Militarization in the Special Indigenous Health District of Maranhao: from the "announced disaster" to the epicenter of the pandemic

This case study used a historiographical methodology to investigate the trajectory and performance of the Special Indigenous Health District of Maranhao, having as a parameter what the National Policy for Health Care for Indigenous Peoples, still officially in force in 2021, recommended. It has the general context of health policies in successive federal governments as background. The period analyzed and discussed ranges from 2010 to 2021, covering: the crisis in the management of the National Health Care Policy for Indigenous Peoples, implemented by the National Health Foundation;the subsequent creation of the Special Secretariat for Indigenous Health and the transfer, to its scope, of the role of manager of this policy, in 2010;the challenges faced by the Special Secretariat for Indigenous Health in its first years of management, in the context of the political crises that led to the impeachment of President Dilma Rousseff and the administration of Michel Temer;the administration of Jair Messias Bolsonaro, with the consequent systematic attack on principles and guidelines inscribed in the 1988 Brazilian Constitution and the dismantling and/or sabotage of the National Health Care Policy for Indigenous Peoples;the advent of the covid-19 pandemic in this context and its specific impacts on the indigenous population, in Brazil and Maranhao, until 2021.

Ethical considerations on placebo-controlled vaccine trials in pregnant women

Placebo use in clinical trials, whenever a proven effective treatment exists, is one of the most debated topics in contemporary research ethics. This article addresses the ethical framework for placebo use in clinical trials assessing vaccine efficacy in pregnant women. Vaccine trial participants are healthy at the outset and some must be infected during the study to demonstrate the product's efficacy, meaning that placebo-treated participants are under risk of serious and irreversible harm. If effective vaccines exist, such risk precludes placebo use. This interdiction should be extended to any clinical trial of vaccine efficacy in pregnant women, because a demonstration of clinical efficacy in nonpregnant individuals and comparable immunogenic responses in pregnant women are predictors of efficacy in pregnancy as well. Moreover, product effectiveness in real-world use scenarios can be ascertained by observational studies conducted after its inclusion in vaccination campaigns. © 2023, Conselho Federal de Medicina. All rights reserved.

Perspective on Two Major Pandemics: Syphilis and COVID-19, a Scoping Review

The syphilis and COVID-19 pandemics have marked a turning point in the history of mankind. The aim of this review is to analyze what two pandemics caused by different diseases have in common. It is a scoping review made up of papers covering everything related to syphilis and COVID-19. The dialectical structural model of care (DSMC) is applied, focusing on three thematic plots that explain the historical and current context of the topic addressed. To this end, we compiled information from books, journals, and databases such as Cochrane, National Library of Spain, PubMed/Medline, Scielo, and Google Scholar. Syphilis is a bacterial disease transmitted sexually. COVID-19 is a viral infection transmitted by droplets. Despite their similarities and differences, both have triggered pandemics that have claimed the lives of thousands of people. Both still exist as active diseases. The origin of both remains a scientific enigma;many human and material resources have been devoted to tackling these two infections, and a wide range of drugs have been developed to combat them. © 2023 by the authors.

Severe Acute Liver Injury due to Secondary Hemophagocytic Lymphohistiocytosis: A Case Report

