What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39;p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136;p = 0.6), antibiotic therapy (57% versus 64%;p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%;p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5];p = 0.002) and presented a higher use of vasopressors (47% versus 36%;p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%;p < 0.001) at admission, prone positioning (45% versus 36%;p = 0.04), and hydroxychloroquine (59% versus 10%;p < 0.001) and lopinavir/ ritonavir (41% versus 10%;p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%;p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave. © 2023 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.

Institutional repositories and increased use in times of a pandemic: true image or mirage?

In 2021, because of the COVID-19 pandemic and restrictions on in-person access to libraries, the number of downloads, consultations, and access to digital collections increased. The University of Lisbon was no exception to this rule. In the present work we seek to find out if, after a decrease felt in previous years, there will be a gradual trend towards growth in access to digital information. Some authors refer that a more developed digital literacy allows more critical access to information sources. Is our institutional Repository already gaining the trust of the academic community, in order to constitute itself as a fundamental resource, or is this pandemic period nothing more than a momentary opportunity that, when it ends, will not consolidate the evolution of access to digital information? What actions and strategies have libraries been developing for their dissemination? How is the importance of the Repository communicated to researchers and students? This is the context for an exploratory study that leaves the future of institutional repositories open. To this end, given the data obtained from the platform usage statistics, a questionnaire survey is carried out to those responsible for the libraries of the 18 schools that make up the University of Lisbon, with a double objective: to understand the dissemination strategies that have been used with the academic community and to evaluate its integration in the routines of study and research. Based on the results, we seek to observe what clues are left for us to improve the visibility of the institutional repository, to consolidate its use.

Older people's social representations of their social isolation during the COVID-19 pandemic

Background: Isolation is adopted worldwide during the different phases of the pandemic in an at-tempt to flatten the contagion curve and protect vulnerable groups. Objective: To discuss the social representations of older people about their social isolation during the COVID-19 pandemic. Methodology: Qualitative research based on the structural approach of social representations. 117 elderly people who sought immunization for influenza in a Brazilian Basic Health Unit in 2020 par-ticipated. Sociodemographic data and evocation technique were collected. Prototypical analysis was carried out after lexicographic, semantic reconciliation and co-occurrence testing in the EVOC and Iramuteq software. Results: The representations were aimed at “distancing” and anchored in the justifications “neces-sary-safe, make-possible, stay-home, limit-exit, danger-disease and prevention” that reflected the process of building social representations. Conclusion: The representations were objectified by distancing and anchored in the expressed justifications necessary-safe, make-possible, stay-at-home, limit-out, danger-disease and prevention, which reflected the process of construction of representations in a knowable perspective. © 2022, Escola Superior de Enfermagem de Coimbra. All rights reserved.

Guillain-Barré syndrome associated with SARS-CoV-2 infection

Introduction: Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy characterized by flaccid, areflexic, ascending and symmetrical paralysis, which may have an infectious origin. It has recently been associated with COVID-19. Case presentation: Two pediatric patients with GBS and in whom COVID-19 was diagnosed by PCR are described. In both patients, the diagnosis of GBS was confirmed by neuroconduction studies. Both received treatment with immunoglobulin and had complete resolution of the neurological symptoms. Conclusions: Given that GBS can occur in pediatric patients with COVID-19, both conditions should be suspected in patients with clinical data similar to the cases reported here.

COVID-19: how did the pandemic influence the quality of medical students' sleep?

Introduction: Sleep is considered a cyclical physiological state due to the alternation between sleep and wakefulness that occur in most living beings. It is characterized by five fundamental stages and the total or partial absence of quality nighttime sleep can cause sleep and wake disorders, which are related to damage to the health of the population. Relating the theme to medical students, it is known that this population experiences, since college, the reality of a few hours to sleep and rest. Also, by associating this issue in the current context of COVID-19, it is possible that the quality of sleep in this population has changed. Objective: To identify the prevalence of the occurrence of Sleep Disorders and associated factors among medical students from a higher education institution in the forest region of Minas Gerais. Methods: The research, with a cross-sectional design, was conducted online through a semi-structured questionnaire with social, personal, demographic variables and also using the Epworth Sleepiness Scale and the Pittsburg Sleep Quality Index. Results: Of the total of 340 academics invited to participate in the study, 63.8% participated in the survey. 41% of the participants stated that they had a sleep duration per night of less than six hours and in relation to the usual sleep efficiency, 50.7% certified that they have an efficacy of less than 84%, evidencing a high frequency of sleep disorders (94, 9%). Also regarding the analysis of the Pittsburg Scale for Assessment of Sleep Quality, comparing cycles (basic, clinical and internship), 14% of students in the basic cycle need to use medication to sleep 3 or more times a week, as opposed to 7% denounced by the analysis of both the clinical cycle and the internship. About 40% of basic cycle students, 22% of clinical cycle students and 4% of boarding students reported having daytime dysfunction 5 to 6 days a week, such as difficulty staying awake and focused on their daily activities, in as a result of disturbed nights of sleep. As for the Epworth sleepiness scale, only 31.7% of the sample had normal sleep and in 44% of students an abnormal (pathological) sleepiness was identified. Conclusion: It is concluded that the perception of poor sleep quality was high for all years of the medical graduation course. Regarding the comparison of course phases, students in the early years (basic cycle group) reported worse sleep quality and greater daytime dysfunction.

