Integra Project: strengthening social participation in the agenda of health policies, services, and technologies. / Projeto Integra: fortalecimento da participação social na agenda das políticas, serviços e tecnologias em saúde.

The 16th National Health Conference illustrated the interest of health councils to intervene in public policies in order to guarantee the right to health technologies. The INTEGRA project (Integration of policies for Health Surveillance, Pharmaceutical Care, Science, Technology, and Innovation in Health) is a partnership among the National Health Council, the National School of Pharmacists, and the Oswaldo Cruz Foundation (Fiocruz), with support from the Pan American Health Organization (PAHO), with the goal of strengthening participation and social engagement in the theme, as well as the integration of health policies and practices within different sectors of society (social movements, health councils, and health professionals), with the various stages related to the access to medicines (research, incorporation, national production, and services) being the main theme in the context of the COVID-19 pandemic. It seeks to offer training for leadership groups in the health regions and activities with a broad national and political scope, and it hopes to establish an intersectorial and integrated network of leaders capable of acting collaboratively to defend the development of science, public policies, national sovereignty, and social control of health.

A 16ª Conferência Nacional de Saúde demonstrou o interesse do controle social em intervir sobre as políticas públicas a fim de garantir o direito às tecnologias de saúde. O projeto Integra - Integração das Políticas de Vigilância em Saúde, Assistência Farmacêutica, Ciência, Tecnologia e Inovação em Saúde -, nasce da parceria entre o Conselho Nacional de Saúde, a Escola Nacional dos Farmacêuticos e a Fundação Oswaldo Cruz (Fiocruz), com apoio da Organização Pan-Americana de Saúde (OPAS) com objetivo de fortalecimento da participação e engajamento social na temática e a integração das políticas e práticas de saúde em diferentes setores da sociedade (movimentos sociais, controle social e profissionais de saúde), tendo as diversas etapas relacionadas ao acesso aos medicamentos (pesquisa, incorporação, produção nacional e serviços) como mote principal, no cenário da pandemia de COVID-19. Oferta-se, neste projeto, capacitação para grupos de lideranças nas regiões de saúde e atividades de grande abrangência nacional e política. Espera-se alcançar o estabelecimento de uma rede intersetorial, integrada de lideranças capazes de atuar colaborativamente para a defesa do desenvolvimento da ciência, das políticas públicas, da soberania nacional e do controle social da saúde.

Chest physiotherapy techniques administered by certified specialists to hospitalized patients with COVID-19 in Brazil: A look towards future practice.

BACKGROUND: Chest physiotherapy for hospitalized patients with COVID-19 has been poorly reported. Although recommendations were published to guide physiotherapists, practice might have differed depending on education and training. OBJECTIVE: To analyze the differences in chest physiotherapy applied for hospitalized patients with COVID-19 between certified specialists and non-certified specialists. METHODS: An online questionnaire survey was developed for physiotherapists involved in the management of hospitalized patients with COVID-19. The questionnaire inquired about professional information and characteristics of physiotherapy practice. RESULTS: There were 485 respondents, yielding a completion rate of 76%. Of these, 61 were certified specialists and 424 non-certified specialists. The certified specialists were older, had more years of professional experience, were more qualified, and had better job conditions. For mechanically ventilated patients, the certified specialists used the ventilator hyperinflation maneuver more frequently (50.4% vs 35.1%, p = 0.005), and the hard/brief expiratory rib cage compression (ERCC) (26.9% vs 48.3%, p = 0.016), soft/long ERCC (25.2% vs 39.1%, p = 0.047), and manual chest compression-decompression (MCCD) maneuver (22.4% vs 35.6%, p = 0.001) less often. For spontaneously breathing patients, the certified specialists used the active cycle of breathing technique (30.8% vs 67.1%, p<0.001), autogenic drainage (7.7% vs 20.7%, p = 0.017), and MCCD maneuver (23.1% vs 41.4%, p = 0.018) less frequently. CONCLUSIONS: Certified specialists with higher levels of expertise seem to prefer the use of chest physiotherapy techniques that are applied with the mechanical ventilator over manual techniques. Furthermore, they use techniques that could potentially increase the work of breathing less frequently, mitigating the risk of exacerbating respiratory conditions in patients with COVID-19.

