ABSTRACT
On 30 June 2021, the European Commission proposed a new Directive on consumer credit (COM (2021) 347 final) which aims to modernise and strengthen, at European level, the protection of consumers who take out credits and which, if approved, will repeal the current Directive 2008/48/EC. Digitalisation has made it possible to disseminate new ways of acquiring credit, through online platforms, and has changed the way in which banks assess a consumer's creditworthiness, using automated decision-making systems and obtaining non-traditional data, both for obtaining credit and for purchasing goods or using services. The revision of the Directive is also the result of new developments brought about by the COVID-19 crisis. This article has the main objective of analysing the proposed Directive in relation to consumer behaviour in the digitalisation of retail financial services for the purpose of obtaining credit to purchase goods and services on the market. It also aims to assess whether, and to what extent, the solutions contemplated in the Proposal solve the issues of financial information (generally not easily understandable and of high technical complexity that the consumer clearly does not decipher) and consumer over-indebtedness. The problem is all the more pertinent since it is certain that both can compromise the objectives outlined for the development and consolidation of the internal market, above all in cross-border transactions. We conclude that this proposal will strengthen the legal protection of consumers in particularly difficult times, but that their vulnerability remains. Consumers sometimes adopt irresponsible online behaviour and are increasingly dependent on detailed and explained information from lenders. Some measures already result from the law in force and are enshrined in the proposal, but as they are insufficient and ineffective, it is recommended that they be strengthened in the new directive. © 2022 Seventh Sense Research Group®.
ABSTRACT
Introducao: Asvacinas anti-Sars CoV-2 demonstraram que sao primordiais para o controle da pandemia por possibilitarem o desenvolvimento de imunidade em pessoas devidamente vacinadas. Objetivos: O objetivo do presente estudo foi avaliar o desenvolvimento de anticorpos neutralizantes em profissionais de saude apos duas doses das vacinasCoronaVac e AstraZeneca. Metodologia: Exames com principio de quimioluminescencia LIAISONSARS CoV-2 S1/S2 IgG - DIASORIN foram realizados no Laboratorio de Sorologia do Hemocentro de Joao Pessoa, e contagens acima de 15 AU/mL (Unidades Formadoras de Anticorpos por mL) caracterizaram desenvolvimento de protecao anti-Sars CoV-2. Cem (100) profissionais de saude foram estudados apos imunizacao com CoronaVac e AstraZeneca. Resultados: Apos a primeira dose da vacina CoronaVac, 61,4% dos profissisonais de saude ainda permaneceram com baixos niveis de anticorpos;apenas 38,6% conseguiram se imunizar. Ja apos a segunda dose da CoronaVac, apenas 12% permaneceram nao imunes, e 88% se imunizaram. Desses nao imunes, um profissional de saude faleceu com Covid-19.Considerando a vacina Astrazeneca, apenas 23,8% dos profissionais de saude nao se imunizaram apos a primeira dose, sendo que 76, 2% desenvolveram anticorpos neutralizantes. Apos receberem a segunda dose da Astrazeneca, 100% dos profissionais ficaram imunizados. Discussao: Considerando que, apos contato com a vacina, nosso organismo demora entre 7 - 14 dias para desenvolvimento de anticorpos, e que estes tem meia vida entre 20 a 28 dias, os soros dos participantes foram coletados apos exatos 20 dias a partir da imunizacao dos participantes para garantia de deteccao de anticorpos. Com o final da meia vida circulante dos anticorpos IgG, os linfocitos T de memoria serao os responsaveis pela resposta imune do nosso organismo. Conclusao: O presente estudo demonstrou a evolucao do desenvolvimento de anticorpos neutralizantes contra Covid-19 apos cada dose dos diferentes tipos de vacinas aplicados em profissionais de saude, bem como a importancia de mais de uma dose de imunizante para completa seguranca vacinal da populacao. Copyright © 2022
ABSTRACT