Severe acute liver injury (ALI) is mostly triggered by viral infections and hepatotoxic drugs;however, it can also be seen in systemic diseases. Hemophagocytic lymphohistiocytosis (HLH) is a rare, immune-mediated syndrome that presents as a life-threatening inflammatory disorder affecting multiple organs. Secondary causes occur mainly in the set of malignancy, infection, and autoimmune disease, and are seldom triggered by vaccination. Although liver involvement is common, presentation as severe ALI is rare. We describe a case of a 65-year-old male with history of low-risk chronic lymphocytic leukemia and rheumatoid arthritis treated with prednisolone who presented with persistent fever and jaundice 1 week after COVID-19 vaccination. The diagnosis was challenging given the predominant liver impairment, characterized by hyperbilirubinemia, transaminases over 1,000 U/L, and prolonged INR, which prompted an extensive investigation and exclusion of autoimmune, toxic, and viral causes of hepatitis. Laboratory workup revealed bicytopenia, hyperferritinemia, which together with organ failure and evidence of hemophagocytosis in bone marrow suggested the diagnosis of HLH. After excluding infectious etiologies, flare of rheumatological disease, and the progression of hematological disease, HLH was diagnosed. He was successfully treated with etoposide and corticosteroids, with dramatic improvement of liver tests. After exclusion of other causes of secondary HLH, the recent vaccination for COVID-19 was the likely trigger. We report a case of double rarity of HLH, as it presented with severe liver dysfunction which was probably triggered by vaccination. In this case, the predominant liver involvement urged extensive investigation of liver disease, so a high index of suspicion was required to make an early diagnosis. Clinicians should consider HLH in patients with unexplained signs and symptoms of systemic inflammatory response and multiorgan involvement, including severe liver involvement as the first presentation. © 2023 S. Karger AG. All rights reserved.

Universal access to vaccines in post-COVID bioeconomy: Redesign for variants of concern and patent protection

The new global eco-social and economic conditions, aggravated by extreme poverty, accelerated urbanization and intensification of populational mobility into disruptive ecological niches, have had a dramatic impact on the patterns of infectious disease emergence and transmission worldwide. These changing conditions, in spite of all alerts from scientists since the 1990s, have favored the emergence of pandemic or potentially pandemic diseases such as COVID-19 and their related variants. This scenario has been aggravated by the highly restricted global access to COVID-19 vaccine doses, with 75% of doses currently concentrated in just 10 developed countries and by the extremely low availability of the Active Pharmaceutical Ingredients (IFA) restricted to few manufacturers, mainly in 2 countries: India and China. This extreme concentration has been intensified by bans and restrictions to vaccine exports by several countries (United States, European Union and India). In this chapter the authors alert on the dramatic consequences of this extreme concentration scenario, since universal access to vaccines is the only way to achieve herd immunity from immunization. They also alert that probably COVID-19 will persist in seasonal outbreaks, in the same way as Influenza, requiring annual immunizations for vaccine and vaccine redesign for new variants, which supports the crucial importance of universal access to vaccines. This need for vaccine development and redesign will require, besides innovation strategies, an exponential increase in funding and novel incentives for vaccine innovation and development ("patent pools” and awards), supported by technological transfer agreements to developing countries' manufacturers. We discuss SARS-CoV-2 variants and nucleic acid COVID-19 vaccine technologies, examining applied patents in the world and BRICS' countries applications. © 2023 Elsevier Inc. All rights reserved.

Playing and Socializing—Adults' Perceptions of the FIFA Digital Game

Gamers' perceptions of using competitive digital games, especially concerning anxiety and socialization, have raised doubts about the benefits of playing such games. Since different studies highlight different results, this research aims to explore these differences by analyzing the perceptions of adults involved in playing a competitive digital game, in this case, FIFA, considering data that were collected during the COVID-19 pandemic period. The main question is ‘How do adults perceive anxiety, stress, and socialization when playing the FIFA digital game?'. The research comprises two studies involving volunteer participants: In the first part, which adopts a qualitative approach, the participants' perceptions of what they think and feel when playing FIFA were analyzed and interpreted using text mining analysis. In the second, a quantitative study, FIFA users' perceptions of the gaming experience were statistically analyzed. The results show that adult users tend to refer to positive perceived stress and socialization. The fact that participants identified manipulations and interference in the game and no longer allowed its use to influence their mood reveals that perceptions of attacks of rage were considered possible reactions to the use of the game, interpreted from the interface, and leading to the creation of knowledge. © 2022 by the authors.

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.