Mobile heath applications for self-management in chronic lung disease: a systematic review.

Integration of mobile health (mHealth) applications (apps) into chronic lung disease management is becoming increasingly popular. MHealth apps may support adoption of self-management behaviors to assist people in symptoms control and quality of life enhancement. However, mHealth apps' designs, features, and content are inconsistently reported, making it difficult to determine which were the effective components. Therefore, this review aims to summarize the characteristics and features of published mHealth apps for chronic lung diseases. A structured search strategy across five databases (CINAHL, Medline, Embase, Scopus and Cochrane) was performed. Randomized controlled trials investigating interactive mHealth apps in adults with chronic lung disease were included. Screening and full-text reviews were completed by three reviewers using Research Screener and Covidence. Data extraction followed the mHealth Index and Navigation Database (MIND) Evaluation Framework (https://mindapps.org/), a tool designed to help clinicians determine the best mHealth apps to address patients' needs. Over 90,000 articles were screened, with 16 papers included. Fifteen distinct apps were identified, 8 for chronic obstructive pulmonary disease (53%) and 7 for asthma (46%) self-management. Different resources informed app design approaches, accompanied with varying qualities and features across studies. Common reported features included symptom tracking, medication reminders, education, and clinical support. There was insufficient information to answer MIND questions regarding security and privacy, and only five apps had additional publications to support their clinical foundation. Current studies reported designs and features of self-management apps differently. These app design variations create challenges in determining their effectiveness and suitability for chronic lung disease self-management. Registration: PROSPERO (CRD42021260205). Supplementary Information: The online version contains supplementary material available at 10.1007/s13721-023-00419-0.

Features and characteristics of publicly available mHealth apps for self-management in chronic obstructive pulmonary disease.

Mobile health applications (mHealth apps) may be able to support people living with chronic obstructive pulmonary disease (COPD) to develop the appropriate skills and routines for adequate self-management. Given the wide variety of publicly available mHealth apps, it is important to be aware of their characteristics to optimize their use and mitigate potential harms. Objective: To report the characteristics and features of publicly available apps for COPD self-management. Methods: MHealth apps designed for patients' COPD self-management were searched in the Google Play and Apple app stores. Two reviewers trialed and assessed the eligible apps using the MHealth Index and Navigation Database framework to describe the characteristics, qualities, and features of mHealth apps across five domains. Results: From the Google Play and Apple stores, thirteen apps were identified and eligible for further evaluation. All thirteen apps were available for Android devices, but only seven were available for Apple devices. Most apps were developed by for-profit organizations (8/13), non-profit organizations (2/13), and unknown developers (3/13). Many apps had privacy policies (9/13), but only three apps described their security systems and two mentioned compliance with local health information and data usage laws. Education was the common app feature; additional features were medication reminders, symptom tracking, journaling, and action planning. None provided clinical evidence to support their use. Conclusions: Publicly available COPD apps vary in their designs, features, and overall quality. These apps lack evidence to support their clinical use and cannot be recommended at this time.

Anti-tumor necrosis factor therapy is associated with attenuated humoral response to SARS-COV-2 vaccines in patients with inflammatory bowel disease.

