas que dos adultos (20–40% em 5 anos) e a maioria dos casos não fez RT. A adição do anticorpo monoclonal anti-CD20, Rituximabe, ao tratamento, foi baseada em estudos recentes realizados com crianças e adolescentes com LNH de células B maduras de alto grau. Houve remissão em 95% dos pacientes que usaram a terapia combinada (rituximabe e QT) com uma maior taxa de sobrevida livre de eventos em 3 anos quando comparado àqueles que receberam somente QT (95,1% vs. 87,3%). Devido a agressividade da doença, a intensificação do tratamento se faz necessária. O uso combinado do rituximabe com a poliquimioterapia, gera maior risco de toxicidade, principalmente mielotoxicidade. O paciente em questão teve boa resposta parcial ao tratamento, porém apresentou intercorrências graves durante os 3 períodos de aplasia pós QT, o que levou ao seu óbito.

Restart tourism , build the future. (Special Issue: Global trends: measuring tourism success: are we on the brink of a new paradigm?)

Purpose: This viewpoint aims to explore the question: How can we restart and monitor the path towards the tourism of the future? Design/methodology/approach: This paper identifies the progress made at scientific, institutional, political and technological levels, and how it is possible to foresee that we will enter in a new era of tourism indicators. Findings: A significant body of literature clearly demonstrates that tourism cannot be viewed simply from an economic point of view as it has a great influence on sociocultural and environmental dimensions. The impact of tourism and how to ensure its long-term success has been invoked for the last few decades, leading to the direct consideration of sustainability indicators in a wide array of scientific publications. However, despite significant advances, the lack of funding, lack of support or interest from the political community, bureaucracies or lack of methodological guidance and of technical skills along the entire value chain pose clear challenges to the development and adoption of wide data systems to support sustainable tourism policies. Originality/value: The paper sheds light on the Portuguese position regarding the recovery of the tourism sector in the aftermath of the COVID-19 pandemic. It also highlights the commitment to knowledge and monitoring of sustainability in tourism, articulated at international level, and how this is essential in order to make progress and to overcome the challenges facing the sector. At the same time, it demonstrates how fundamental it is to identify solutions to boost the potential of tourism as an economic, social, environmental and cultural phenomenon.

Restart tourism ;build the future

Purpose: This viewpoint aims to explore the question: How can we restart and monitor the path towards the tourism of the future? Design/methodology/approach: This paper identifies the progress made at scientific, institutional, political and technological levels, and how it is possible to foresee that we will enter in a new era of tourism indicators. Findings: A significant body of literature clearly demonstrates that tourism cannot be viewed simply from an economic point of view as it has a great influence on sociocultural and environmental dimensions. The impact of tourism and how to ensure its long-term success has been invoked for the last few decades, leading to the direct consideration of sustainability indicators in a wide array of scientific publications. However, despite significant advances, the lack of funding, lack of support or interest from the political community, bureaucracies or lack of methodological guidance and of technical skills along the entire value chain pose clear challenges to the development and adoption of wide data systems to support sustainable tourism policies. Originality/value: The paper sheds light on the Portuguese position regarding the recovery of the tourism sector in the aftermath of the COVID-19 pandemic. It also highlights the commitment to knowledge and monitoring of sustainability in tourism, articulated at international level, and how this is essential in order to make progress and to overcome the challenges facing the sector. At the same time, it demonstrates how fundamental it is to identify solutions to boost the potential of tourism as an economic, social, environmental and cultural phenomenon. © 2021, Emerald Publishing Limited.

