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Objectives: As of March 5th, 2022, around 1.585 cases of MIS-C and 98 deaths (6,4%) were reported in Brazil. The state of Rio de Janeiro State (RJ) having 94 cases (5,9%) and 4 deaths (4,2%)1.Our aim was to evaluate clinical and laboratory features, and management of MIS-C in seven pediatric hospitals in RJ, Brazil. Method(s): Multicenter, observational, ambidirectional cohort study in seven tertiary hospitals in RJ(Brazil), assessing medical charts of pediatric inpatients (0-18 years) diagnosed with MIS-C according to WHO/CDC criteria, from August, 2020 to February, 2022. Descriptive statistics were used to analyze distributions of continuous variables, frequencies, and proportions. Result(s): A total of 112 cases of MIS-C were enrolled. The mean age was 4.2 years and thre was male predominance (59,8%). All cases had a SARS-CoV-2 contact (29.5% close contact;31.3%:positive PCR;serology:43.8%).Only 12.5% had comorbidities. Length of stay (LOS) was 7 days.Median duration of fever was 8 days. Most common symptoms were: rash(67%);gastrointestinal (67%);conjunctivitis (42%);neurological(39.6%);cardiovascular(37.5%);cervical lymphadenopathy (36.6%), and shock/hypotension(28.6%).Co-infection occurred in 3 patients. Forty-four patients fulfilled criteria for Kawasaki disease. Most patients were admitted to PICU(12;62,5%) for amedian of 2 days. Respiratory distress was seen in 18,7%;hypotension:28,6%, and shock in 23,2%. Main laboratory findings were: high C-reactive protein in 95%;D-dimer:77%, anemia:77%, thrombocytosis:63%;transaminitis:43.8%, lymphopenia:38%;hypoalbuminemia:34%;thrombocytopenia: 29%;hypertriglyceridemia:28%, and high pro-BNP in 27%. Echocardiogram was performed in 91/112 patients;abnormal in 70,3%;exhibiting myocardial dysfunction( 25%);pericardial effusion(21%);coronary dilation/aneurysms(11%) and, valvulitis (14.5%). IVIG+corticosteroids (CTC) were administered in 59.8%(67/ 112);18.6%(18/112) IVIG only;10.7%(12/112) CTC only;3.4%(4/112)biologics, and 15(13.3%) received no treatment. ASA low dose in 77.7% (87/112) and moderate/high dose in 34.8%. Oxygen support was needed in 27,7%;vasoactive amines:18,7%;dialysis:5,3%, and transfusion:18,7%.One patient died from a cytokine storm syndrome. Conclusion(s): Our study reports a higher number of MIS-C cases in RJ than the number reported to Brazilian authorities, highlighting underreporting. Our patients were younger, had fewer comorbidities, cardiovascular/gastrointestinal/renal involvement, shortest LOS in ICU, and a higher frequency of myopericarditis.
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Background: At the global level, the dynamics of the COVID-19 pandemic have been driven by several epidemiological waves, determined by the emergence of new SARS-CoV-2 variants from the original viral lineage from Wuhan, China. While the SARS-CoV-2 dynamic has been described globally, there is a lack of data from Sub-Saharan African. Method(s): A laboratory-based survey was conducted in Cameroon, from March 1, 2020 to March 30, 2022, through an assessment of the evolutionary patterns of SARS-CoV-2 lineages across the four COVID-19 waves in the country. Data on full-length sequencing from all four sequencing laboratories were consecutively entered into the GISAID platform. These data were downloaded, and the molecular phylogeny of the SARS-CoV-2 sequences was performed using Nexstrain. The Mann-Whitney U test was used to calculate the correlation between the duration of each outbreak and the number of confirmed cases and between hospitalised cases and CFR, with a p value < 0.05 considered statistically significant. Result(s): A total of 3,881 samples were successfully processed, of which 38.9% (n=1,509) using PCR mutation assay, 41.5% (n=1,612) using targeted sequencing, and 19.6% (n=760) using whole-genome sequencing. The mean age of the study population was 36 years (min-max: 2-86), and 45% were within the age range 26-45. Regarding gender distribution, 50.9% were male, and 49.1% were female. Phylogenetic analysis of the 760 whole-genome sequences generated from March 2020 to March 2022 revealed that the greater proportion of SARS-CoV-2 circulating in Cameroon belonged to the viral sub-lineages of the original strain from Wuhan (74%), 15% Delta variant, 6% Omicron variant, 3% Alpha variant and 2% Beta variant.The pandemic was driven by SARS-CoV-2 lineages of origin in Wave 1 (16 weeks, 2.3% CFR), the Alpha and Beta variants in Wave 2 (21 weeks, 1.6% CFR), Delta variants in Wave 3 (11 weeks, 2.0% CFR), and Omicron variants in Wave 4 (8 weeks, 0.73% CFR), with a declining trend over time (p=0.01208). Conclusion(s): In a nutshell, the SARS-CoV-2 epidemic in Cameroon appears to have been driven by the SARS-CoV-2 lineage of origin in Wave 1, the cointroduction of the Alpha and Beta variants in Wave 2, the Delta variant in Wave 3, and the Omicron variant in Wave 4, with an overall declining trend in the wave duration, confirmed cases and hospitalisations over time.The SARS-CoV-2 lineage of origin and the Delta variant appeared to be the drivers of COVID-19 severity in Cameroon.