Background: Virtual platforms are used to share educational content and improve medical education learning. With the COVID-19 pandemic, the Radiation Oncology (RO) field is using these platforms to augment the quality and size of the audience reached. Objective(s): The hypothesis is that using Twitter to discuss the latest RO literature in a global journal club format can improve clinical practice and opportunities for collaboration. Method(s): This Twitter journal club is on the 3rd weekend each month. It has an asynchronous portion that allows for global participation (to overcome time zone differences) and a one-hour live Twitter chat to facilitate active discussion between authors, invited discussants and participants. A short summary and guiding questions are posted on the website prior and is broadcast to a mailing list. Participants use dual hashtags (#RadOnc #JC) in tweets to follow the discussion. This analysis focuses on the January 2021-February 2022 experience. NodeXL (Social Media Research Foundation, CA) and Symplur (W2O, CA) were used for analytics. Result(s): Mean total number of participants was 56 (range: 36-97). Mean increase in the Altmetric Attention Score (AAS), a measure of volume and source of attention chosen articles received, was 22 (Range: 4 to 83). The Prostate Cancer and Exercise journal club in January 2022 had the most participants (n=97). At baseline, 45% of respondents would sometimes encourage patients to exercise, 32% always, 15% rarely and 8% never (n=47). At the end of the journal club, 82% would recommend exercise to patients in the future and 12% would consider it (n=36). Exercise options encouraged were Group Programs (60.8%, 76/125), Monitoring Apps (24.8%, 31/125), Online Classes (12/125), and Pamphlets/Brochures (4.8%, 6/125). The most active journal clubs were on Bladder Cancer (BCON, 696 tweets and 57 participants), Postoperative Prostate Cancer (RADICALS, 599 tweets and 51 participants), and Radiobiology/Toxicity (HyTEC, 580 tweets). Conclusion(s): COVID-19 has shifted the medical education landscape in RO and the global oncology community. Twitter and social media platforms can be used to engage learners and discuss RO advances with the help of experts worldwide. This can foster interdisciplinary, global conversations for the benefit of medical education, integrated collaboration, and potentially translate to improved clinical outcomes (Table 1).
ABSTRACT
Background: The SARS-CoV-2 virus has caused a worldwide health crisis. Patients with infammatory arthritis are at higher risk of hospitalization and death by COVID-19 due to comorbidities or immunosuppressive treatments. Vaccination is one the most important strategies to control the pandemic. Objectives: To evaluate the incident cases of SARS-CoV-2 infection in a multi-centric cohort of infammatory arthritis in Brazil. Methods: BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their frst bDMARD or tsDMARD (1). The present analysis is a retrospective evaluation of adult patients with infam-matory arthritis (rheumatoid arthritis-RA, spondylarthritis-SpA and psoriatic arthritis-PsA) that were alive since the beginning of the COVID-19 pandemics in Brazil in February 2020. We evaluated the incidence and severity of COVID-19 infection and the adherence to anti-SARS-CoV-2 vaccines schedules, up to January 2022. Results: A total of 300 patients were interviewed and 69 (23.0%) reported con-frmed anti-SARS-CoV infection and 5 (1.7%) had a second infection. Among known infected patients, 18.8% need hospitalization and oxygen support, 7.2% were admitted at ICU, and 5.8% died. After COVID-19 infection, 31.8% reported worsening of disease activity but only 6.1% had modifcation in medication due to disease activity. Distribution of cases followed the pattern of waves observed in Brazil (Figure 1). Regarding vaccination, 285 (95%) reported to have received at least one dose of any anti-SARS-CoV-2 vaccine: 43% received the frst with the adenovirus ChAdOx1 nCoV-19 (AstraZeneca) adenovirus vaccine, 32% received the Sinovac-CoronaVac inactivated vaccine, 22% received the BNT162b2 (Pfzer-BioNtech) mRNA vaccine and 3% received the BNT162b2 (Pfzer-BioNtech) adenovirus vaccine. Almost all (98.1%) of these patients had already received the second dose of vaccine and after the frst and second vaccine doses, 6% and 4% of patients, respectively, reported worsening of articular disease activity, while, after the third dose, no patient reported disease activity worsening. Conclusion: During the pandemics, patients with infammatory arthritis had a pattern of distribution of cases very similar to general population. Adherence to vaccination is high and well tolerated.
