Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

Objective: To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. Methods: This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. Results: We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98;95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62;95%CI 0.72 - 3.44). Conclusion: Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.

DEATHS DUE TO COVID-19 AMONG BRAZILIAN NURSING WORKERS: A CROSS-SECTIONAL STUDY

Objective: to analyze deaths due to COVID-19 in Brazilian Nursing professionals, with confirmed diagnoses of the disease and in quarantine, hospitalized or deceased, at the Federal Nursing Council Observatory. Method: a cross-sectional study conducted in Brazil between March 2020 and August 2021, via the Federal Nursing Council Observatory. The data were analyzed using descriptive and inferential statistics. Results: the prevalence of death due to COVID-19 in Brazilian Nursing professionals was 2.5% (825/32,560) and 4.9% (109/2,224) in nursing assistants, these latter with a higher mean age (p<0.0001). Although 84.5% (27,508/32,560) of the sample was female, the percentage of deaths was higher in the male gender, with 5.2% (263/5,052) (p<0.0001). The logistic regression analysis showed that gender and professional category can predict deaths due to COVID-19 among Brazilian Nursing workers. Conclusion: the study contributes to evidencing the risks faced by the professional category in coping with COVID-19, as well as to rethinking measures to reduce the harms imposed by the pandemic on this population segment. © 2022, Universidade Federal do Parana. All rights reserved.

Repercussions of infodemia associated with COVID-19 on the mental health of the elderly in Brazil

The phenomenon called infodemia refers to the increase in the volume of information on a specific topic, which multiplies rapidly in a short period of time, and has stood out in the context of the health crisis triggered by the COVID-19 pandemic. Too much information can trigger feelings of fear, anxiety, stress, and other conditions of mental distress. The study aims to describe the profile of exposure to information about COVID-19 and its repercussions on the mental health of elderly Brazilians. This is a cross-sectional study carried out with 1924 elderly Brazilians. Data were collected through a web-based survey sent to the elderly via social networks and email, from July to October 2020. The results of the descriptive analysis of the data show that most of the elderly were aged between 60 and 69 years (69.02%), female (71.26%), married (53.79%) and white (75.57%). About 21.67% (n = 417) concluded their graduation, 19.75% (380) concluded their specialization and 16.63% (320) concluded their master's or doctoral degrees. Television 862 (44.80%) and social networks 651 (33.84%) were reported as frequent sources of exposure to news or information about COVID-19. Participants indicated that television (46.47%;n = 872), social networks (30.81%;n = 575) and radio (14.48%;251) affected them psychologically and/or physically. Receiving fake news about COVID-19 on television (n = 482;19.8%) and on social media (n = 415;21.5%) mainly resulted in stress and fear. The disseminated information contributes to awareness, but also affects physically and/or psychologically many elderly people, mainly generating fear and stress. © 2022, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

Competition policy's role in the economic recovery process from the Covid-19 pandemic crisis-insight from UNCTAD

The COVID-19 pandemic outbreak disrupted markets and had a serious negative impact in economies across the world. Competition Authorities were at the forefront of initial public response measures through strong law enforcement and active market monitoring actions, temporary exemptions from competition provisions, merger control procedural adjustments and advocacy, an increasingly important function vis-a-vis Governments and all relevant stakeholders. Competition law and policy have therefore remained highly relevant during this period in both developed and developing countries. Current common challenges faced are raised by the increased digitalization of the economy and the dominance of digital platforms, especially considering the number and market share of micro and Small and Medium Sized enterprises (SMEs), the most seriously affected by the pandemic lockdown measures. Several jurisdictions and international organizations are equipping themselves with new legislation and instruments to address these challenges, namely supporting SMEs fair access to digital markets and promoting competitive public procurement, but less experienced and resource-constrained authorities of developing countries must prioritize otherwise. Competition advocacy is now more than ever a priority for them so that the economic recovery packages preserver open, fair, and equitable markets. International cooperation, bringing together developed and developing countries authorities, provides a crucial framework of support especially at this time. UNCTAD is particularly well placed to support developing countries' Competition Authorities contributions to "building back better" in times of crisis.

COVID-19 vaccination in pediatric age-what do parents know and think?

Background: Vaccination against COVID-19 in pediatric age has been a hot topic recently. This study aimed to assess parents' intention to vaccinate their children against COVID-19 and identify which factors may influence this decision. Methods: An observational study was conducted between June and July 2021 by applying an anonymous questionnaire to a sample of caregivers of children and adolescents followed in ambulatory care in a Portuguese central hospital. We included sociodemographic data, immunization history, personal background, exposure to COVID-19 and caregivers' beliefs. At the time of the study, there was still no official recommendation from health authorities regarding vaccination in pediatric age. Results: A total of 78 questionnaires were conducted. The mean age of the children was 9.2 years (±5.9), 56.4% were male, 94.8% had an updated immunization history, and 65.8% had extra vaccines. Of these children, 22.1% had comorbidities. Among the caregivers, 83.3% were mothers, the mean age was 39.4 years (±9.4), and 26.9% had attended university. The vaccine was considered safe by 61.5%, and 34.6% answered they did not know whether to consider it safe or not. Information about the vaccine was obtained through television in 84.6%, social networks in 42.3% and 34.6% in the information given by health professionals. Regarding the intention to vaccinate their children, 76.9% answered "yes", 7.7% did not answer and 15.4% answered "no". The vaccine's ineffectiveness (n=5) and inappropriate age (n=3) were the most cited reasons not to vaccinate. In 82.9%, the number of doses of the vaccine would not influence the decision. Conclusions: The study results show that caregivers have considerable resistance to the vaccination of children and adolescents against COVID-19, mainly based on the belief in the vaccine's ineffectiveness. The majority obtained information about the vaccine in the media, which reinforces the importance and the opportunity for intervention by transmitting credible and perceptible information in these media.