COVID-19 and the Challenges of Chemotherapy: The Failure Case of Hy-droxychloroquine in the Clinical Treatment of SARS-CoV-2 Infection

In December 2019, in Wuhan, China, an outbreak of a respiratory disease was reported, and the causative agent of which was discovered to be the new coronavirus. This disease spread rapidly around the world, and in March 2020, the WHO declared a state of pandemic. According to the WHO situation in October report, more than 41,570.883 were affected, and 1,134.940 deaths had occurred. Thus, the urgency to find therapeutic targets to prevent viral replication and a vaccine to protect against the disease became a great challenge for researchers around the world. A French group began using, in patients, a drug that had already been approved for human use, hy-droxychloroquine (HQ) alone or in combination with azithromycin. The use of a drug already approved by regulatory agencies can enable treatment strategies to be put in place rapidly;however, even though in vitro may indicate success, this is not always guaranteed. For HQ, some studies have shown a satisfactory response in patients, while in many others, the result was not positive and patients actually died. Furthermore, many adverse effects of HQ have been described. In this re-view, we will briefly discuss how this therapy became an option for the treatment of SARS-CoV-2 infection. We will address the use of HQ in different pathologies and COVID-19 specifically;de-scribing the doses used, as well as the main adverse effects. The take-home message is that more ef-forts are still required to conclude the efficacy of HQ against COVID-19, however, most of the studies carried out currently are showing that the use of HQ does not bring benefits during treatment of COVID-19.Copyright © 2021 Bentham Science Publishers.

The Extended Information Systems Success Measurement Model: e-Learning Perspective

This study investigated the crucial factors for measuring the success of the information system used in the e-learning process, considering the transformations in the work environment. This study was motivated by the changes caused by COVID-19 witnessed after the shift to fully online learning environments supported by e-learning systems, i.e., learning emphasized with information systems. Empirical research was conducted on a sample comprising teaching staff from two European universities: the University of Novi Sad, Faculty of Technical Sciences in Serbia and the Polytechnic Institute of Castelo Branco in Portugal. By synthesizing knowledge from review of the prior literature, supported by the findings of this study, the authors propose an Extended Information System Success Measurement Model—EISSMM. EISSMM underlines the importance of workforce agility, which includes the factors of proactivity, adaptability, and resistance to change, in the information system performance measurement model. The results of our research provide more extensive evidence and findings for scholars and practitioners that could support measuring information system success primarily in e-learning and other various contextual settings, highlighting the importance of people's responses to work environment changes. © 2023 by the authors.

SARS-CoV-2 spike variants differ in their allosteric response to linoleic acid.

The SARS-CoV-2 spike protein contains a functionally important fatty acid (FA) binding site, also found in some other coronaviruses (e.g. SARS-CoV and MERS-CoV), which binds linoleic acid. When occupied by linoleic acid, it reduces infectivity, by 'locking' the spike in a less infectious conformation. Here, we use dynamical-nonequilibrium molecular dynamics (D-NEMD) simulations to compare the response of spike variants to linoleic acid removal. D-NEMD simulations show that the FA site is coupled to other, some distant, functional regions of the protein, e.g. the receptor-binding motif, N-terminal domain, furin cleavage site, and regions surrounding the fusion peptide. D-NEMD simulations also identify the allosteric networks connecting the FA site to the functional regions. Comparison of the response of the wild-type spike with four variants (Alpha, Delta, Delta plus, and Omicron BA.1) shows that the variants differ significantly in their response to linoleic acid removal. The allosteric connections to the FA site on Alpha are generally similar to those on the wild-type protein, with the exception of the receptor-binding motif and the S71-R78 region, which show a weaker link to the FA site. In contrast, Omicron is the most affected variant exhibiting significant differences in the receptor-binding motif, N-terminal domain, V622-L629, and the furin cleavage site. These differences in allosteric modulation may be of functional relevance, potentially affecting transmissibility and virulence. Experimental comparison of the effects of linoleic acid on SARS-CoV-2 variants, including emerging variants, is warranted.