The COVID - 19 pandemic's impact on the behavioral trends in the use of printed book or e-book: a case study in Portugal and Brazil

In a time of serious health crisis worldwide, this study is the extension of a case study already started (in February and March 2020) about the issue, reading behaviors, and preferences between the use of books and e-books. The COVID-19 pandemic came to impose social distancing in the world, closing universities, schools, and other services. The implementation of Internet services has presented itself as a valid response to the change that has so brutally arisen. Naturally, everyone had to adapt to it. In this context, the question about the preferences in using books or e-books is now even more relevant. This paper analyses the impact of COVID-19 in the behavioral trends in the use of scientific information from printed books and e-books in Portugal and Brazil. To this end, a survey was conducted on a user sample from various Portuguese and Brazilian higher education schools and public libraries. The first part focused on the characterization of the respondents, which includes data on gender and qualifications attended. In the second part, we obtained viewpoints about the advantages and disadvantages of each medium, frequency of use, choice of medium according to the purpose of reading, and devices used. The results let us examine the factors that influence and change the behaviors of users concerning their choice. Research such as this is beneficial to support the decision not only in selecting the information resources to be bought or pondering user preferences, but also to define strategies for advocating the use of various media that, rather than competitors, should be complimentary.

Consumer fear and healthy eating during COVID-19 pandemic

Purpose This study aims to contribute to the healthy eating literature by analyzing whether fear of coronavirus disease 2019 (COVID-19), ability to prepare food and the safety-seeking are antecedents of the intention to consume healthy foods during COVID-19 pandemic. Design/methodology/approach The authors conducted two studies. The first study was done with a sample of 546 valid respondents. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to analyze data. The second study was qualitative, in which 40 subjects took part. Data were analyzed using thematic analysis. Findings The main findings reveal that ability to prepare food and the safety-seeking are strong antecedents of the intention to consume healthy foods. In addition, safety-seeking mediates the relationship between fear of COVID-19 and intention to consume healthy eating. However, high levels of fear did not influence the ability to prepare food and intention to consume healthy foods. Also, the ability to prepare food does not mediate the relation between fear of COVID-19 and intention to consume healthy food. Originality/value This study is among the first to consider terror management propositions to analyze the intention to consume healthy foods during COVID-19 pandemic. From a scientific point of view, it has several contributions to the literature. First, this study provides advances and innovation in the field by identifying new explanatory relations. Second, this study extends the scope of terror management health model (TMHM) by analyzing it in the pandemic context. Third, the findings seem to provide empirical support for recent criticism of TMHM assumptions. Moreover, practical implications are outlined to public health decision-makers and healthy food businesses on increasing consumers' intention to healthy eating.

The role of diagnostic radiological imaging in combating COVID-19

Introduction: Diagnostic imaging has played a key role in the Covid-19 frontline, because its diagnostic imaging exams allow the medical team to evaluate the structures affected by the virus.

Anaesthetic approach in pregnants infected with COVID-19 in a tertiary maternity

Background and AimsThe authors analyse the anaesthetic approach in pregnants infected (PI) with COVID-19 admitted in a tertiary maternity (TM) during 12 months. They report and compare data from three-month period and data from not infected pregnants (NIP).MethodsDescriptive and retrospective observational study, with no need to ethical approval according to local committee. Data from a sample of 2288 pregnants (April 1,2020 – March 31,2021). Variables and their associations were analysed with statistical tests using the SPSS tool.Results2.8% of pregnants were infected with COVID-19. 11% of these were admitted in the 1st quarter, 2% in 2nd, 29% in 3rd and 58% in 4th.The anaesthetic approach was, with statistically significant, different between PI and PNI(p<,001). Use of neuraxial labour analgesia/anaesthesia in PI increased (42,9% -1st vs 65,8% -4th). General anaesthesia decreased (10,5% -1st vs 5,3% -4th). Comparing deliveries, there was a statistically significant difference(p=0.01): 38% of births were caesarean section (CS) in PI vs 23% in PNI. In PI there was a decrease of 8,7% in CS between the 1st and 4th quarter. The need for emergency surgery (ES) had statistically significant difference(p=0.02), 26.2% of ES in PI vs 15.1% in PNI. In PI there was no statistically significant difference(p>0,05) when comparing the occurrence of ES in the different quarters.ConclusionsAn increase of neuraxial labour analgesia/anaesthesia and decrease in GA was verified, despite the higher percentage of ES in PI. This can be related to increase in experience and knowledge, demostrating that neuraxial thecniques are safe/recommended in pregnants infected with COVID-19.