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Vaccines are an essential public health resource for disease containment and reduction of associated mortality rates. With the emergence of COVID-19, public debates on the themes of vaccines and vaccination processes became important topics on diverse media and social networking platforms. In this article, our objective was to identify and reflect on the emotions evoked in the Brazilian public with respect to the COVID-19 vaccine during 2020 and 2021 on Facebook. To achieve this, we used the Crowdtangle graphical interface to extract complete copies of posts made by public Facebook profiles during this timeframe, from which a random sample of 1,067 posts was selected for analysis. Identification of emotions was performed using the Human-Machine Interaction Network on Emotion (HUMAINE) descriptors as a baseline reference. Emotions were then grouped into categories following Core Affect Model guidelines. Data analysis and interpretation indicated a prevalence of positive emotions such as trust, interest, and hope directed toward vaccines in the Brazilian domestic scenario. Negative emotions such as worry and disapproval were also expressed, albeit in reference to contextual issues (for example, the spread of COVID-19, delays in vaccine access, and the emergence of new variants) and public figures, such as the President of Brazil. © COMUNICAR, 76 (2023-3)
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Recurrent disease outbreaks caused by a range of emerging and resurging pathogens over the past decade reveal major gaps in public health preparedness, detection, and response systems in Africa. Underlying causes of recurrent disease outbreaks include inadequacies in the detection of new infectious disease outbreaks in the community, in rapid pathogen identification, and in proactive surveillance systems. In sub-Saharan Africa, where 70% of zoonotic outbreaks occur, there remains the perennial risk of outbreaks of new or re-emerging pathogens for which no vaccines or treatments are available. As the Ebola virus disease, COVID-19, and mpox (formerly known as monkeypox) outbreaks highlight, a major paradigm shift is required to establish an effective infrastructure and common frameworks for preparedness and to prompt national and regional public health responses to mitigate the effects of future pandemics in Africa.Copyright © 2022 Elsevier Ltd
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During a pandemic, public discussion and decision-making may be required in face of limited evidence. Data-grounded analysis can support decision-makers in such contexts, contributing to inform public policies. We present an empirical analysis method based on regression modelling and hypotheses testing to assess events for the possibility of occurrence of superspreading contagion with geographically heterogeneous impacts. We demonstrate the method by evaluating the case of the May 1st, 2020 Demonstration in Lisbon, Portugal, on regional growth patterns of COVID-19 cases. The methodology enabled concluding that the counties associated with the change in the growth pattern were those where likely means of travel to the demonstration were chartered buses or private cars, rather than subway or trains. Consequently, superspreading was likely due to travelling to/from the event, not from participating in it. The method is straightforward, prescribing systematic steps. Its application to events subject to media controversy enables extracting well founded conclusions, contributing to informed public discussion and decision-making, within a short time frame of the event occurring. © 2023 by the authors.