Palliative care amidst the COVID-19 pandemic: challenges and contributions

Objective: To analyze the scientific evidence on palliative care implementation amidst the COVID-19 pandemic. Method: This is a scoping review based on the methodology proposed by the Joanna Briggs Institute. Virtual Health Library, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, EBSCO, Embase, PsycInfo (R) and Science Direct were analyzed using the descriptors "palliative care" and "coronavirus" and the keyword "COVID-19". Thirty studies were selected for analysis. Results: This review showed strategies for palliative care implementation using protocols and telemedicine, to facilitate communication, and showed how palliative therapy approach has been, revealing the need to promote comfort and welcoming patients and family members in times of pain and grief. Conclusion: The palliative care principles contribute to comprehensive care, but its implementation amidst the crisis is a challenge. It is important to provide conditions to apply it in the daily life of health services, even in pandemic scenarios.

Mortality and survival of COVID-19.

This study aims to identify the risk factors associated with mortality and survival of COVID-19 cases in a state of the Brazilian Northeast. It is a historical cohort with a secondary database of 2070 people that presented flu-like symptoms, sought health assistance in the state and tested positive to COVID-19 until 14 April 2020, only moderate and severe cases were hospitalised. The main outcome was death as a binary variable (yes/no). It also investigated the main factors related to mortality and survival of the disease. Time since the beginning of symptoms until death/end of the survey (14 April 2020) was the time variable of this study. Mortality was analysed by robust Poisson regression, and survival by Kaplan-Meier and Cox regression. From the 2070 people that tested positive to COVID-19, 131 (6.3%) died and 1939 (93.7%) survived, the overall survival probability was 87.7% from the 24th day of infection. Mortality was enhanced by the variables: elderly (HR 3.6; 95% CI 2.3-5.8; P < 0.001), neurological diseases (HR 3.9; 95% CI 1.9-7.8; P < 0.001), pneumopathies (HR 2.6; 95% CI 1.4-4.7; P < 0.001) and cardiovascular diseases (HR 8.9; 95% CI 5.4-14.5; P < 0.001). In conclusion, mortality by COVID-19 in Ceará is similar to countries with a large number of cases of the disease, although deaths occur later. Elderly people and comorbidities presented a greater risk of death.

Rigid social isolation during COVID-19 pandemics in a state of brazilian northeast

Objective: This study aimed to analyze the temporal trend of incidence, mortality, coverage of wards and intensive care beds, and rigid social isolation in the Ceara State and correlate them. Methods: Ecological study, which outcome variable was the mortality rate. Predictors were incidence, occupation rate of bed wards and intensive care beds, and social isolation rate. It was performed a multiple linear regression considering significant when p<0.05. Results: It was observed an increasing trend of incidence and mortality by COVID-19 in the Ceara State (p = 0.01). On the other hand, it was seen a decreasing trend in the occupation of wards and intensive care beds (p = 0.02). The social isolation rate significantly decreased during the period (p = 0.001). In the multiple linear regression, social isolation remained inversely related to mortality by COVID-19 (beta = 0.08;p = 0,02). Conclusion: It was seen the effect of rigid social isolation during the COVID-19 pandemics. The anticipated implementation of it, with other public health actions, showed relevance to guarantee the continuity of its benefits.

Social vulnerability and COVID-19 incidence in a Brazilian metropolis

Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (beta=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (beta=1.40), and maximum per capita household income of the poorest fifth (beta=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.

Interprofessional work in health in the context of the COVID-19 pandemic: a scoping review Trabajo interprofesional en salud en el contexto de la pandemia del COVID-19: revision del alcance

Objective: to map the scientific production on interprofessional relationships in health in the first year of the COVID-19 pandemic. Method: this is a scoping review performed in PubMed, Scopus, LILACS, CINAHL, Web of Science, Google Scholar and Science Direct databases, covering the period of publication in 2020, using the acronym PCC (Population = health professionals;Concept = interprofessional relationships;Context = health services) and respective search strategies. Results: fourteen scientific articles were selected and the content discussed in the manuscripts was standardized, analyzed and organized into categories of affinities and similarities of their results: 1 - Interprofessional collaboration;2 - Collaborative practice;3 - Interprofessional work;4 - Interactive and interprofessional learning. Conclusion: the pandemic demanded quick and effective responses that were only possible through collaboration and interprofessionalism dimensions. Interprofessional work in health during the first year of the COVID-19 pandemic confirms the importance of interprofessional work and its dimensions for the provision of more comprehensive, resolute and safer health services.

Digital technologies in the care of people with diabetes during the COVID-19 pandemic: a scoping review

OBJECTIVE: To map evidence on the use of digital technologies in the care of people with diabetes during the COVID-19 pandemic. METHOD: This is a scoping review, based on the JBI manual, which included scientific articles and gray literature from nine primary and seven secondary databases. Articles were independently assessed by two reviewers. Rayyan® was used to select the studies. The description of study characterization is presented in a table and tables, ending in a narrative synthesis. RESULTS: A total of 1,964 studies were identified and, after selection, 23 publications remained for analysis. It turned out that telemedicine was used in all studies and remote consultation support technologies included continuous glucose monitoring devices, glucose data analysis software, insulin delivery systems, applications, audio and/or voice communication devices, which facilitated remote diabetes mellitus monitoring and management. CONCLUSION: Telehealth, monitoring technologies, insulin delivery systems and communication devices were tools used to monitor patients with diabetes during the pandemic.