Playing with Escape Room Games for Children: An online experience at home in times of pandemic

The research shows how, in the Covid-19 pandemic, Escape Room games can be used with a child to develop perception, logical thinking and cooperative work. Guidance on BNCC skills and gamification elements were used to evaluate the applications of games in a case study. Eight digital games with children's themes were used in apps or online and later a physical Escape was built at the residence, based on the experience with the digital games. It is concluded that adult-child collaboration is essential to develop BNCC skills and that new physical versions of play can be richer, with new themes and components. © 2021 AISTI.

COVID-19, FISCAL FEDERALISM AND THE CITIES' FINANCIAL CRISIS

The cooperative federalism present in the 1988 Constitution is the most recommended model for the containment of the pandemic caused by COVID-19. In this structure, the Federal Union has fundamental action as coordinator of policies at the national level. However, in the opposite direction, the Brazilian federal government has led us to a non-cooperative and conflictive federalism. In front of this scenario of pandemia and interfederative conflicts, the cities are the most vulnerable entities technically and financially, however they were extremely demanded, in special face to the federal inaction, to take necessary and urgent measures to minimize the economic, social and health effects provoked by the sanitary crisis. The present research, of exploratory bias, tried to make a literature review - based on the legal doctrine and interdisciplinary studies launched mostly during the pandemic - about the financial situation of the municipalities previously and during the pandemic, with the purpose to relate it to the weakening of the cooperative federalism and the degree of social vulnerability of these cities, in order to verify if it is possible to identify them as possible factors that contributed to the lack of control of COVID-19 in Brazil. It was concluded that, based on the theoretical basis adopted, it is possible to associate these factors to the high rate of contamination and deaths in the pandemic.

The importance of compulsory notification in the face of the Severe Acute Respiratory Syndrome (SARS) and the novel coronavirus

Introduction: In 2020, the WHO declared a Public Health Emergency of International Concern due to the advancement of COVID-19 disease. As it is a new virus whose details are not yet very known, it is essential to observe both previous pandemic and epidemic scenarios together with the applied strategies, especially concerning monitoring the evolution of cases and escalation of contagions. Objectives: To understand the impact and importance of rapid and efficient notification through e-SUS Notifica and RNDS (National Health Data Network) to health professionals.

Pediatric anesthesia techniques during the COVID-19 pandemic

The pediatric population is a contagion fuel for SARS CoV-2, putting health care workers at risk. Exposure to respiratory droplets and aerosols are a major cause of disease transmission during airway procedures. Crying, coughing, laryngospasm, airway obstruction and hypoxia, which are more frequent in children than adults, directly or indirectly increase aerosol production and hence the risk of transmission to health workers. We present recommendations for the perioperative management of children suspected or confirmed positive for COVID-19, with the aim of reducing the risk of infection in these patients and in the healthcare team.

Distance learning in nursing training: Reflections on the COVID-19 pandemic

Objective: to reflect on the use of distance learning in nursing graduate programs in Brazil in the scenario of the COVID-19 pandemic. Method: critical essay through reflections anchored in the literature about the use of distance learning in the training of nurses and circumscriptors resulting from the pandemic. Results: discussions on the use of distance learning in nursing education in Brazil respond to different educational, professional, political and economic interests. In the context of the COVID-19 pandemic, since 2020, such debates have been intensified due to the use of distance learning methodologies in the continuity of many training courses, once exclusively in person. Conclusion: although the methodologies of distance learning allow, at first, the continuity of the training processes in nursing, it is reaffirmed that teaching-learning for health care demands proximity and contact. © 2020 Universidade Federal da Bahia. All rights reserved.

Prosthodontic practice during the COVID-19 pandemic: prevention and implications

The objective of this review is to identify preventive measures for COVID-19 to safeguard dental professionals providing prosthodontic dental care. Electronic searches were performed in PubMed, Scopus, and Cochrane databases using the following descriptors and/or words: "COVID-19," "SARS-CoV-2," "Dental practice," "Prosthodontics," and "Dental infection control." Prosthodontists are at high risk for exposure to the novel coronavirus through aerosols and possibly contaminated surfaces and indirect contact with dental laboratories and dental technicians through impressions, dental stone casts, and fixed and removable prosthetic appliances. Therefore, preventive measures should be implemented, including performing emergency treatments only, rescheduling patients with suspected disease, disinfecting surfaces and prosthodontic materials with biocidal substances, and using protective equipment such as N95 masks, disposable gowns, and face-shields.