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Introduction: Current literature on 1-minute sit-to-stand (1-STS) role in COVID-19 focuses on its ability to predict need for hospitalization or home discharge, but not Long COVID diagnosis where gaps in knowledge are recognized in NICE Long COVID guidelines. Aim(s): Assess 1-STS role in Long COVID definition. Method(s): Prospective ongoing cohort of post COVID-19 patients referred to body plethysmography at a university tertiary hospital. Result(s): Thirty-two patients were analyzed (53.1% male, mean 54 years-old), of whom 15 (46.9%) fulfilled Long COVID criteria. Of these, the most common symptoms were insomnia and/or excessive fatigue (n=8, 53.3%) and dyspnea (n=4, 26.7%). Long COVID patients had higher body mass index (29.7+/-6.0 vs 26.2+/-3.3Kg/m2;p=0.043). Patients with and without Long COVID were similar regarding age (p=0.827), hospitalization due to COVID-19 (p=0.811) or smoking history (p=0.234). Parameters of the 1-STS most associated with Long COVID were lower heart rate (HR) at 30' (89.1+/-14.0 in Long COVID vs 105.9+/-14.3bpm for no Long COVID criteria;p=0.002) and at 60' (99.3+/-24.0 vs 120.8+/-13.9bpm;p=0.004), as well as lower SpO at 60' (94.5+/-4.4 vs 97.1+/-1.6%;p=0.046). The parameter with the highest predictive power for Long COVID was HR at 60'(AUC=0.808;p=0.003), and when <80bpm revealed 90% sensitivity and 99% specificity in this study population. Decline of SpO during 1-STS was tendentially greater in those with Long COVID, yet without significance (-2.7+/-4.4 vs -0.8+/-1.4%;p=0.093). Conclusion(s): Lower final SpO and HR on 1-STS, as well as 30' HR, were associated with the occurrence of Long COVID. Final HR<80 bpm in a post COVID-19 setting might be the best 1-STS predictor of Long COVID.
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Purpose: This paper's main aim is to check the mediating effect of supply chain memory in the relationship between using digital technologies and both supply chain resilience and robustness. In addition, the impact of the COVID-19 disruption was tested as a moderator of the impact of supply chain memory on supply chain resilience and robustness. Design/methodology/approach: Altogether, 257 supply chain managers answered the questionnaire, and data were analysed through structural equation modelling. Findings: This paper contributes to theory and practice by demonstrating that the experience, familiarity and knowledge to deal with disruptions partially mediate the relationship between digital technologies, resilience and robustness. Moreover, our results show that memory is less efficient for the supply chain to maintain an acceptable level of performance in case of a new extreme disruptive event like COVID-19. The full model was able to explain 36.90% of supply chain memory, 41.58% of supply chain resilience and 46.21% of supply chain robustness. Originality/value: The study helps to understand how to develop supply chain memory, positioning digital technologies as an antecedent of it. The impact of supply chain memory on supply chain resilience and robustness is proved. Knowledge about the impact of industry 4.0 technologies on disruption management is quantitatively improved. It demonstrates that digital technologies impact resilience and robustness mainly through supply chain memory. The study proves that supply chain memory is less efficient for the chain remains effective when a non-routine disruptive event occurs, but it is still imperative to recover from it. © 2022, Emerald Publishing Limited.
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The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020 led to a significant change in human behaviors, mainly because of the quarantine to avoid the spread of the virus. Measures affected both economic activities and citizens' behaviors as they developed more intense hygiene habits to avoid contamination and switched to home offices. These exceptional behaviors also affected the way that water is consumed and need to be fully understood to manage supply systems. Therefore, this study aims to investigate changes in residential and commercial water consumption in 31 municipalities in the state of São Paulo, Brazil, during SARS-CoV-2. To do this, the expected consumption for the first half of 2020 was forecasted using the Holt-Winters multiplicative method and compared with the data observed for the same period. In addition, we compared monthly records of new contaminations and the social distancing index to establish a correlation with changes in water consumption. The results show an average difference between forecasted and observed consumption equal to +6.23% and -18.59% for residential and commercial activities, respectively. For the first one, the consumption per capita increased at the rate of 8.44 L.person-1.day-1. The observed changes in consumption seem to be a consequence of hygiene habits, social distancing and the closing of nonessential services in commerce. © 2022 American Society of Civil Engineers.