Teleconsultation in respiratory medicine - A position paper of the Portuguese Pulmonology Society.

The COVID-19 pandemic crisis, among so many social, economic and health problems, also brought new opportunities. The potential of telemedicine to improve health outcomes had already been recognised in the last decades, but the pandemic crisis has accelerated the digital revolution. In 2020, a rapid increase in the use of remote consultations occurred due to the need to reduce attendance and overcrowding in outpatient clinics. However, the benefit of their use extends beyond the pandemic crisis, as an important tool to improve both the efficiency and capacity of future healthcare systems. This article reviews the literature regarding telemedicine and teleconsultation standards and recommendations, collects opinions of Portuguese experts in respiratory medicine and provides guidance in teleconsultation practices for Pulmonologists.

2022 Annual World Congress of the Pulmonary Vascular Research Institute

Pulmonary hypertension (PH) is a severe disease that can progress to clinical decompensation, risk of hospitalization and death owing to disease-related or other diseases. In the context of coronavirus disease 2019 (COVID-19), PH was considered a risk factor for complications. The purpose of the study was to assess the mortality rate of COVID-19 in PH patients from a PH Center in Brazil. We conducted a telephone survey between June and August 2021 among all patients or relatives from the PH referral center who were followed after the first case of COVID- 19 in Brazil. Only patients with a confirmed diagnosis of PH were included in the analysis. Of the 426 patients followed in the first 18 months of the pandemic, 115 patients were excluded (lost to follow-up, post-acute PE or unconfirmed PH). Among 311 patients included, 39 had a confirmed diagnosis of COVID-19 (COVID-19 + ), and 38.5% of patients were hospitalized. The estimated incidence rate was 12.5%. Comparing the COVID-19+ versus patients without infection (COVID-19 - ) in the period, the mean age was similar (55 +/- 17 vs. 54 +/- 16 years) and the majority in the COVID-19+ group were female (85% vs. 69%, p = 0.039), respectively. There was no difference in the proportion of patients diagnosed with pulmonary arterial hypertension (PAH;49% and 42%) and chronic thromboembolic pulmonary hypertension (CTEPH;24% and 33%) between groups. All PAH patients and the majority of CTEPH patients were treated on specific therapy (combination/triple therapy, 70%). The case fatality rate in the PH-COVID-19+ group was 23%. Considering only PAH and CTEPH, the case fatality rate was 21,9%, while COVID-19 mortality was 2.9% and overall lethality in Brazil was 2.8%. In the COVID-19+ group, the mean pulmonary artery pressure was 48 +/- 14 mmHg, cardiac index 2.7 +/- 0.6 L/min/m2 and pulmonary vascular resistance 730 +/- 424 dyn.s/cm5. In conclusion, among PH patients there was high incidence and mortality from COVID-19, even in those with PHspecific therapy. Further studies are needed to evaluate the prognostic predictors in PH-COVID-19 patients.

PNAE and actions in the State of Rio de Janeiro during the pandemic

The COVID-19 pandemic brought impacts of several types, among them it affected the execution of the National School Feeding Program (PNAE), demanding adaptations of strategies and regulations for the continuity of food supply to Brazilian students enrolled in the public school network. This study aimed to recognize the strategies for implementing the PNAE in Rio de Janeiro (RJ), its limits and contributions to the promotion of Food and Nutritional Security for students from Rio de Janeiro, and to analyze the regulations related to the management of the program in the pandemic. A cross-sectional and descriptive study was carried out, with an online questionnaire being applied to the executing entities (EEx) of the PNAE in the state of RJ from March to July 2020. Most of the EEx continued the PNAE, adopting as a priority the delivery of food kits and the transfer of financial resources, carried out through intersectoral partnerships and with the participation of nutritionists, education workers and School Feeding Councils;however, sometimes violating the PNAE guidelines, regarding universality, equity and purchase of foodstuffs from family farming. It was concluded that many implementing entities did not fulfill or partially fulfilled the PNAE objectives in the first half of 2020, enhancing the high prevalence of food insecurity observed in the country.

