Relationship between primary vaccination coverage and booster coverage against COVID-19, socio-economic indicators, and healthcare structure in Brazil.

OBJECTIVE: To investigate the relationship between vaccination coverage and booster coverage against COVID-19, socio-economic indicators, and healthcare structure in Brazil. STUDY DESIGN: This is a nationwide population-based ecological study. METHODS: We have obtained data on COVID-19 vaccination for each Brazilian state until December 22, 2022. Our outcomes of interest were primary and booster vaccination coverage. The independent variables included: human development index (HDI); Gini index; population density; unemployment rate; percentage of the population covered by primary health care (PHC); percentage of the population covered by community health workers; number of family health teams; and number of public health establishments. Statistics were performed by using a multivariable linear regression model. RESULTS: Lower rates of primary vaccination coverage were found in states with lower HDI (P = 0.048), population covered by PHC (P = 0.006), and number of public health establishments (P = 0.004). Lower rates of booster coverage were also found in states with lower population density (first booster: P = 0.004; second booster: P = 0.022), PHC (first booster: P = 0.033; second booster: P = 0.042), and public health establishments (first booster: P < 0.001; second booster: P = 0.027). CONCLUSION: Our findings showed heterogeneity in access to vaccination against COVID-19 in Brazil, with lower vaccination coverage in localities with the worst socio-economic indicators and limited healthcare resources.

Colchicine reduces the activation of NLRP3 inflammasome in COVID-19 patients.

OBJECTIVE: To evaluate whether colchicine treatment was associated with the inhibition of NLRP3 inflammasome activation in patients with COVID-19. METHODS: We present a post hoc analysis from a double-blinded placebo-controlled randomized clinical trial (RCT) on the effect of colchicine for the treatment of COVID-19. Serum levels of NOD-like receptor protein 3 (NLRP3) inflammasome products-active caspase-1 (Casp1p20), IL-1ß, and IL-18-were assessed at enrollment and after 48-72 h of treatment in patients receiving standard-of-care (SOC) plus placebo vs. those receiving SOC plus colchicine. The colchicine regimen was 0.5 mg tid for 5 days, followed by 0.5 mg bid for another 5 days. RESULTS: Thirty-six patients received SOC plus colchicine, and thirty-six received SOC plus placebo. Colchicine reduced the need for supplemental oxygen and the length of hospitalization. On Days 2-3, colchicine lowered the serum levels of Casp1p20 and IL-18, but not IL-1ß. CONCLUSION: Treatment with colchicine inhibited the activation of the NLRP3 inflammasome, an event triggering the 'cytokine storm' in COVID-19. TRIAL REGISTRATION NUMBERS: RBR-8jyhxh.

Direct Costs of COVID-19 Inpatient Admissions in a Portuguese Tertiary Care University Centre

Background: The COVID-19 pandemic has posed greater financial pressure on health systems and institutions that had to respond to the specific needs of COVID-19 patients while ensuring the safety of the diagnosis and treatment of all patients and healthcare professionals. To assess the financial impact of COVID-19 patients admitted to hospitals, we have characterized the cost of COVID-19 admissions, using inpatient data from a Portuguese Tertiary Care University Centre. Methods: We analysed inpatient data from adult patients diagnosed with COVID-19 who were admitted between March 1, 2020 and May 31, 2020. Admissions were eligible if the ICD-10-CM principal diagnosis was coded U07.1. We excluded admissions from patients under 18 years old, admissions with incomplete records, admissions from patients who had been transferred to or from other hospitals or those whose inpatient stay was under 24 h. Pregnancy, childbirth, and puerperium admissions were also excluded, as well as admissions from patients who had undergone surgery. Results: We identified 223 admissions of patients diagnosed with COVID-19. Most were men (64.1%) and aged 45-64 years (30.5%). Around 13.0% of patients were admitted to intensive care units and 9.9% died in hospital. The average length of hospital stay was 12.7 days (SD = 10.2) and the average estimated cost per admission was EUR 8,177 (SD = 11,534), which represents more than triple the inpatient base price (EUR 2,386). Human resources accounted for the highest proportion of the total costs per admission (50.8%). About 92.4% of the admissions were assigned to Diagnosis Related Group (DRG) 723, whose inpatient price is lower than COVID-19 inpatient costs for all degrees of severity. Conclusion: COVID-19 admissions represent a substantial financial burden for the Portuguese NHS. For each COVID-19 hospitalized patient it would have been possible to treat three other hospitalized patients. Also, the price set for DRG 723 is not adjusted to the cost of COVID-19 patients. These findings highlight the need for additional financial resources for the health system and, in particular, for hospitals that have treated high volumes of hospitalized patients diagnosed with COVID-19. © 2022 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health.