BACKGROUND: Immunosuppressive therapy used in the treatment of inflammatory bowel disease (IBD) is known to reduce vaccine immunogenicity. AIMS: This study aimed to 1) predict the humoral response elicited by SARS-CoV-2 vaccination in IBD patients based on their ongoing treatment and other relevant patient and vaccine characteristics and 2) assess the humoral response to a booster dose of mRNA vaccine. METHODS: We conducted a prospective study in adult IBD patients. Anti-spike (S) IgG antibodies were measured after initial vaccination and again after one booster dose. A multiple linear regression model was created to predict anti-S antibody titer following initial complete vaccination in different therapeutic groups (no immunosuppression, anti-TNF, immunomodulators and combination therapy). A two-tailed Wilcoxon test for two dependent groups was performed to compare anti-S values before and after the booster dose. RESULTS: Our study included 198 IBD patients. The multiple linear regression identified anti-TNF and combination therapy (versus no immunosuppression), current smoking, viral vector (versus mRNA) vaccine and interval between vaccination and anti-S measurement as statistically significant predictors of the log anti-S antibody levels (p < 0.001). No statistically significant differences were found between no immunosuppression and immunomodulators (p = 0.349) and between anti-TNF and combination therapy (p = 0.997). Statistically significant differences for anti-S antibody titer before and after the booster dose of mRNA SARS-CoV-2 vaccine were found, both for non-anti-TNF and anti-TNF groups. CONCLUSIONS: Anti-TNF treatment (either alone or in combination therapy) is associated with lower anti-S antibody levels. Booster mRNA doses seem to increase anti-S both in non-anti-TNF and anti-TNF treated patients. Special attention should be paid to this group of patients when planning vaccination schemes.

The implications of social withdrawal on the psychosocial health of the elderly in times of pandemic / As implicações do distanciamento social à saúde psicossocial do idoso em tempos de pandemia / Las implicaciones del distanciamiento social en la salud psicosocial de los ancianos en tiempos de pandemia

O objetivo deste trabalho foi analisar os efeitos do distanciamento social à saúde psicossocial da pessoa idosa no período da pandemia da COVID-19. Metodologia: Estudo revisão integrativa, realizado entre abril e Setembro de 2022, documentos dispo- nível como artigos científicos; ano de publicação 2020 a 2022. Os critérios de exclusão foram artigos de revisão, arquivos do tipo dissertação e teses. A pesquisa incluiu 47 do- cumentos; posteriormente foi realizada leitura crítica e reflexiva dos assim, estabeleceu- se a amostra de 11 artigos. Resultados e Discussão: Mediante todas as medidas tomadas para conter a pandemia, o distanciamento social é a estratégia até então mais eficiente para evitar a disseminação do vírus. Entretanto, as evidências mostram que o mesmo pode trazer prejuízos de natureza psicológica e psicossomática à população, principalmente à população idosa, que é um dos grupos de risco para contágio da doença. Além disso, pode provocar hábitos como o sedentarismo e inatividade física, condições que também são atreladas ao desenvolvimento de doenças físicas, mentais e, consequentemente, ao risco de morte em populações vulneráveis. Conclusão: Trata-se de um fenômeno social com- plexo e que exige atenção das entidades prestadoras de serviço à comunidade idosa, assim como os gestores e familiares. Desse modo, as linhas de cuidado devem se basear nas respostas em rede, que realizam esforços intersetoriais que envolvem políticas públicas de saúde, apoio do estado, assistência social, seguridade e justiça em ação das proteções de direitos, instituídos no Estatuto do Idoso.

The objective of this work was to analyze the effects of social distancing on the psychosocial health of the elderly during the COVID-19 pandemic. Methodology: Integrative review study, carried out between April and September 2022, documents available as scientific articles; year of publication 2020 to 2022. Exclusion criteria were review articles, dissertation and theses type files. The research included 47 documents; later, a critical and reflective reading of the articles was carried out, thus, a sample of 11 articles was established. Results and Discussion: Through all the measures taken to contain the pandemic, social distancing is the most efficient strategy so far to prevent the spread of the virus. However, evidence shows that it can bring psychological and psychosomatic damage to the population, especially the elderly population, which is one of the risk groups for contagion of the disease. In addition, it can cause habits such as physical inactivity and physical inactivity, conditions that are also linked to the development of physical and mental illnesses and, consequently, to the risk of death in vulnerable populations. Conclusion: It is a complex social phenomenon that requires attention from entities providing services to the elderly community, as well as managers and family members. In this way, the lines of care must be based on network responses, which carry out intersectoral efforts that involve public health policies, state support, social assistance, security and justice in action of the protections of rights, established in the Statute of the Elderly.

