The impact of "the war that drags on" in Ukraine for the health of children and adolescents: Old problems in a new conflict?

The early months of 2022 have already included several distressing world events. From the ongoing COVID-19 pandemic, to protests against vaccine mandates and COVID-19 restrictions, to the Russian invasion of Ukraine. Escalating conflict in Ukraine poses an immediate and growing threat to the lives and well-being of the country's 7.5 million children. Humanitarian needs are multiplying - and spreading by the hour. Children have been killed. Children have been wounded. They are being profoundly traumatized by the violence all around them. Hundreds of thousands of people are on the move, and family members are becoming separated from their loved ones.

Domestic violence and suicide in India.

India has the highest number of suicides in the world. Indian men account for a quarter of global suicides, while Indian women account for 36% of all global suicides in the 15-39 age group. One suicide every 25 min. These are not isolated incidents. Mental health experts say that one of the main reasons for this situation is rampant domestic violence. India's official data are hugely underestimated and do not convey the true scale of the problem. Women from this country are responsible for 36% of global female suicide deaths. In a country like India, with its wide sociocultural variations, there can be multiple risk factors: hanging, pesticide consumption, drug overdose, and self-immolation. Access to these "lethal" resources is an important factor.

Anatomopathological Aspects and Clinical Correlation of COVID-19: A Systematic Review.

OBJECTIVE: The objective of this systematic review was to analyze the main morphofunctional changes in the involvement of multiple organs in patients infected with SARS-CoV-2, correlating anatomopathological findings with the clinical picture. METHODS: The present study selected articles through electronic search of indexed journals in the PubMed and SciVerse Scopus databases, from December 2019 to May 2020, using the keywords "autopsy," "pathogenicity," and "COVID-19." Two hundred nine articles were identified, and the full texts of 18 articles were reviewed, 5 of them being selected for this review. RESULTS: The ACE2 receptor plays a role in introducing viral material into the cell, having high expression in type II alveoli. Histopathological analyzes of the lungs of patients with COVID-19 show that SARS-CoV-2 produces, in this organ, in addition to an inflammatory process, a diffuse alveolar damage (DAD), which can cause acute respiratory distress syndrome (ARDS). Macroscopically, the lungs become heavier, firmer, and redder. The clinical features of these patients are variable; the most common are respiratory symptoms associated with fever, myalgia, or fatigue. CONCLUSION: The observations points to the consensus that the lungs are the main targets of COVID-19, with morphological and functional changes of interest, including important sequels, and presenting diffuse alveolar damage as a substrate for an unfavorable outcome with ARDS. Changes in micro and macroscopic levels corroborate to the clinical progression of the disease and that these alterations are not specific, which ratify, in addition to the anatomopathological examination, a need to use the association of clinical and epidemiological data for diagnostic confirmation.

COVID-19's Clinical-Pathological Evidence in Relation to Its Repercussion on the Central and Peripheral Nervous System.

INTRODUCTION: Although respiratory symptoms predominate in the disease caused by the SARS-Cov-2, the new coronavirus, the related neurological implications increase with numbers of new infected, requiring new tools and sufficient medical apparatus to improve the patients' prognosis. The purpose of this publication is based on the need to clarify the pathophysiological process of COVID-19 from a neurological perspective. The present study aims to review and describe the main neurological aspects associated with SARS-CoV-2, in addition to presenting proposals for conducting and managing these issues. METHODS: The MEDLINE (through PubMed) and Scopus databases were used for systematic research on the correlation between COVID-19 and the nervous system. The reference period were publications between May 2005 and July 2020. The temporal delimitation was based on the objective of elucidating the pathophysiology of neurological involvement seen in the current pandemic. Thus, in 2005, we found articles that reported different etiologies and mechanisms of action of the antiphospholipid syndrome, which helped to understand its current association with COVID-19. Other articles from years prior to the current one contributed, in the same sense of linking, with description of associated processes, in articles from 2020, the SARS-CoV-2 infection. The processes described in times before 2020 and currently correlated with cerebral dysfunction of COVID-19 were distribution of angiotensin II receptors in the brain, inflammation associated with the blood-brain barrier imbalance, and brain barrier function. "SARS-CoV-2 and complications," "neurology," "pathogeny of COVID-19," "stroke," and "encephalopathy" were terms included in the research. The relevance of the articles found was based on congruence with the search terms and on availability of the full text. RESULTS: Recent articles published reported mild neurological symptoms, with, for example, headache and anosmia as part of the set of common symptoms of COVID-19, highlighting the causal link between the disease and neurological complications that may exist during its evolution. It is still unknown whether the neurological clinical expression concomitant with the new coronavirus infection is a consequence or a coincidence. In order to properly treat and monitor these patients from the neurological point of view, it is essential, in times of pandemics, to suspect primary infection by SARS-Cov-2 and diagnose it to proceed with isolation and clinical support. CONCLUSION: The neurological implications of COVID-19 range from initial symptoms, such as headache, to serious complications, such as ischemic stroke. Although the pathogenesis of neurological phenomena requires further studies, targeted management of the patient is feasible, considering agility in recognizing the infection. Therefore, medical precaution and clinical reasoning are emphasized when providing services to the patient.