Repercussions of infodemia associated with COVID-19 on the mental health of the elderly in Brazil

The phenomenon called infodemia refers to the increase in the volume of information on a specific topic, which multiplies rapidly in a short period of time, and has stood out in the context of the health crisis triggered by the COVID-19 pandemic. Too much information can trigger feelings of fear, anxiety, stress, and other conditions of mental distress. The study aims to describe the profile of exposure to information about COVID-19 and its repercussions on the mental health of elderly Brazilians. This is a cross-sectional study carried out with 1924 elderly Brazilians. Data were collected through a web-based survey sent to the elderly via social networks and email, from July to October 2020. The results of the descriptive analysis of the data show that most of the elderly were aged between 60 and 69 years (69.02%), female (71.26%), married (53.79%) and white (75.57%). About 21.67% (n = 417) concluded their graduation, 19.75% (380) concluded their specialization and 16.63% (320) concluded their master's or doctoral degrees. Television 862 (44.80%) and social networks 651 (33.84%) were reported as frequent sources of exposure to news or information about COVID-19. Participants indicated that television (46.47%;n = 872), social networks (30.81%;n = 575) and radio (14.48%;251) affected them psychologically and/or physically. Receiving fake news about COVID-19 on television (n = 482;19.8%) and on social media (n = 415;21.5%) mainly resulted in stress and fear. The disseminated information contributes to awareness, but also affects physically and/or psychologically many elderly people, mainly generating fear and stress. © 2022, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

AVALIAÇÃO CLÍNICA E EPIDEMIOLÓGICA DOS ACIDENTES POR ESCORPIÕES EM CIDADES DO NOROESTE PAULISTA

Introdução: No mundo foram descritas aproximadamente 1.500 espécies de escorpiões pertencentes a 18 famílias, a maioria das espécies perigosas pertencem à família Buthidae, incluindo os Tityus na América do Sul. Existem três espécies de escorpião com maior importância epidemiológica no Brasil: Tytius serrulatus, Tityus bahiensis e Tityus stigmurus. O Tityus serrulatus é encontrado nos estados da Bahia, Minas Gerais, São Paulo, Espírito Santo, Paraná, Rio de Janeiro e Goiás;o Tityus bahiensis ocorre nas regiões Sul e Sudeste;e o Tityus stigmurus predominante na região Nordeste. A picada do escorpião libera toxinas que agem estimulando a liberação de neurotransmissores do sistema nervoso autônomo, causando dor intensa no local com irradiação pelo membro afetado, náuseas, vômitos, salivação, arritmia cardíaca e alterações respiratórias. Conforme a sintomatologia as formas clínicas são classificadas em leve, moderada e grave. Metodologia: Esta revisão de literatura foi embasada nas fontes de pesquisa da Google scholar, Pubmed, Fiocruz, Biblioteca Virtual em Saúde e levantamento de dados na vigilância epidemiológica. Resultados: Foram coletadas informações durante o período de janeiro de 2015 a dezembro de 2020, através de dados cedidos pela vigilância epidemiológica da cidade. No período ocorreram 2124 casos de acidentes com escorpiões, com queda no ano de 2020. Foram analisadas as seguintes variáveis: formas clínicas, terapêutica com soroterapia, sexo e sintomas mais comuns. Em relação ao sexo, a maioria foi do sexo masculino, correspondendo a 53,81% dos casos. De acordo com a apresentação clínica, a maioria dos casos foram leves, sendo 96,75% do total, seguidos de moderados (2,30 %) e graves (0,61 %). O sintoma mais frequente foi a dor no local do acidente, correspondendo a 97,08% dos casos. Edema no local da picada foi outro sintoma frequente, correspondendo a 33,70 % do total. A soroterapia foi utilizada em todos os acidentes graves e em alguns moderados, com total de 47 prescrições, correspondendo a 2,21 % dos casos. Não foi constatado nenhum óbito durante o período. Conclusão: Através do levantamento das informações no período de 2015 a 2020, ocorreram 2124 casos na região, demonstrando uma diminuição no número de casos em 2020, por provável impacto da pandemia de COVID-19. Os resultados reforçam a importância da classificação clínica adequada como medida essencial para prescrição da soroterapia, evitando a mortalidade dos acidentes.