El objetivo de este trabajo fue analizar los efectos del distanciamiento social en la salud psicosocial de los ancianos durante la pandemia de COVID-19. Metodología: Estudio de revisión integradora, realizado entre abril y septiembre de 2022, documentos disponibles como artículos científicos; año de publicación 2020 a 2022. Los criterios de exclusión fueron artículos de revisión, archivos tipo disertación y tesis. La investigación incluyó 47 documentos; posteriormente, se realizó una lectura crítica y reflexiva de los artículos, así, se estableció una muestra de 11 artículos. Resultados y Discusión: A través de todas las medidas tomadas para contener la pandemia, el distanciamiento social es la estrategia más eficiente hasta el momento para prevenir la propagación del virus. Sin em- bargo, la evidencia muestra que puede traer daños psicológicos y psicosomáticos a la población, especialmente a la población anciana, que es uno de los grupos de riesgo de contagio de la enfermedad. Además, puede provocar hábitos como la inactividad física y el sedentarismo, condiciones que también están relacionadas con el desarrollo de enfer- medades físicas y mentales y, en consecuencia, con el riesgo de muerte en poblaciones vulnerables. Conclusiones: Se trata de un fenómeno social complejo que requiere atención por parte de las entidades prestadoras de servicios a la comunidad de adultos mayores, así como de los gestores y familiares. De esta forma, las líneas de atención deben basarse en respuestas en red, que realicen esfuerzos intersectoriales que involucren políticas públicas de salud, apoyo estatal, asistencia social, seguridad y justicia en acción de las protecciones de derechos, establecidas en el Estatuto del Anciano.

Effectiveness of Using the FreeStyle Libre® System for Monitoring Blood Glucose during the COVID-19 Pandemic in Diabetic Individuals: Systematic Review.

BACKGROUND: Artificial Intelligence (AI) is an area of computer science/engineering that is aiming to spread technological systems. The COVID-19 pandemic caused economic and public health turbulence around the world. Among the many possibilities for using AI in the medical field is FreeStyle Libre® (FSL), which uses a disposable sensor inserted into the user's arm, and a touchscreen device/reader is used to scan and retrieve other continuous monitoring of glucose (CMG) readings. The aim of this systematic review is to summarize the effectiveness of FSL blood glucose monitoring during the COVID-19 pandemic. METHODS: This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and was registered in the international prospective register of systematic reviews (PROSPERO: CRD42022340562). The inclusion criteria considered studies involving the use of the FSL device during the COVID-19 pandemic and published in English. No publication date restrictions were set. The exclusion criteria were abstracts, systematic reviews, studies with patients with other diseases, monitoring with other equipment, patients with COVID-19, and bariatrics patients. Seven databases were searched (PubMed, Scopus, Embase, Web of Science, Scielo, PEDro and Cochrane Library). The ACROBAT-NRSI tool (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies) was used to evaluate the risk of bias in the selected articles. RESULTS: A total of 113 articles were found. Sixty-four were excluded because they were duplicates, 39 were excluded after reading the titles and abstracts, and twenty articles were considered for full reading. Of the 10 articles analyzed, four articles were excluded because they did not meet the inclusion criteria. Thus, six articles were included in the current systematic review. It was observed that among the selected articles, only two were classified as having serious risk of bias. It was shown that FSL had a positive impact on glycemic control and on reducing the number of individuals with hypoglycemia. CONCLUSION: The findings suggest that the implementation of FSL during COVID-19 confinement in this population can be confidently stated to have been effective in diabetes mellitus patients.

Cough Assessment and Management in Pulmonary Rehabilitation- A Canadian Survey.

Pulmonary rehabilitation is a cornerstone intervention for controlling respiratory symptoms in people with chronic respiratory diseases. Chronic cough affects up to 90% of people with chronic respiratory diseases, however, it is currently unknown whether chronic cough is assessed and/or managed in pulmonary rehabilitation. This study aimed to determine if and how chronic cough is assessed and managed in pulmonary rehabilitation. This was a cross-sectional study. Pulmonary rehabilitation programs in Canada were identified via online websites. A representative from each program was invited to complete an online survey including the following topics: program demographics, assessment and management practices, and barriers and facilitators. Of 133 programs contacted, 31 returned a completed survey (23% response rate). Approximately half (52%) of respondents reported enrolling patients with chronic cough. Of those, 45% reported assessing and 62% reported intervening in chronic cough. Inadequate knowledge of assessment and management techniques was commonly identified to be a barrier and increased education was suggested as a possible facilitator. Based on pulmonary rehabilitation programs that responded to our survey, chronic cough is a prevalent symptom; however, it is scarcely assessed and managed. A need for structured education and the use of standardised strategies were reported as facilitators to the assessment and management of chronic cough in pulmonary rehabilitation.