Epidemiology and Etiopathogeny of COVID-19.

Despite the recent announcement of the new pathogenic coronavirus to man, SARS-CoV2, a large number of publications are presented to the scientific community. An organized and systematic review of the epidemiological, etiological, and pathogenic factors of COVID-19 is presented. This is a systematic review using the databases MEDLINE, EMBASE, Web of Science, SCIELO; the descriptors coronavirus, SARS-CoV-2, etiology, epidemiology, pathophysiology, pathogenesis, COVID-19, with publications from December 2019 to January 2021, resulting in more than 800 publications and 210 selected. The data suggest that COVID-19 is associated with SAR-CoV-2 infection, with the transmission of contagion by fomites, salivary droplets, and other forms, such as vertical and fecal-oral. The bat and other vertebrates appear to be reservoirs and part of the transmission chain. The virus uses cell receptors to infect human cells, especially ACE2, like other coronaviruses. Heat shock proteins have different roles in the infection, sometimes facilitating it, sometimes participating in more severe conditions, when not serving as a therapeutic target. The available data allow us to conclude that COVID-19 is a pandemic viral disease, behaving as a challenge for public health worldwide, determining aggressive conditions with a high mortality rate in patients with risk factors, without treatment, but with the recent availability of the first vaccines.

Vaccination for COVID-19 in children: Denialism or misinformation?

In the current pandemic scenario, vaccines for children have been scientifically approved; however, there is a challenge faced globally: parents' hesitation about vaccinating their children for COVID-19, which can hamper adherence to vaccine campaigns. This issue is due to the lack of information or access to fake news that affects the parents' power of judgment. The experience of the vaccine process with Pfizer's immunizer in several countries successfully reduced the number of hospitalized and prevented hundreds of child deaths from COVID-19. All health professionals must encourage the vaccination of children from the age of 5, sharing reliable scientific data, thus reducing the spread of fake news.

Deaths announced in Brazil - A dark sweetness: COVID-19 among children and adolescents.

While the Ministry of Health of Brazil postpones the inclusion of children aged 5-12 years in the National Immunization Plan against COVID-19, current evidence highlights that the number of hospitalizations and deaths caused by COVID-19 in the pediatric population, of in general, including the group of children aged 5-11 years, it is not within acceptable levels. Unfortunately, child mortality and fatality rates in Brazil are among the highest in the world. In 2020, there were 1203 deaths from Severe Acute Respiratory Syndrome (SRAG). In 2021, there were 2293. Also 65 deaths were reported from Pediatric Multisystem Inflammatory Syndrome (P-SIM); an aggressive manifestation of the virus in children.

Impact of COVID-19 and its variants on indigenous Brazilian children.

The indigenous population has suffered from the impacts caused by Covid-19 since the beginning of the pandemic. Especially children, who live in a reality of extreme poverty, low level of education and precarious health services close to their communities. Health professionals must look closely at indigenous children so that they can help them deal with the impact that the pandemic has brought with it.

Reflections on early childhood education in the COVID-19 pandemic.

The COVID-19 pandemic is a complex and multifaceted event, and it is even argued that it should be seen as a syndemic and not a pandemic . Its impacts will still be felt over the years and, perhaps, are irreparable in some aspects. It is essential to mobilize Governments, civil society and non-governmental organizations to outline measures to combat school dropout and social inclusion.

Challenges to food safety for children and adolescents in Brazil.

Malnutrition increases the chance of cognitive delay, recurrent infections, micro and macronutrient deficiencies, stigmatization. According to the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria), more than half (58%) of Brazilian families with children and adolescents reported changes in eating habits in the same period. For 31%, there was an increase in consumption of processed foods such as chocolate, filled cookies, instant noodles, and canned foods. Therefore, despite food security being a human right contemplated in article 25 of the Universal Declaration of Human Rights and reiterated by article 6 of the Brazilian Federal Constitution in 2010, the country still has a long way to go. With the advent of the COVID-19 pandemic, there was a deepening of poverty, misery, and hunger in the country, which directly reflected on the income of families and placed children/adolescents in a situation of extreme vulnerability.

"Between the cross and the sword": Brazilian children face an influenza epidemic while still dealing with the COVID-19 pandemic.