Cartoons, acid visual document: a critical analysis of president Jair Bolsonaro's speech and covid-19

Objective: It discusses the cartoon as a document from a neodocumentalist perspective that examines the social, economic and political effects of Brazilian reality, especially in the speeches of President Jair Bolsonaro and Covid-19. Method: Qualitative in nature, the research combines documentary and bibliographic research, from the perspective of Critical Discourse Analysis (ACD) in which the cartoons in the newspapers were analyzed in Gazeta, O Liberal and Diário Catarinense and also sites such as Dom Total, Blog do Brito dos chargistas Carlos Britto, Jota Bosco, Amarildo, Duke and Zé Dassilva. Result: The cartoon was analyzed as a catalyst element of information that works with the conception of sharing visual and imagery information, as interdisciplinary forms that can be analyzed from the meanings attributed to them, therefore, an important source of social information to be thought of in IC. In the literature on IC, the cartoon is still considered as a material document and reduced to the technical treatment of information, which contributes greatly to the field of IC. Conclusions: In short, our analysis concluded that the cartoon is also a neodocument documentary evidence that represents information and that needs to be treated and stored for future research, as a type of symbolic information, which raises critical dialogues about time and memory. © 2023, Universidade Federal de Santa Catarina. All rights reserved.

Intergenerational Perspectives on Media and Fake News During Covid‐19: Results From Online Intergenerational Focus Groups

This article reflects on intergenerational perspectives on media habits and fake news during Covid‐19. Active participation is closely linked to the citizens' media literacy competencies. Due to the Covid‐19 pandemic, inequalities in access, use, and understanding of the information conveyed by the media became more evident. Digital skills are essential to encourage co‐learning and active ageing among different generations. This article relies on data collected during two online inter-generational focus groups with family pairs of different ages (grandparents and grandchildren) conducted in Portugal in the context of the European project SMaRT‐EU. The focus groups addressed subjects such as news, fake news, critical perspective towards social networks and digital communication, and younger and older people's perspectives regarding these matters. The thematic analysis of the Portuguese data suggests that, by placing grandparents and grandchildren side by side, the online intergenerational focus groups promoted sharing and exchange of knowledge, valuing the intergener-ational encounter and the voices of one of society's most fragile groups. Data also shows that participants have different perspectives on communication and digitally mediated interaction, mainly related to age factors and media literacy skills. As for fake news, although grandparents and grandchildren show awareness of the phenomenon, for the youngest participant it was complex to identify characteristics or the spaces where they are disseminated. The young adult participant was the most proficient and autonomous digital media user. Results further indicate that, although the online environment contributed to continuing research in times of pandemic, bringing together family members with different media literacy skills and ages poses difficulties related to the recruitment of participants. © 2022 by the author(s);licensee Cogitatio (Lisbon, Portugal). This article is licensed under a Creative Commons Attribution 4.0 International License (CC BY).

Covid-19 and its propagation dynamics in the urban network of Maranhão, Brazil

The present work aims to analyze the dynamics of the spread of covid-19 from the urban network of Maranhão. To this end, it establishes the relationship between the phenomenon and the provision of health services in the state. The period analyzed comprises one year of a pandemic, counting from the first recorded case. Data from the spatialization of medical specialties and medical-hospital equipment are considered, as well as information on viral evolution in this period, based on the number of cases and deaths. The main sources of data are the survey Regions of Influence of Cities 2018 (Regic 2018), by IBGE;the Datasus database, from the Ministry of Health;and the Secretary of State for Health of Maranhão. The results suggest that the spread of covid-19 in Maranhão has been triggered, to some extent, in a hierarchical way, following the centralities and polarizations of the main centers towards the smallest, based on the rarefied supply of health services in Maranhão. © 2022, Universidade Federal de Goias. All rights reserved.