Dynamics for the containment of COVID-19 transmission in a city in the interior of Amazonas State / Dinâmica para contenção da transmissão da COVID-19 em um município do interior do Amazonas / Dinámica de contención de la transmisión del COVID-19 en interior del Amazonas

Problema: A pandemia da COVID-19 causada pelo novo coronavírus (SARS-CoV-2) tornou-se um dos maiores desafios de saúde pública deste século. Método: Trata-se de um estudo do tipo relato de experiência, realizado por alunos finalistas dos cursos de Medicina, Enfermagem e Odontologia da Universidade do Estado do Amazonas (UEA), na disciplina de "Estágio rural em saúde coletiva", no município de Itapiranga, estado do Amazonas. A experiência que deu origem a este relato ocorreu nos meses de agosto e setembro de 2020. Resultados: Os alunos foram inseridos nas equipes de saúde da família do município, com as quais desenvolveram atividades como visitas domiciliares, ações educativas em saúde, testes rápidos para COVID-19, visitas a comunidades ribeirinhas, consultas e atendimentos de enfermagem, medicina e odontologia. As medidas de prevenção da COVID-19 no município começaram com a orientação dos profissionais de saúde para o manejo da doença. Uso de máscaras, isolamento social e fechamento do comércio foram algumas providências adotas após o primeiro caso confirmado do vírus, ocorrido no dia 21 de abril de 2020. Foi realizada testagem em massa na população para a detecção dos casos sintomáticos e assintomáticos. Além disso, foram contratados mais profissionais de saúde como médicos, enfermeiros, psicólogos, técnicos de enfermagem e fisioterapeutas a fim de reforçar a equipe de saúde. Conclusão: O estágio rural em saúde coletiva na cidade de Itapiranga representou uma oportunidade ímpar de interação entre os discentes e as equipes de saúde do município, além da possibilidade de se ter uma visão mais ampla da funcionalidade da atenção primária à saúde, principalmente em período pandêmico, quando esse nível de atenção se mostrou tão importante para o diagnóstico precoce da doença quanto para a efetividade das medidas de contenção.

Problem: The COVID-19-CoV pandemic caused by the novel coronavirus (SARS-CoV-2) has become one of the greatest public health challenges of this century. Method: This was an experience report study carried out by final-year students in medicine, nursing and dentistry at Amazonas State University (Universidade do Estado do Amazonas, UEA), in the discipline of "Rural Internship in Collective Health," in the municipality of Itapiranga, state of Amazonas. The experience that prompted the students' report took place in August and September of 2020. Results: The students were included in the municipality's family health teams, with which they developed activities such as visits to riverside communities, consultations, and nursing, medical and dental care. COVID-19 prevention measures in the municipality were implemented with the guidance of health professionals in the management of the disease. The use of masks, social distancing and closing of shops were some measures adopted after the first confirmed case of the virus, which occurred on April 21, 2020. Mass testing was carried out in the population to detect symptomatic and asymptomatic cases. In addition, more health professionals including physicians, nurses, psychologists and nursing technicians were hired to reinforce the health team. Conclusion: The Rural Internship in Collective Health in Itapiranga represented a unique opportunity for interaction between students and the health teams in the municipality, and made it possible for students to have a broader view of the functioning of primary health care, especially in a pandemic period, when the level of care proved to be as important for early diagnosis of the disease as for the effectiveness of containment measures.