COVID-19 predictability in Portugal using Google Trends

Background Infodemiology is a valuable public health tool which analyses internet sources and real-time data to establish populational trends, thus assisting disease surveillance. Google trends (GT) is a popular infodemiology source widely used in previous reports to study the correlation between internet relative search volume (RSV) and surges in various pathologies. This study aims to explore the association between GT and Covid-19 symptoms and to access the possibility of predicting new surges from internet searches. Methods Individual data was extracted from GT RSV on four main Covid-19 related symptoms in the Health category (fever, headache, cough and shortness of breath) in Portugal between 2020/03/02 and 2021/02/15, corresponding to each of the identified surges of daily new cases (DNC) in Portugal, retrieved from GitHub. Pearson's-correlation coefficient was used for assessment. Additionally, a 14 days time-lag correlation analysis between data for the same period of time was performed. Results Statistically significant correlations were found between ‘fever' web searches and the DNC in the first (p = 0.02) and third (p = 0.02) wave. No statistically significant correlations were found between any other variables. Through time lag analysis, we found a maximum Pearson association between web searches for ‘cough' and the DNC during the first wave at 14 days (r = 0.55), as well as during the third wave, with a maximum association at 3 days time lag (r = 0.55). Conclusions Monitoring behaviour and public interest in health related issues, such as crisis, is necessary and may help in the establishment of better and target oriented health policies. Despite previously stated potential, constraints such as the exclusion of social media platforms or internet users' representativeness, could partly explain our limited results for portuguese predictability of new COVID-19 surges. A better understanding of GT's algorithm may lead to more detailed and precise data. Key messages Monitoring behaviour and public interest in health related issues is necessary to establish better and more targeted health policies. Google trends seems to be an helpful infodemiology source, but doesn’t allow for full representation of the population and needs better understanding.

Tomographic Identification and Evaluation of Pulmonary Involvement Due to SARS-CoV-2 Infection Using Artificial Intelligence and Image Segmentation Technique

In 2019 coronavirus pandemic was required to find ways to further early diagnosis of COVID-19. This research aims to implement deep neural networks. Thus, we sought work to present analyses about the Deep Learning model, CNN, COVID-19 detection, and segmentation image. The training dataset to train the model we used exams the computerized tomography (CT scan) with dataset the Harvard Dataverse, available since May 2020, was used. The data were collected from the Public Hospital of the Government of the Employees of São Paulo (HSPM) and the Hospital Metropolitano da Lapa - São Paulo - Brazil. We applied it to four different architectures like VGG 19, Resnet 50, Inception, Xception. Each architecture has its advantages and disadvantages, and to supply the needs that each architecture presents, we generated ensembles among them. In general, the segmentation has shown that it is possible to capture regions with COVID-19 and differentiate them from other diseases. This study has pointed out the accuracy of 95.05% with a low false-positive rate for detection using computed tomography imaging. Thus, for automatic image renewal to show lung involvement, preliminary results translate into the lung and area affected by SARS-CoV-2. Future works can be done to improve our results, in particular, more databases may include detection of multiple disease cases such as pneumonia, bronchitis. Thus, it may be indicated more information to the classification result. © 2021, Springer Nature Switzerland AG.

VR training for critical tasks - assembling the INSPIRE emergency pulmonary ventilator for COVID-19 treatment

This paper describes a VR system designed to train health professionals and volunteers to properly assemble the replaceable pneumatic circuit of the Inspire emergency pulmonary ventilator. The simulator's primary goal is to internalize a mindful attitude in the trainee, as even minor mistakes may lead to disastrous consequences during the machine's operation, such as sequels and even patient death. The system was based on the state of the art of medical VR training and proposes innovative ways to communicate and demonstrate instructions, possible repercussions of mistakes, and feedback mechanisms to portray step completion and execution accuracy. The main challenge was dealing with standard VR systems' limitations, particularly the absence of force feedback.

Student's social vulnerability in distance learning in COVID-19 times

This work aims to analyze the social vulnerability of students in the disciplines taught in distance education in the context of the COVID-19 pandemic. This is a theoretical study, reflective analysis on the various issues of social vulnerability, focusing on how students experience distance learning within the social isolation obligation context. The following points are based on literature review with discussion: Distance learning as a realistic response on the fight against social isolation and social vulnerability, on higher education students, while aiming to avoid losing any semester topics. As a result, it is important to highlight the student's requirements in terms of preparation with information and communication technologies and, especially, those in a situation of social vulnerability who do not have all the necessary resources to access contents taught in this teaching modality, at a distance. There must be a perception of diversity, accessibility and the principles of inclusion so that the demands of students in situations of social vulnerability can be met in an equitable way. © Proceedings of the 14th IADIS International Conference e-Learning 2020, EL 2020 - Part of the 14th Multi Conference on Computer Science and Information Systems, MCCSIS 2020. All rights reserved.