ABSTRACT
Objetivo: Correlacionar as internações hospitalares por embolia e trombose arteriais com as infecções por SARS-Cov-2 no Brasil, através da lista de morbidade do CID-10 (CID 10 - I74) no período de maio de 2020 a maio de 2021. Materiais e métodos: Estudo epidemiológico, descritivo e retrospectivo, de análise quantitativa, cuja fonte de dados foi o Sistema de Morbidade Hospitalar (SIH-SUS) do Ministério da Saúde, tabulados em gráficos e tabelas no programa Microsoft Excel 2016. Resultados: Entre maio de 2020 e maio de 2021 foram observadas 24.971 internações por embolia e tromboses arteriais, sendo que 23.209 (93%) foi em caráter de urgência. Já entre maio de 2019 e abril de 2020 o número de internações foi de 20.706, valor que entre maio de 2018 e abril de 2019 foi de 20.400. Discussão: A infecção por SARS-Cov-2 em pacientes que desenvolvem a forma grave da Covid-19 é associado ao maior risco de formação de coágulos e, consequentemente, de embolias e tromboses. Uma das principais teorias para explicar a associação entre Covid-19 e coagulopatias é que o estado de hiperinflamação provoca uma desregulação nos eventos trombóticos. Desse modo, o aumento de 12% no número de internações por embolia e trombose arteriais observados entre maio de 2020 e maio de 2021 quando comparado ao período de maio de 2019 a abril de 2020 pode ter sido causado pela pandemia da Covid-19 iniciada em março de 2020. Além disso, uma análise retrospectiva mostra que esse aumento foi o maior em números absolutos nos últimos cinco anos. Conclusão: É possível notar o aumento do número de casos de embolias e tromboses arteriais no contexto pandêmico, corroborando com os estudos que associam a Covid-19 com os distúrbios da coagulação.
ABSTRACT
Healthcare services, in particular, are one of the areas in which Lean can be applied and benefits can be reached through it. In order to analyze the suitability of Lean implementation in healthcare units, this research focused on a case study, namely in Hospital of Santo António emergency area, in the city of Porto, Portugal. The study was conducted in the year 2020, during the pandemic of COVID-19, which forced the change of screening processes. This research analyses and compares the new and previous sorting model and discusses if Lean methodology was applied. It was concluded, through data collected in the interview to the leading nurse, that despite de fact she is not familiar with the Lean concept and methodology, as process simplification and time reduction were taken into account, the new process can be considered Lean. The flow charts that reflect both the sorting structure used in the urgencies before and after were developed. Hospital culture, lack of communication before the new process implementation, and the facilities were some of the identified barriers. © 2021, IGI Global.
ABSTRACT
The COVID-19 Pandemic affected institutions, students, and faculty around the world. As if it wasn't already evident that technologies were gaining more space on the educational policy agenda, the decision by governments to close educational institutions made it imperative to move to online using distance learning strategies, mainly technological solutions. In this paper, we analyzed an online course created to help Portuguese teachers from different educational levels. This course aimed to support teachers transitioning from face-to-face to online and provide them with an experience as distance student. The information shared by participants, as well as satisfaction questionnaire allowed us to realize two things. On one hand, that the difficulties experienced in Portugal are similar to those identified in previous studies, on the other hand to identify specific needs by education level. We conclude that pedagogical training on distance learning methodologies and hybrid contexts is emerging, should be continued and should integrate governments and educational institutions' strategy. © 2021 IEEE.
ABSTRACT
This visual essay uses accompaniment methodology to address the urban experience of a digital platform delivery guy in Valdivia, in the south of Chile. Through images, we question the notion of "place of production", which is fundamental for Labor Process Theory (LPT) studies. In this sense, this perspective has identified the place of production as a physical, unitary, and stable space for both traditional industries and services economies. Our urban journey, accompanying a digital platform delivery guy, observes the place of production as the attempt to suppress the physical space between the customer and the desired product, which can only be done by activating a vast urban experience by those who transport the products.
ABSTRACT
IntroductionThe current SARS-CoV-2 pandemic has many implications, one of them being alcohol consumption. The impact of long-term distancing measures in terms of alcohol use and misuse is yet unknown. Any increase, would not only add to the usual disease burden associated with alcohol, but also add to the COVID-19 load, given that alcohol use may weaken the immune response.ObjectivesTo characterize and compare the pattern of alcohol consumption throughout the pandemic in patients with the diagnosis of Alcohol Use Disorder;to identify factors considered as most relevant in the increase of alcohol consumption.MethodsWe conducted a observational study in an outpatient population in Centro Hospitalar Psiquiátrico de Lisboa (Portugal) with diagnosis of Alcohol Use Disorder, 6 months after the pandemic lockdown. We characterized our sample regarding social, demographic and clinical categories. We applied auto-filled questionnaires, particularly: Mental Health Inventory (MHI), Positive Mental Health Scale (PMHS) and Severity of Alcohol Dependence Questionnaire (SADQ-C).ResultsA total of 65 patients were included. More than 30% changed their drinking habits because of the pandemic. Nearly half of these increased consumption, and half decreased (16% vs 14%). The increase affected particularly men, and was related with the severity of alcohol dependence, stress-related coping strategies and psycopathology;on the other hand, a lowered level of consumption based on the decrease of alcohol accessability and affordability.ConclusionsThe current situation is unique in terms of mass physical distancing and may trigger different behaviours that should be monitored. Governments should give public health warning about excessive alcohol consumption to protect vulnerable individuals.DisclosureNo significant relationships.