Evaluation of long-term clinical findings among COVID-19 survivors: preliminary results of a prospective cohort study (Recovida)

Introduction: Little is known about long-term clinical consequences of Covid-19. Objectives: We aimed to follow-up patients surviving the acute phase of disease to identify and eventually describe persistent symptoms related to it. Methods: RECOVIDA is a prospective cohort study conducted in a public-affiliated tertiary-care hospital, in Brazil. From May 1 to December 31, 2020, we recruited participants on the Post-Covid-19 ambulatory of the study facility, which offers clinical follow-up to adult patients, most of them discharged after being admitted due to Covid- 19. We classified their acute disease following WHO severity of disease criteria. Results: 175 patients were included in the study and evaluated up to 120 days after the onset of symptoms (mean = 57 days). Regarding demographic features, 51.4% of participants were female, and average age was 53 ± 14 years. Past medical history included hypertension (37%), diabetes mellitus (28%) and obesity (mean body mass index of 31.7 ± 7.3). By the time of evaluation, 80% of participants still experienced at least one long-term symptom, as described in Table 1. Conclusion: Covid-19 disease does not necessarily end with the end of its acute phase. In fact, a large proportion of patients, even after a mild disease, persist with clinically meaningful symptoms up to 120 days after the disease onset.

Inpatient Hospitalizations during the First Wave of COVID-19 in Portugal

The objective of this study was to analyze the impact of the pandemic on inpatient hospital admissions during the first wave in Portugal. Data from hospital admissions in mainland Portugal from 2008 to 2017 were used to forecast inpatient hospital admissions for March to May 2020. The observed number of hospitalizations and their characteristics were compared to forecasted values. Variations were compared by hospital and region. Statistical analysis was used to investigate whether patterns of variations existed according to hospital characteristics. There were 119,315 fewer hospitalizations than expected during March to May 2020 in Portugal, which represented a 57% reduction. Non-COVID-19 hospitalizations had a higher mean length of stay and proportion of inpatient deaths than forecasted values. Differences between observed and forecasted values varied greatly among regions and hospitals. These variations were not associated with COVID-19 hospital admissions, region, forecasted number of hospitalizations, type of hospital, or occupation rate. The impact on inpatient hospital admissions for each hospital was not consistent or proportional to the expected use across Portugal, as indicated by variations between forecasted and observed values. The appropriate planning of future responses may contribute to improving the necessary balance between the level of hospital admissions for usual health needs of the population and the response to COVID-19 patients. © 2021 American Medical Association. All rights reserved.

Prevalence of virological and serological markers of SARS-CoV-2 infection in the population of Ribeirão Preto, Southeast Brazil: an epidemiological survey

INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.

Environmental restraint of the elderly in long-term care facilities in times of Covid-19: theoretical reflection

A theoretical and reflexive study addressing the phenomenon of environmental restraint in long-term care facilities for the elderly, presenting the topic under the light of human rights and the legislation in force, which postulate good care practices to institutionalized elderly even in the face of the Covid-19 situation. By considering the negative impacts of environmental restraint on the physical and mental health of the elderly, it is suggested that the technical team of long-term care institutions for the elderly should be better trained, and that the phenomenon needs to be explored to guarantee more dignified conditions that respect the freedom of the elderly.