Problema: La pandemia de Covid-19-CoV causada por el nuevo coronavirus (SAR-2)S se ha convertido en uno de los mayores desafíos de salud pública de este siglo. Método: Se trata de un estudio de relato de experiencia, realizado por estudiantes del último año de las carreras de medicina, enfermería y odontología de la Universidade do Estado do Amazonas (UEA), en el curso de internado rural en salud colectiva, en el municipio de Itapiranga, estado de Amazonas. Resultados: La experiencia que dio origen a la salud de los estudiantes no ocurrió el 20/09/19, visitas a comunidades ribereñas, enfermería, consultas y consultas médicas y odontológicas. Se implementaron medidas de prevención del Covid-19 en el municipio con la orientación de profesionales para el manejo de la enfermedad. Uso de mascarillas, aislamiento social y cierre de comercios fueron algunas de las medidas adoptadas tras el primer caso confirmado del virus, ocurrido el 21 de abril de 2020. Se realizaron testeos masivos en la población para detectar síntomas sintomáticos. Además, se contrataron profesionales de la salud como médicos, enfermeros, psicólogos y técnicos de enfermería para fortalecer el equipo de salud. Conclusión: La pasantía de salud rural en el municipio de Itapiranga representa una oportunidad única de interacción entre los estudiantes y, como equipos de salud del municipio, la oportunidad de una visión más amplia de la funcionalidad de la atención primaria de salud, especialmente en un período de pandemia. La atención es igual de importante tanto para la atención de la enfermedad como para la alerta de medidas de contención.

Post-acute sequelae of COVID-19 is characterized by diminished peripheral CD8+ß7 integrin+ T cells and anti-SARS-CoV-2 IgA response.

Several millions of individuals are estimated to develop post-acute sequelae SARS-CoV-2 condition (PASC) that persists for months after infection. Here we evaluate the immune response in convalescent individuals with PASC compared to convalescent asymptomatic and uninfected participants, six months following their COVID-19 diagnosis. Both convalescent asymptomatic and PASC cases are characterised by higher CD8+ T cell percentages, however, the proportion of blood CD8+ T cells expressing the mucosal homing receptor ß7 is low in PASC patients. CD8 T cells show increased expression of PD-1, perforin and granzyme B in PASC, and the plasma levels of type I and type III (mucosal) interferons are elevated. The humoral response is characterized by higher levels of IgA against the N and S viral proteins, particularly in those individuals who had severe acute disease. Our results also show that consistently elevated levels of IL-6, IL-8/CXCL8 and IP-10/CXCL10 during acute disease increase the risk to develop PASC. In summary, our study indicates that PASC is defined by persisting immunological dysfunction as late as six months following SARS-CoV-2 infection, including alterations in mucosal immune parameters, redistribution of mucosal CD8+ß7Integrin+ T cells and IgA, indicative of potential viral persistence and mucosal involvement in the etiopathology of PASC.

What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care. / O que mudou entre os períodos de pico e de platô durante a primeira onda do SARS-CoV-2? Estudo multicêntrico português em unidades de cuidados intensivos.

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.

OBJETIVO: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. MÉTODOS: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. RESULTADOS: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). CONCLUSÃO: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

Piloting an interprofessional virtual cadaveric dissection course: Responding to COVID-19.

Interprofessional learning improves students' clinical and interprofessional competencies. COVID-19 prevented delivering in-person education and motivated the development of a virtual interprofessional cadaveric dissection (ICD) course. This study reports on the effects of a virtual ICD course compared to a previously delivered in-person course, on students' readiness for, and perceptions about, interprofessional learning. Students attending the ICD course in-person (2019-2020) or virtually (2020-2021) completed the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS). Students in the virtual course also provided written feedback. Thirty-two (24 women; Median: 24 [Q1-Q3: 22-25] years) and 23 students (18 women; 22 [21-23] years) attended the in-person and virtual courses, respectively. In the virtual cohort, the RIPLS total score (82 [76-87] vs. 85 [78-90]; p = 0.034) and the roles and responsibilities sub-score (11 [9-12] vs. 12 [11-13]; p = 0.001) improved significantly. In the in-person cohort, the roles and responsibilities sub-score improved significantly (12 [10-14] vs. 13 [11-14]; p = 0.017). No significant differences were observed between cohorts (p < 0.05). Themes identified in the qualitative analysis were advantages and positive experiences, competencies acquired, disadvantages and challenges, and preferences and suggestions. In-person and virtual ICD courses seem to have similar effects on students' interprofessional learning. However, students reported preferring the in-person setting for learning anatomy-dissection skills.