ABSTRACT
IntroductionStarting in December 2019, the coronavirus SARS-CoV-2 emerged and soon acquired a pandemic dimension. The evidence that 1 in 3 patients presented neuropsychiatric symptoms highlighted SARS-CoV-2 neurotropic properties. The involvement of the Central Nervous System (CNS) seems to be associated with poor prognosis, and it can occur independently of the respiratory system.ObjectivesTo assess neuropsychiatric symptoms in SARS-CoV-2 patients and possible mechanisms of CNS invasion;to reflect on what changes should be made in order to avoid short and long-term complications.MethodsA non-systematic literature review was performed, including publications between January and August 2020.ResultsThe most frequent CNS presentations included fatigue (38-75%), headache (6,5-34%), nausea or vomiting (1-13,7%). Regarding PNS involvement, three kinds of hypoesthesia (hyposmia, hypogeusia, and hypopsia) were commonly present. Additionally, cases of neurological syndromes associated with SARS-CoV2 were reported, being related to a poor prognosis in cases such as brainstem infiltration. Another major concern regarding CNS involvement is the possibility of permanent neurological disabilities. Importantly there are reports of patients who tested positive for SARS-CoV-2 in CFS, without samples from nasopharyngeal swabs. Different hypothesis are postulated to explain possible mechanisms through which SARS-CoV-2 affects CNS, including: direct invasion through the olfactory nerve, hematogenous route through ACE-2 (angiotensin-converting enzyme) receptor expressed in blood-brain-barrier;or indirect mechanisms.ConclusionsHere we discuss the neuropsychiatric manifestations of SARS-CoV-2 infection and the potential mechanisms by which they occur at an early stage. Awareness, prevention and early treatment of potential neuropsychiatric symptoms of COVID-19 should not be overlooked, especially because they seem to predict a worse prognosis.DisclosureNo significant relationships.
ABSTRACT
Background: In March 2020, the Brazilian Ministry of Health (MoH) announced COVID-19 countrywide community transmission and issued guidelines on social distancing measures. Using real life data, we aimed to analyze the impact of COVID-19 on HIV care in Brazil, and summarize the actions taken by the MoH to guarantee proper health care for people living with HIV (PLWHIV). Methods: We obtained MoH electronic records, from January-October 2019/2020, on HIV self test (HIVST), viral load (VL), CD4+ T counts (CD4), genotyping, and antiretroviral (ART) prescription, including post- (PEP) and pre-exposure (PrEP) prophylaxis. We used descriptive statistics to quantify COVID-19 impact on HIV care in Brazil and compared indicators of both years by unpaired T-tests. Results: In April 2020, PEP and PrEP dispenses fell 57% and 53%, respectively, when compared to January, and new PrEP users dropped 70%. Four months supplies provision and telemedicine resulted on 64% and 53% increase on PEP and PrEP dispenses and 288% rise on new PrEP users in October, when compared to April. The number of HIVST distributed by MoH and PLWHIV who had the first CD4 and VL before ART initiation dropped 35% and 48%, respectively, when comparing April to January 2020, reflecting the pandemic impact on HIV diagnosis. In return, MoH recommended HIVST for key/ priority populations, pregnant women, patients with TB, STI, viral hepatitis, immunossupressed, or hospitalized due to respiratory syndrome. When comparing to April, HIVST distribution raised 95% in October and the number of PLWHIV who had the first CD4 and VL before ART initiation was 56% higher, in September. When comparing 2020 to 2019, the number of PLWHIV who started ART and those that had the first CD4 and VL before ART initiation was 29% and 48% lower in April 2020, respectively;but 18% and 15% in September. Considering January-October, the proportion of PLWHIV overdue for ART dispensation raised 11% and ART dispense for 30 days dropped 53% in 2020;but increased 27% and 105%, for 60 and 90 days, respectively. The use of telemedicine, annual VL for those clinically stables, and 90-days ART supply held link to public health services and viral load suppresion. Conclusion: PLWHIV are vulnerable during COVID-19 pandemic due to compromised immune system or care continuum interruption by community containment measures. Monitoring of HIV care indicators associated to timely actions is an effective way to overcome COVID-19 pandemic challenges and guarantee proper health care for PLWHIV.
