The impact of the Covid-19 pandemic on the hotel Industry's economic performance: Evidence from Portugal.

This paper estimates the impact of the Covid-19 pandemic on the economic and financial performance of the Portuguese mainland hotel industry. For that purpose, we implement a novel empirical approach to gauge the impact of the pandemic during the 2020-2021 period in terms of the industry's aggregated operating revenues, net total assets, net total debt, generated cash flow, and financial slack. To that end, we derive and estimate a sustainable growth model to project the 2020 and 2021 'Covid-free' aggregated financial statements of a representative Portuguese mainland hotel industry sample. The impact of the Covid pandemic is measured by the difference between the 'Covid-free' financial statements and the historical data drawn from the Orbis and Sabi databases. An MC simulation with bootstrapping indicates that the deviations of the deterministic from the stochastic estimates for major indicators vary between 0.5 and 5.5%. The deterministic operating cash flow estimate lies within plus or minus two standard deviations from the mean interval of the operating cash flow distribution. Based on this distribution, we estimate the downside risk, measured by cash flow at risk, at 1294 million euros. Overall findings shed some light on the economic and financial repercussions of extreme events such as the Covid-19 pandemic, providing us with a better understanding of how to design public policies and business strategies to recover from such an impact.

LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol.

Approximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC's burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The "Cardiovascular and respiratory events following COVID-19" component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The "Physical and mental symptoms following COVID-19" component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.

Adherence, safety, and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial.

PURPOSE: To assess safety, satisfaction, and overall adherence of a center-based cardiac rehabilitation (CBCR) program for cancer survivors at increased cardiovascular (CV) risk, compared to community-based exercise training (CBET). METHODS: The CORE study was a single-center, prospective, randomized controlled trial enrolling cancer survivors exposed to cardiotoxic cancer treatment and/or with previous CV disease. Participants were randomized to an 8-week CBCR program or CBET, twice a week. Overall feasibility (consent, retention, and completion rates), intervention adherence (percentage of exercise sessions attended), and safety were assessed. Adverse events (AEs) were registered, and participants' satisfaction was measured at the end of the study. RESULTS: Eighty out of 116 potentially eligible individuals were included; consent rate was 72.4%, and 77 (96.2%) started the study (retention rate 100% in CBCR vs 92.5% in CBET); completion rate was 92.5%. Intervention adherence was higher in CBCR (90.3 ± 11.8% vs 68.4 ± 22.1%, p < 0.001). Exercise-related AEs were mainly related to musculoskeletal conditions in both groups (7 in CBCR vs 20 in CBET, p < 0.001), accounting for exercise prescription modification in 47 sessions (18 (3.3%) in CBCR vs 29 (7.2%) in CBET, p = 0.006), none motivating exercise discontinuation. No participants reported major CV events. Overall, the satisfaction with the different aspects of the programs (e.g., expectations, monitoring) was higher in the CBCR. CONCLUSION: This exploratory analysis of the CORE trial suggests that both exercise-based interventions are feasible and safe in this setting. The higher intervention adherence and patient satisfaction in CBCR suggest that this comprehensive approach could be of interest in this population.

Drawings as tools to (re)imagine space in interdisciplinary global health research.

Understanding the role of space in infectious diseases' dynamics in urban contexts is key to developing effective mitigation strategies. Urbanism, a discipline that both studies and acts upon the city, commonly uses drawings to analyze spatial patterns and their variables. This paper revisits drawings as analytical and integrative tools for interdisciplinary research. We introduce the use of drawings in two interdisciplinary projects conducted in the field of global public health: first, a study about the heterogeneous burden of tuberculosis and COVID-19 in Lima, Peru, and second, a study about urban malaria in Jimma, Ethiopia. In both cases, drawings such as maps, plans, and sections were used to analyze spatial factors present in the urban context at different scales: from the scale of the territory, the city, and the district, to the neighborhood and the household. We discuss the methodological approaches taken in both cases, considering the nature of the diseases being investigated as well as the natural and social context in which the studies took place. We contend that the use of drawings helps to reimagine space in public health research by adding a multidimensional perspective to spatial variables and contexts. The processes and products of drawing can help to (a) identify systemic relations within the spatial context, (b) facilitate integration of quantitative and qualitative data, and (c) guide the formulation of policy recommendations, informing public and urban health planning.