Social Media Use and Its Association with Mental Health and Internet Addiction among Portuguese Higher Education Students during COVID-19 Confinement.

The use of social media was one of the most common way to keep in touch with friends and family during confinement. For higher education students, the fact that their universities were closed was a major change in their lives. The aim of this study is to relate the prevalence and type of social media with Internet addiction and mental health of university students in a district of Portugal during COVID-19 confinement. Mental health was studied by applying the reduced version of the Mental Health Inventory (MHI-5) and to measure the Internet use and dependence, the Internet Addiction Test (IAT) was used. The study (cross-sectional, descriptive, and correlational) used an online questionnaire, conducted on Google® Forms and the link was sent to 4450 students, in the months of April to June 2020, during the confinement. A total of 329 valid questionnaires were obtained. We can conclude that regarding mental health, students in the 18-24 age group, single or divorced and who are not in a relationship, and with worse academic results, show worse levels of mental health. It is noteworthy that the students with the same characteristics also have the highest levels of addiction to internet.

The Impact of COVID-19 Confinement on Substance Use and Mental Health in Portuguese Higher Education Students.

The mental health of higher education students is a constant concern, and the pandemic situation caused by COVID-19 has intensified this concern. The social measures imposed to control and minimize the disease have led, among other things, to the reconfiguration of higher education students' academic life habits, which has naturally altered their emotional balance, mental health, and substance abuse. This cross-sectional, descriptive, and correlational study assesses the influence of higher education students' personal characteristics on their (self-reported) use of addictive substances (alcohol, tobacco, drugs, and pharmaceutical drugs) before and during their first compulsory confinement in Portugal, as well as its relationship with mental health. An online questionnaire was applied between 15 April and 20 May 2020, to students from various study cycles of higher education institutions in one region of Portugal (northern area of Alentejo), which included the Mental Health Inventory in its reduced version (MHI-5) and questions (constructed by the authors) on personal characterization and on the use of addictive substances before and during confinement. The convenience sample included 329 mostly female health care students between the ages of 18 and 24. In our results, we found a statistically significant decrease in tobacco, alcohol, and drug use; however, there was an increase in tobacco use among older students and an increase in anxiolytic use among students with higher academic achievement and among students who exhibited more active social behavior in the period prior to confinement. Students who took anxiolytics during confinement had higher MHI-5 scores and students who used the most addictive substances during confinement had lower MHI-5 scores than the other students.

Violence against Women during the COVID-19 Pandemic: From Children to the Elderly

Women of all ages can be exposed to violence both within and outside of the home, especially in the context of the COVID-19 pandemic. The purpose of this study is to analyze violence against women (VAW) before and during the first year of the pandemic in Portugal. Crimes perpetrated against female victims from 17 years old and younger to 65 years old and older were analyzed by comparing requests for help in 2019 and 2020. A total of 12,045 requests for help for VAW were received by the Portuguese Association for Victim Support and analyzed in the current study. The findings reveal a 16% increase in requests for help in 2020 and a 95% increase when the lockdown was implemented. That said, the most reported, intimate partner violence (IPV), showed a decrease of 5% in 2020. Furthermore, compared to 2019, requests for help concerning criminal offenses involving psychological violence in non-IPV contexts increased 79% in 2020, especially for victims 17 years old or younger (116%), and attempted femicide/femicide requests for help increased 53%. We are still in the early stages of understanding how the pandemic will affect this situation. Future directions concerning support of female victims during the pandemic are outlined.

Impacts of COVID-19 Pandemic on Sleep Quality Evaluated by Wrist Actigraphy: A Systematic Review.