ABSTRACT
Introduction: Osler developed the 1st journal club in 1875 to reduce financial barriers to keeping up with global medical progress. Journal clubs have since become a widely accessible tool to improve patient safety & quality care. However, maintaining competence today is limited by exponentially increasing complexity & volume while resources stay siloed. In response the “#RadOnc” Twitter journal club was created in 2014 to accelerate knowledge translation across boundaries. Its lung cancer projects have included discussions on globally relevant articles, dual hashtags, & crowdsourced summaries to enhance to enhance clinical knowledge, online communication, & critical appraisal. Methods: We reviewed data from the journal club since 2014. The format included free article access, a weekend-long asynchronous chat, & a live hour including article authors. Targeted invitations were sent prior with introductions posted to a blog. Curated open-access summaries were created using Wakelet to facilitate discussions & allow future referencing. Dual hashtags (#RadOnc #jc) were tested in 2020. Single & dual hashtag data from January & February was analyzed and compared against chat transcripts to determine if dual hashtags appropriately focused content. Selected chats of immediate relevance were thematically analyzed for publication to guide local standards of practice. Results: Fifteen chats (37% ) had direct relevance to lung cancer (including palliative/supportive care, SCLC, & NSCLC) with all attended by article authors. The most recent lung cancer chat had 496 tweets & 2.9 million impressions. Altmetric scores ranged from 15 to 227 (top 5%). We identified 1853 tweets with “# RadOnc” and 1256 (68%) used “#RadOnc #jc”. Dual hashtags were used by 122/558 (22%). Participants spanned 13 countries (radiation oncologists (54/122, 44%), trainees (15/122, 12%), other physicians (9/122, 7%), patients (5/122, 4%), physicists (2/122, 2%), & radiation therapists (1/122, 1%)). Chats averaged 19 dual hashtag tweets/hr compared to 9 other “#radonc” tweets/hr (p=0.036). Most dual hashtag content was related to the journal club (542/542 for January & 713/714 for February). Two recent chats resulted in publications in academic journals. Conclusion: #RadOnc #jc has overcome limitations of traditional journal clubs & remained at the forefront of changing online practices to sustainably facilitate active global lung cancer discussions. This includes use of dual hashtags that are feasible to filter conversations & enable a chat within the hashtag of a growing community of practice. It has nurtured diverse perspectives including multidisciplinary experts, patients, & trainees from HICs & LMICs for rich digitized peer review & discussion. This informed the publication of the first crowdsourced global oncology guidelines for the COVID19 pandemic & emerging standard techniques for SCLC. Aggregation through Wakelet summaries may further reduce the reading burden. Together, #RadOnc #jc is becoming a platform for rapid knowledge translation & creation by encouraging & amplifying the voices of the global oncology community through crowdsourcing, rapid review, and open-access publication. We continue to assess its outcomes for quality improvement including reviewing our lung cancer specific data, chat metrics, author & article impact, & engagement including feedback from all stakeholders working towards improving cancer care. Keywords: Social Media, global oncology, Medical Education
ABSTRACT
In this text it is postulated that the social outbreak or popular revolt, added to the COVID-19 glimpse a series of problematic elements for Chile. One of them is: the institutional and public policy crisis regarding the capacity to institutionalize phenomena of socio-political conflict and control of the pandemic. Henceforth, it is held that institutionality and public policy are the mainstays for overcoming the social and health crisis. However, if we continue with their rigid character and lack of porosity towards the citizens themselves, it is difficult for them to live up to this. As a result, the need to implement profound transformations is proposed, increasing the capacity of the State and reclaiming the notion of institutional development. This requires an increase in political capacity through the insertion of binding citizen participation mechanisms that are sustained over time and provide a normative sense to the measures developed. At the same time, the state's administrative capacity must also be increased, based on having personnel trained in the construction and management of technological mechanisms capable of keeping records of large volumes of data.