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The consumption of vegetables is essential for the population's quality of life, especially in a period of sanitary crisis caused by the new coronavirus. Thus, this study aimed to analyze the initial impact of the pandemic on vegetable consumption habits in Brazil, evaluating the relationship between monthly income and the main factors that guided consumers when purchasing vegetables in Brazil. With this purpose, at the beginning of the pandemic, a questionnaire was applied through GoogleR Forms, which was disseminated online through applications and social networks in the form of an opinion poll. Statistical analysis was performed using the chi-square test in order to verify the association of income with decision-making factors in the consumption of vegetables in Brazil. The results indicated that income shapes consumer behavior and exerts different impacts for certain vegetable crops. In addition, quality stood out as a more important factor than nutritional benefits when consumers were purchasing vegetables, even during the Covid-19 pandemic in Brazil.
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PURPOSE/INTRODUCTION: The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding. METHODS: A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017-2019), relative to the COVID-19 periods (2020). RESULTS: Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33-45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels. CONCLUSIONS: This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the "crisis" around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.
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COVID-19 , Osteoporosis , Alberta/epidemiology , COVID-19/epidemiology , COVID-19/therapy , Communicable Disease Control , Cross-Sectional Studies , Diphosphonates/therapeutic use , Humans , Osteoporosis/epidemiology , Osteoporosis/therapy , PandemicsABSTRACT
Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic. PURPOSE/INTRODUCTION: This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior. METHODS: A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017-2019) and COVID-19 restrictions periods (2020) were calculated. RESULTS: Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9-64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods. CONCLUSIONS: These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.
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COVID-19 , Hip Fractures , Osteoporotic Fractures , Aged , Alberta/epidemiology , COVID-19/epidemiology , Cross-Sectional Studies , Hip Fractures/epidemiology , Hospitals , Humans , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/surgery , Pandemics , Retrospective StudiesABSTRACT
With the suspension of presential classes due to Covid-19, Remote Learning was adopted, imposing obstacles to the teachers. Therefore, the objective of this research was to investigate how the work of teachers has developed during the pandemic of Covid-19. To fulfill this, a questionnaire to be answered by teachers in the area of Nature Science and Mathematics in basic education was prepared and shared through social networks, obtaining 43 responses. From these, it was concluded that the teachers are not sufficiently trained to act in processes mediated by digital resources, in addition to not believing that they receive the proper support from the institutions in which they work. They also question the effectiveness of their students' learning and assess their engagement. in remote activities as just regular. The results thus pointed to the precariousness of the profession and the need for investments in teachers.
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The finding of an exceptional situation, such as the need to combat a pandemic, has an effect on a number of social spheres, requiring a legal response that will securely regulate the relations arising from this new reality. The present work aims to identify legal responses under construction to adverse social issues, with a focus on limiting the circulation of people as a measure to combat the spread of the Covid-19 virus, and to analyze them with a focus on delimiting the competence for determining such measures, as well as the related criminal aspects. To this end, comparative jurisprudential, bibliographic and law research was used to identify the answers already available for these situations. It has been found that legal science lives sui generis moment, and that the impacts of the pandemic on law will be felt in the long term, leading to new and challenging interpretations of its institutes. © 2022, University of Passo Fundo. All rights reserved.
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The COVID-19 pandemic is one of the greatest challenges that humankind has faced in generations. It has already cost more than five million lives globally, sickened over 300 million people around the world, upended countless livelihoods, and caused substantial economic loss. Despite advances in the development and rollout of vaccines as well as in the clinical management of patients with COVID-19, the end of the worst public-health crisis in a century is not yet in sight as new variants that decrease the effectiveness of the public health interventions and vaccines continue to emerge. Since the beginning of the pandemic, there have been multiple SARS-CoV-2 variants across the world. The early COVID-19 pandemic was dominated by the D614G mutation, which was more transmissible. Over the past two years, several more variants have been identified with five becoming rapidly dominant within their countries and have raised concerns, including: Alpha (B.1.1.7/VOC-202012/01), Beta (501Y.V2/B.1.351), Gamma (P.1/B.1.1.28.1), Delta (B.1.617.2) and Omicron (B.1.1.529). This presentation reflects on the identification, through genomic surveillance, and public health response to variants of concern in South Africa with a particular focus on the Beta and Omicron variants that were first identified in the country. South Africa has experienced four distinct waves. The first was associated with a mix of SARS-CoV-2 lineages, while the second and third waves were driven by the Beta and Delta variants, respectively. The most recent wave was dominated by the Omicron variant. In November 2021, genomic surveillance teams in South Africa and Botswana detected a new SARS-CoV-2 variant associated with a rapid resurgence of infections in Gauteng Province, South Africa. Within three days of the first genome being uploaded, it was designated a variant of concern (Omicron) by the World Health Organization and, within three weeks, had been identified in 87 countries. The Omicron variant is exceptional for carrying over 30 mutations in the spike glycoprotein, predicted to influence antibody neutralization and spike function. The genomic profile, early transmission, and rapid spread of Omicron will be highlighted.