Cartoons, acid visual document: a critical analysis of president Jair Bolsonaro's speech and covid-19

Objective: It discusses the cartoon as a document from a neodocumentalist perspective that examines the social, economic and political effects of Brazilian reality, especially in the speeches of President Jair Bolsonaro and Covid-19.Method: Qualitative in nature, the research combines documentary and bibliographic research, from the perspective of Critical Discourse Analysis (ACD) in which the cartoons in the newspapers were analyzed in Gazeta, O Liberal and Diario Catarinense and also sites such as Dom Total, Blog do Brito dos chargistas Carlos Britto, Jota Bosco, Amarildo, Duke and Ze Dassilva.Result: The cartoon was analyzed as a catalyst element of information that works with the conception of sharing visual and imagery information, as interdisciplinary forms that can be analyzed from the meanings attributed to them, therefore, an important source of social information to be thought of in IC. In the literature on IC, the cartoon is still considered as a material document and reduced to the technical treatment of information, which contributes greatly to the field of IC. Conclusions: In short, our analysis concluded that the cartoon is also a neodocument documentary evidence that represents information and that needs to be treated and stored for future research, as a type of symbolic information, which raises critical dialogues about time and memory.

Modeling the Geospatial Evolution of COVID-19 using Spatio-temporal Convolutional Sequence-to-sequence Neural Networks

Europe was hit hard by the COVID-19 pandemic and Portugal was severely affected, having suffered three waves in the first twelve months. Approximately between January 19th and February 5th 2021 Portugal was the country in the world with the largest incidence rate, with 14-day incidence rates per 100,000 inhabitants in excess of 1,000. Despite its importance, accurate prediction of the geospatial evolution of COVID-19 remains a challenge, since existing analytical methods fail to capture the complex dynamics that result from the contagion within a region and the spreading of the infection from infected neighboring regions. We use a previously developed methodology and official municipality level data from the Portuguese Directorate-General for Health (DGS), relative to the first twelve months of the pandemic, to compute an estimate of the incidence rate in each location of mainland Portugal. The resulting sequence of incidence rate maps was then used as a gold standard to test the effectiveness of different approaches in the prediction of the spatial-temporal evolution of the incidence rate. Four different methods were tested: a simple cell level autoregressive moving average (ARMA) model, a cell level vector autoregressive (VAR) model, a municipality-by-municipality compartmental SIRD model followed by direct block sequential simulation, and a new convolutional sequence-to-sequence neural network model based on the STConvS2S architecture. We conclude that the modified convolutional sequence-to-sequence neural network is the best performing method in this task, when compared with the ARMA, VAR, and SIRD models, as well as with the baseline ConvLSTM model.

Environmental evaluation of a prefab construction method employed to build the Evandro Chagas National Institute of Infectious Diseases

As a result of the global pandemic of Covid-19, there was a need to adjust to the sanitary tragedy that occurred during this time, which stimulated the construction of emergency support units to support the existing health system. In the study presented in this paper, the authors evaluate the potential environmental impacts of modular typologies through quantification and analysis of carbon emissions of a typical hospitalar module throughout its life cycle. A systematic Life Cycle Assessment analysis was carried out to quantify GHG emissions related to the construction of a module of the Evandro Chagas National Institute of Infectious Diseases in Brazil and understand the benefits of reuse and recycling processes by comparing a single-use scenario to a cradle-to-cradle approach. Another objective is to compare Polyisocyanurate (PIR), Expanded Polystyrene (EPS) and Rock wool when used as insulation, given that their thermal performance is similar but their density influences the impact rates. Overall, EPS panels present a better environmental performance while maintaining thermal comfort standards found in comparison to rock wool and PIR boards. Lastly, concrete for the slab was responsible for the highest emission rates of kg CO2eq/module year, followed by the rigid PIR foam and steel in the production and sanitary landfill disposal stages.