COVID-19 has probably contributed as a risk factor for sleep disturbance. Actigraphy has been used to evaluate sleep complaints in self-isolated populations and frontline doctors during the COVID-19 pandemic. This systematic review aims to summarize the impact of the COVID-19 pandemic on sleep through wrist actigraphy, estimating sleep latency, total sleep time, awakening-after-sleep onset, and sleep efficiency. Searches were conducted of observational studies on the PubMed, Embase, Scopus, Web of Science, and PEDro databases from 1 December 2019 to 31 December 2022. Ninety articles were found, and given the eligibility criteria, fifteen were selected. Six studies were classified by the National Health and Medical Research Council as evidence level IV, two studies as level III-3, and seven studies as level III-2. According to the ACROBAT-NRSI instrument, three studies were classified as having a "serious" risk of bias, two as having "critical" risk, four as having "moderate" risk, and six as having "low" risk. In the selected publications, various populations were evaluated via actigraphy during the COVID-19 pandemic, with reports of "poor" sleep quality. Actigraphy may be a relevant tool to assess individual day-night rhythms and provide recommendations under enduring pandemic conditions. Moreover, as actigraphy presents objective data for sleep evaluations, it is suggested that this method be used in similar pandemics and that actigraphy be included as part of the sleep hygiene strategy.

Current knowledge on the presence, biodegradation, and toxicity of discarded face masks in the environment.

During the first year of the COVID-19 pandemic, facemasks became mandatory, with a great preference for disposable ones. However, the benefits of face masks for health safety are counteracted by the environmental burden related to their improper disposal. An unprecedented influx of disposable face masks entering the environment has been reported in the last two years of the pandemic, along with their implications in natural environments in terms of their biodegradability, released contaminants and ecotoxicological effects. This critical review addresses several aspects of the current literature regarding the (bio)degradation and (eco)toxicity of face masks related contaminants, identifying uncertainties and research needs that should be addressed in future studies. While it is indisputable that face mask contamination contributes to the already alarming plastic pollution, we are still far from determining its real environmental and ecotoxicological contribution to the issue. The paucity of studies on biodegradation and ecotoxicity of face masks and related contaminants, and the uncertainties and uncontrolled variables involved during experimental procedures, are compromising eventual comparison with conventional plastic debris. Studies on the abundance and composition of face mask-released contaminants (microplastics/fibres/ chemical compounds) under pre- and post-pandemic conditions should, therefore, be encouraged, along with (bio)degradation and ecotoxicity tests considering environmentally relevant settings. To achieve this, methodological strategies should be developed to overcome technical difficulties to quantify and characterise the smallest MPs and fibres, adsorbents, and leachates to increase the environmental relevancy of the experimental conditions.

High mobility group box 1, ATP, lipid mediators, and tissue factor are elevated in COVID-19 patients: HMGB1 as a biomarker of worst prognosis.

The severe acute respiratory syndrome coronavirus 2, the agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, has spread worldwide since it was first identified in November 2019 in Wuhan, China. Since then, progress in pathogenesis linked severity of this systemic disease to the hyperactivation of network of cytokine-driven pro-inflammatory cascades. Here, we aimed to identify molecular biomarkers of disease severity by measuring the serum levels of inflammatory mediators in a Brazilian cohort of patients with COVID-19 and healthy controls (HCs). Critically ill patients in the intensive care unit were defined as such by dependence on oxygen supplementation (93% intubated and 7% face mask), and computed tomography profiles showing ground-glass opacity pneumonia associated to and high levels of D-dimer. Our panel of mediators included HMGB1, ATP, tissue factor, PGE2 , LTB4 , and cys-LTs. Follow-up studies showed increased serum levels of every inflammatory mediator in patients with COVID-19 as compared to HCs. Originally acting as a transcription factor, HMGB1 acquires pro-inflammatory functions following secretion by activated leukocytes or necrotic tissues. Serum levels of HMGB1 were positively correlated with cys-LTs, D-dimer, aspartate aminotransferase, and alanine aminotransferase. Notably, the levels of the classical alarmin HMGB1 were higher in deceased patients, allowing their discrimination from patients that had been discharged at the early pulmonary and hyperinflammatory phase of COVID-19. In particular, we verified that HMGB1 levels above 125.4 ng/ml is the cutoff that distinguishes patients that are at higher risk of death. In conclusion, we propose the use of serum levels of HMGB1 as a biomarker of severe prognosis of COVID-19.