The Influenza activity remained at inter-seasonal levels; however, influenza A(H3N2) detections continue to increase in Brazil, Chile, Paraguay, and Uruguay. Most of the activity and rising trend of A(H3N2) detections are recorded in Brazil. A bulletin issued by the Oswaldo Cruz Foundation (Fiocruz) reported significant presence of the influenza A virus, both in children and in the adult population, among cases of SARS-Cov-2.This situation is worrying, as vaccination campaigns were hampered by the COVID-19 pandemic.

COVID-19 and HIV among children and adolescents: Current inequalities.

The HIV epidemic enters its fifth decade amid a global pandemic. The increasing poverty, mental health problems, and abuse are raising the risk of infection for children, adolescents, and women. The inequalities driving the HIV epidemic, which are now exacerbated by COVID-19, demonstrate the social and clinical inequalities of more children infected with HIV and more children losing their fight against AIDS. In this context, current evidence highlights that, alarmingly, two out of five children living with HIV worldwide are unaware of their status, and just over half of children with HIV are receiving antiretroviral treatment. Discrimination and gender inequalities permeate significant situations in HIV services due to COVID-19 in early 2020 and throughout 2021. It was observed in recent studies substantial reductions in births in health facilities, maternal HIV testing, and initiation of antiretroviral treatment for HIV. An AIDS-free generation should be possible, but we are not there yet. HIV remains a burden.

Cemetery, tombstones, tears and hidden silences: Suicide in children and adolescents.

Recent studies have reported a deterioration in children's mental health since the onset of the COVID-19 pandemic, with an increase in anxiety and mood disorders leading to significant suicidal ideation and suicide rates. Suicide is complex, and individual tragedies and circumstances can diverge. Evidence suggests that the mental health and well-being of some children and youth were substantially affected because of and during the pandemic. Those with pre-existing mental health problems that experienced the most negative impacts compared to pre-pandemic data.

Psychiatric disorders in health professionals during the COVID-19 pandemic: A systematic review with meta-analysis.

INTRODUCTION: During the COVID-19 pandemic period, the structure of the Intensive Care Unit (ICU) activities changed fast. It was observed that the mental and physical health of the frontline workers reached levels of extreme clinical and psychological concern. OBJECTIVE: Understand the impact that COVID-19 is having on the front-line clinical team in the ICU environment, as well as reveal what proposals are being made to mitigate the clinical and psychological impacts that this group experiences. METHOD: A systematic review was made following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). We included any type of study on health workers during the COVID-19 pandemic, with results about their mental health. We were, therefore, interested in quantitative studies examining the prevalence of problems and effects of interventions, as well as qualitative studies examining experiences. We had no restrictions related to study design, methodological quality or language. RESULTS: Twenty-one studies reported on the urgent need for interventions to prevent or reduce mental health problems caused by COVID-19 among health professionals in ICU. Eleven studies demonstrated possibilities for interventions involving organizational adjustments in the ICU, particularly linked to emotional conflicts in the fight against COVID-19. CONCLUSION: The disproportion between the need for technological supplies of intensive care medicine and their scarcity promotes, among many factors, high rates of psychological distress. Anxiety, irritability, insomnia, fear and anguish were observed during the pandemic, probably related to extremely high workloads and the lack of personal protective equipment.

Psychological effects caused by the COVID-19 pandemic in health professionals: A systematic review with meta-analysis.

BACKGROUND: Psychological suffering by health professionals may be associated with the uncertainty of a safe workplace. Front-line professionals exposed and involved in the diagnosis and treatment of COVID-19 patients are more susceptible. METHOD: This review was conducted based on papers that were published at MEDLINE, BMJ, PsycINFO, and LILACS, the according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). RESULTS: Health professionals had a higher level of anxiety (13.0 vs. 8.5%, p < 0.01, OR = 1.6152; 95%CI 1.3283 to 1.9641; p < 0.0001) and depression 12.2 vs. 9.5%; p = 0.04; OR = 1.3246; 95%CI 1.0930 to 1.6053; p = 0.0042), besides somatizations and insomnia compared to professionals from other areas. CONCLUSION: Health professionals, regardless of their age, showed significant levels of mental disorders. We observed a prevalence of anxiety and depression. Insomnia was a risk factor for both.

Analysis of the prison population's mental health in Sars-Cov-2 pandemic: Qualitative analysis.

This study aimed to analyze the possible impacts on the prison population's mental health in the context of the new COVID-19 pandemic. Qualitative study was carried out following a lexical and content analysis using the software IRaMuTeQ, version 0.7 alpha 2, in the speech of the short communication and headlines from newspapers. Three groups emerged from the analysis: "spatial conditions for infection" (39.2% of the text segments); "disease outbreaks in prisons" (30,4%) and "public responsibility" (30,4%). Precarious conditions of prisons, high rate of infections and psychiatric illnesses, and lack of government assistance are issues that should be given special attention in order to formulate health promotion and prevention policies focusing on mental health in prison population.