COVID-19 symptoms: a case-control study, Portugal, March-April 2020.

COVID-19, although a respiratory illness, has been clinically associated with non-respiratory symptoms. We conducted a negative case-control study to identify the symptoms associated with SARS-CoV-2-positive results in Portugal. Twelve symptoms and signs included in the clinical notification of COVID-19 were selected as predictors, and the dependent variable was the RT-PCR test result. The χ2 tests were used to compare notified cases on sex, age group, health region and presence of comorbidities. The best-fit prediction model was selected using a backward stepwise method with an unconditional logistic regression. General and gastrointestinal symptoms were strongly associated with a positive test (P < 0.001). In this sense, the inclusion of general symptoms such as myalgia, headache and fatigue, as well as diarrhoea, together with actual clinical criteria for suspected cases, already updated and included in COVID-19 case definition, can lead to increased identification of cases and represent an effective strength for transmission control.

Evaluate manuscripts or digital assignments fairly and easily

The aim of this article is to present an online assessment system for tasks/papers and/or handwritten or digital exams. Initially teachers or students scan and load the work on the platform. The teachers then classify the work and distribute the results using the web-based platform. The system in question is optimized for three fundamental dimensions: speed, consistency and flexibility. The primary innovation that allows improvements in the three dimensions is a dynamic and efficient evolution for each question in the assessment. This system, which has been in existence for four years, used by professors from numerous institutions has led to an increase in the number of users confined due to the COVID-19 pandemic. Results are presented as data reported by users to the system as feedback on the time saved in carrying out the task of correcting/classifying. The use of this system also pleased the students, both in terms of carrying out assignments/evaluations, and in terms of disclosure of classifications. Teachers contacted in a system questionnaire indicated saving 30% or more compared to the traditional workflow. The authors also found the classification uniform to an individual response regardless of the number of teachers to be in charge of corrected. © 2020 Owner/Author.

Manage of a peritoneal dialysis unit during the COVID-19 pandemic

Background: Peritoneal Dialysis (PD) patients are special, as they are mainly independent in a “life-support technique” but susceptible to various potential complications related. This pandemic brought new challenges and PD Units had to be reorganized considering their specific population, human and material resources. We aimed to understand the impact of our restructuration and discuss some lessons learned. Methods: We retrospectively reviewed the activity and intercurrences at our Unit during the COVID-19 state of emergency declared by our Government, from 19th March to 2nd May (6 weeks), and compared it to the correspondent past two years (table 1). In a normal period, most of our patients are evaluated in a monthly basis. Simple descriptive and Student's paired T-test analysis were performed. Results: We managed 34 patients in the correspondent period of 2018, 36 in 2019 and 38 in 2020. Clinical appointments in this 2020 period were realized by phone. Necessary dislocations to the Unit in 2020 included peritonitis, exit-site infections and catheter malfunctioning. No dropouts occurred. There were no positive cases of COVID-19. Student's paired T-test analysis between 2020 and 2019, plus 2020 and 2018, showed no statistically significant differences in every evaluated phenomenon (except for nonpresential appointments;this discrepancy is justified by the Unit's dynamic, without clinical implications). Conclusions: Despite the restructuring, we were able to provide more teleassistance and the mean of complications/hospital admissions weren't statically worse. Some activities were postponed, but its true impact isn't yet clear. Will suboptimal care bring long-term complications? Nonetheless, PD technique stands out for favorably, mainly if all the necessary support from medical and nurse staff is guarantee.