Time-dependent evolution of IgG antibody levels after first and second dose of mRNA-based SARS-CoV-2 vaccination in haemodialysis patients: a multicentre study.

BACKGROUND: Vaccination programs are essential for the containment of the coronavirus disease 2019 pandemic, which has hit haemodialysis populations especially hard. Early reports suggest a reduced immunologic response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in dialysis patients, in spite of a high degree of seroconversion. We aimed to identify risk factors for a reduced efficacy of an mRNA vaccine in a cohort of haemodialysis patients. METHOD: In a multicentre study, including 294 Portuguese haemodialysis patients who had received two doses of BNT162b2 with a 3-week interval, immunoglobulin G-class antibodies against the SARS-CoV-2 spike protein were determined 3 weeks after the first dose (M1) and 6 weeks after the second dose (M2). The threshold for seroconversion was 10 UR/mL. Demographic and clinical data were retrieved from a quality registry. Adverse events were registered using a questionnaire. RESULTS: At M2, seroconversion was 93.1% with a median antibody level of 197.5 U/mL (1.2-3237.0) and a median increase of 180.0 U/mL (-82.9 to 2244.6) from M1. Age [beta -8.9; 95% confidence interval (95% CI) -12.88 to -4.91; P < 0.0001], ferritin >600 ng/mL (beta 183.93; 95% CI 74.75-293.10; P = 0.001) and physical activity (beta 265.79; 95% CI 30.7-500.88; P = 0.03) were independent predictors of SARS-CoV-2 antibody levels after two vaccine doses. Plasma albumin >3.5 g/dL independently predicted the increase of antibody levels between both doses (odds ratio 14.72; 95% CI 1.38 to 157.45; P = 0.03). Only mild adverse reactions were observed in 10.9% of patients. CONCLUSIONS: The SARS-CoV-2 vaccine BNT162b2 is safe and effective in haemodialysis patients. Besides age, iron status and nutrition are possible modifiable modulators of the immunologic response to SARS-CoV-2 mRNA vaccines. These data suggest the need for an early identification of populations at higher risk for diminished antibody production and the potential advantage of the implementation of oriented strategies to maximize the immune response to vaccination in these patients.

Understanding Cervical Cancer Screening Barriers among Migrant Women: A Qualitative Study with Healthcare and Community Workers in Portugal.

Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation of migrant women living in Portugal. A qualitative study with online focus groups was conducted. Healthcare workers experienced in CCS and community workers working with migrant communities were purposively sampled. A semi-structured guide was used covering the participation of migrant women in CCS, barriers, and strategies to overcome them. Data were analyzed using content analysis. Participants considered that migrant women have low participation in CCS related to insufficient knowledge, low risk perception, and lack of interest on preventive care. Other barriers such as difficulties in accessing the healthcare services, relationship with healthcare workers, language, and cultural differences were highlighted. Promoting continuity of care, disseminating culturally tailored information, and use of self-sampling methods were suggested to improve participation in CCS. Inequalities in access to CCS among migrant women are mostly caused by information gaps and healthcare system-related barriers. Building a migrant-friendly healthcare system that creates opportunities for healthcare workers to establish relationships with their patients and delivering culturally and linguistically adapted information may contribute to overcoming those barriers and increasing the participation of migrant women in screening.

Vaccines Against Covid-19: A Panorama of Immunizers Developed in the World Scenario