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This work presents the results of CAST (Causal Analysis using Systems Theory) application, technique initially created to understand the aerospace accidents root causes, to identify the main reasons that may have contributed to the considerable amount of human deaths caused by the Coronavirus pandemic in Brazil. Through the CAST process, it was possible to identify the dangers involved in safety control mechanisms related to the pandemic and its health implications, understanding the events that allowed this occurrence, identifying why the components related to the system's safety were not effective and, suggest mechanisms that reinforce safety controls at national and global levels, in order to avoid or mitigate similar losses related to pandemics in future events the steps established in the CAST structured approach, allowed to analyze the factors that contributed to the high number of human deaths, obtaining a greater amount of information and details, used in the elaboration of improvement proposals to face the problem, mainly with regard to the health system. © 2021 IEEE.
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Individual Income Tax is a type of tax, its table is progressive and has been considered one of the most important taxes in the country. Updating your table is essential to reverse the injustice caused by the tax system, since the beginning it does not follow the country's inflation, being updated according to the current law of each year, but the last update took place in 2015 and since then this outdatedness has been affecting the population, especially the middle class, implying that they have a higher purchasing power than their reality. In view of so many events that have emerged over these years, especially in 2020 with the Covid 19 pandemic, which required strict measures to reduce the spread of the virus, caused the modification in the table to be postponed once again, affecting especially those with lower income that should be exempt if it followed inflation, on the other hand, if updated, it will generate considerable losses for the country. This research presents the economic effects on the population caused by not updating the IR table, and how the gap affects them, also explaining what it will entail for the State if it is updated. For a better understanding of the subject, the concept, purpose and its history in Brazil will be discussed. With so many failures not only in the tax system, who always ends up bearing the consequences is the population, who often, because they are laypeople on the subject, end up ignoring the importance of updating the IRPF table.
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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted cardiovascular (CV) outcomes and care globally, although to date, limited data exist on the Canadian experience. This study aimed to describe trends in major adverse cardiovascular events (MACE)/procedures during the COVID-19 pandemic in the Province of Alberta, Canada. Methods: A repeated cross-sectional study design compared MACE from inpatient and emergency department visits among Albertan adults between March 15, 2019, and September 14, 2020. The Alberta population was 4.4 million in 2020 and all residents are part of a single payer healthcare system. The percent change between each MACE reported in the control (2019) and COVID-19 restriction periods (2020) were calculated. MACE were defined individually and as a primary composite outcome (CV death, acute coronary syndrome [ACS], ischemic stroke, or coronary revascularization procedures). These preliminary data are part of an ongoing study, measuring outcomes throughout the first year of the pandemic. Results: Compared to March-June 2019, primary MACE during the initial COVID-19 restriction period (March-June 2020) decreased by 15.6% (n=739 patients), and by 7.3% (n=342 patients) during June-September 2020, when COVID-19 restrictions were eased. Most individual MACE followed similar patterns with reduced reported events/procedures during the initial restriction period and an increase towards previous rates thereafter (Figure 1): CV death (17.7% vs 10.2%), ACS (19.1% vs 8.4%), coronary revascularization (17.0% vs 9.2%). The exception was ischemic stroke, which was not notably impacted by pandemic restrictions. Conclusions: Declines in MACE/procedures during the COVID-19 pandemic are suggestive of a substantial gap in patient management and healthcare-seeking behaviour that may have negative downstream implications. Ongoing analyses will further explore reported MACE up to one year after the pandemic began.