The effects caused in the various segments of society due to the Covid-19 pandemic required measures to control the transmission of coronavirus, which involve individual and collective actions. Scientists in less than a year were able to develop the best alternative to contain or reduce the number of cases of this disease, vaccines. However, for this purpose, strict safety criteria were necessary. This study aims to present, through mapping, the vaccines developed in the world against Covid-19, highlighting the main vaccines used in the world, in addition to verifying the vaccines that are being used in Brazil. The methodology of this research is characterized as a quantitative exploratory study, which consists of a mapping of vaccines worldwide against Covid-19. The results presented show that the vaccines developed and those that are under development, registered since the first phase, are vaccines: genetic (19);protein-based vaccines (37);inactivated and attenuated coronavirus vaccines (16). Among these vaccines, 12 of them are the main vaccines in the world. As for efficacy, only EpiVacCorona has an unknown efficacy. However, in Brazil, for emergency use, Vaxzevria-AZD1222, CoronaVac and Comirnaty - BNT162b2 are being used, which have a significant percentage of effectiveness. It is concluded, in light of this study, that countries are entering into partnerships with companies, governments, universities and researchers for the development and testing of vaccines, with the aim of eliminating the pandemic. There are several vaccines whose effectiveness is proven, however, the pandemic will only be extinguished when the number of immunizers is compatible or close to the number of the world population. Os efeitos ocasionados nos variados segmentos da sociedade devido à pandemia da Covid-19 exigiram medidas para o controle da transmissão do coronavírus, as quais envolvem ações individuais e coletivas. Os cientistas em menos de um ano conseguiram desenvolver a melhor alternativa para conter ou reduzir o número de casos dessa doença, as vacinas. No entanto, para este feito, foram necessários rigorosos critérios de segurança. Este estudo tem como objetivo apresentar, por meio de mapeamento, as vacinas desenvolvidas no mundo contra a Covid-19, destacando as principais vacinas utilizadas no mundo, além de verificar as vacinas que estão sendo utilizadas no Brasil. A metodologia desta pesquisa é caracterizada como um estudo exploratório quantitativo, o qual é constituído por um mapeamento das vacinas no âmbito mundial contra a Covid-19. Os resultados apresentados evidenciam que as vacinas desenvolvidas e as que estão em desenvolvimento, registradas desde a primeira fase, são vacinas: genéticas (19);vacinas baseadas em proteínas (37);vacinas de coronavírus inativadas e atenuadas (16). Dentre essas vacinas, 12 delas são as principais vacinas no mundo. Quanto à eficácia, apenas a EpiVacCorona apresenta eficácia desconhecida. Entretanto, no Brasil, para uso emergencial, estão sendo utilizadas a Vaxzevria-AZD1222, CoronaVac e Comirnaty - BNT162b2, as quais apresentam uma percentagem significante de eficácia. Conclui-se, diante deste estudo, que os países estão realizando parcerias com empresas, governos, universidades e pesquisadores para o desenvolvimento e teste das vacinas, com o intuito de eliminar a pandemia. Existem várias vacinas cuja eficácia é comprovada, porém, a pandemia só será extinta quando o quantitativo de imunizantes for compatível ou aproximado do quantitativo da população mundial. [ABSTRACT FROM AUTHOR] Copyright of Revista FSA is the property of Revista FSA (Faculdade Santo Agostinho) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Insights into the actions of angiotensin-1 receptor (AT1R) inverse agonists: Perspectives and implications in COVID-19 treatment.

New coronavirus SARS-CoV-2 (COVID-19) has caused chaos in health care systems. Clinical manifestations of COVID-19 are variable, with a complex pathophysiology and as yet no specific treatment. It has been suggested that the renin-angiotensin-aldosterone system has a possible role in the severity of cases and the number of deaths. Our hypothesis is that drugs with inverse agonist effects to the angiotensin-1 receptor can be promising tools in the management of patients with COVID-19, possibly avoiding complications and the poor evolution in some cases. Any risk factors first need to be identified, and the most appropriate time to administer the drugs during the course of the infection also needs to be established. Several angiotensin receptor blockers (ARB) have a favorable profile and are important candidates for the treatment of COVID-19. In this review we discussed a set of compounds with favorable profile for COVID-19 treatment, including azilsartan, candesartan, eprosartan, EXP3174, olmesartan, telmisartan, and valsartan. They are effective as inverse agonists and could reduce the "cytokine storm" and reducing oxidative stress. As COVID-19 disease has several evolution patterns, the effectiveness of ARB therapy would be related to infection "timing", patient risk factors, previous use of ARBs, and the specific molecular effects of an ARB. However, controlled studies are needed to identify whether ARBs are beneficial in the treatment of patients with COVID-19.