Factors associated with carrying out molecular tests for the diagnosis of COVID-19 in the State of Espírito Santo, Brazil

Backgroung: Brazil was slow to implement an expanded testing policy for COVID-19, which may have affected the most vulnerable population's access to testing services. Objective: to evaluate the factors associated with performing the molecular test for COVID-19. Methods: cross-sectional study of secondary data from the COVID-19 panel in the state of Espírito Santo. COVID-19 suspicion notification forms were included between September 11, 2020 and March 2, 2021. Hierarchical logistic regression was used to estimate the odds ratio (OR) with 95% confidence interval (CI95%). Results: 419,771 notification forms were analyzed. The prevalence of performing the molecular teste for COVID-19 was 81.1% (CI95% 81.0-81.2). Elderly (OR= 2.70 – CI95% 2.56-2.85), health professional (OR=1.43 – CI95% 1.36-1.50), chronic cardiovascular disease (OR=1.13 – CI95% 1.09-1.17), diabetes mellitus (OR=1.07 – CI95% 1.01-1.14) and hospitalization (OR=5.95 – CI95% 4.53;7.82) were more likely to have undergone the molecular test. Male sex (OR=0.96 – CI95% 0.94-0.98), black skin color (OR=0.75 – CI95% 0.73-0.78), yellow skin color (OR=0.74 – CI95% 0.71-0.77), residing in the northern health region (OR=0.37 – CI95% 0.36-0.39) and the homeless population (OR=0.76 – CI95% 0.67-0.85) had the lowest chance of having undergone the molecular test. Conclusion: Social, economic, contextual factors and the risk of aggravation of the disease were associated with carrying out the molecular test for COVID-19 in the state of Espírito Santo. Actions are needed to guarantee the access of the most vulnerable population to molecular testing. © The authors (2023), this article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4. 0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1. 0/) applies to the data made available in this article, unless otherwise stated.

State capacities and municipal education policies during the COVID-19 pandemic Capacidades estatales y pol?ticas municipales de educaci?n durante la pandemia de Covid-19

The development of pedagogical activities through remote teaching became common during the pandemic. Based on a survey carried out by the National Confederation of Municipalities, a set of heterogeneities was identified regarding the actions adopted in the area of education in Brazil. This study finds support in the concept of state capacities and aims to deepen the understanding of the factors that contributed to the increase of municipalities' capacity to respond to the crisis. A regression was performed considering a set of variables linked to the characteristics of the local governments. It was concluded that variables related to technical-administrative and political-relational capacities related to the existence of participatory channels were fundamental in this process.

Sleep and alimentation: actions for improving quality of life in times of COVID 19

Introduction: Sleep is characterized as a condition of physical and mental rest, in which the person ignores everything going on around him. There is a scientifically proven association between sleep deprivation and unhealthy eating habits, increasing cases of emotional and uncontrolled eating leading to malnutrition. In addition, a bad night's sleep has been associated with worsening mental health, especially in times of pandemic. Objective: In light of the above, this study aimed to report the experience and stimulate reflection about the results of a poll shared on the social network Instagram with the objective of analyzing the quality of sleep of students at a public higher education institution during the COVID-19 Pandemic. Methods: This is an experience report of the extension group “Sleep and Food in times of Pandemic”, composed of students of nursing, nutrition, medicine and mathematics of a public institution of higher education. The group, through its profile on the social network Instagram, shared a sleep satisfaction scale, where users reported in posts according to the condition of their sleep on a scale between good and bad. The scale was made available publicly and online, so the answers were freely accessible to everyone who followed the group's profile. Results: The project had a large significant reach of participants, since the present was observed through the social media of we can mention Instagram e Facebook, that is, an average of 600 posts observed, of these, 34.5% of students reported having a good night's sleep during the pandemic, while 65.5% responded by pointing out a bad night's sleep. Sleep deprivation is inversely related to the regulation of the circadian cycle, is associated with neuroendocrine and metabolic functions, such as reduced leptin and increased ghrelin, increasing appetite and food intake.In parallel to this, individuals in this stressful situation tend to consume foods that are pleasing to the palate, which usually contain higher amounts of sugar and/or fat, because they serve as comfort for the stress they are going through, but may contribute to the risk of developing obesity, insulin resistance, and cardiovascular disease. Conclusion: Some protective factors can help in this change, such as maintaining a daily routine, practicing physical activity, following a dietary pattern and taking care of sleep hygiene. Finally, we emphasize the need for more studies with a more rigid methodological content.

COMPARAÇÃO DOS GASTOS EM SAÚDE POR LINFOMA NÃO-HODGKIN ANTES E DURANTE A PANDEMIA DO COVID-19

Objetivos: Analisar comparativamente as características relativas aos gastos dispensados em saúde para tratamento de pacientes internados por Linfoma não-Hodgkin antes e durante a pandemia de Covid-19. Material e métodos: Este estudo possui caráter transversal, descritivo e retrospectivo. Os dados utilizados foram obtidos mediante o Departamento de Informática do Sistema Único de Saúde (DATASUS), em que foi analisado o perfil de internações ocasionadas por Linfoma não-hodgkin, bem como os gastos empreendidos com tais pacientes no período de janeiro de 2019 a dezembro de 2020, por região no país. Resultados: Durante a pandemia, houve redução de 9,84% no número de internações (17.443 em 2019 e 15.725 em 2020) e de 9,46% no valor total gasto com pacientes portadores de Linfoma não-hodgkin (R$ 35.083.926,83 em 2019 e R$ 31.761.600,24 em 2020). Em contrapartida, houve um aumento de 0,42% no valor médio gasto por paciente (R$2.011,35 em 2019 e R$2.019,82 em 2020). A média de permanência em 2019 foi de 7,6 dias, enquanto que no período de pandemia reduziu para 7 dias. A taxa de mortalidade também obteve queda de 1,01% quando comparado ao ano anterior da pandemia de Covid-19 (8,82% em 2019 e 7,87% em 2020). Discussão: Diante de tais resultados, observa-se que há uma redução significativa no número de internações relacionadas ao Linfoma não-hodgkin, contrastando, com o relatório de 2020 do INCA, no qual, o estado o Rio de Janeiro apresentou uma queda na quantidade de internações por causas oncológicas (13.438 em 2019 e 10.384 em 2020). Tal fato, relaciona-se com a separação de leitos para pacientes com suspeita ou contaminados por Covid-19, o que acarretou na diminuição da disponibilidade de leitos para internação. Ademais, o mesmo relatório apresentou uma redução na quantidade de consultas médicas, quimioterapias, transplante de medula óssea, consultas multiprofissionais e outros, pela implantação de uma política de cancelamento das consultas de acompanhamento dos pacientes, uma vez que o risco relacionado ao deslocamento e à eventual contaminação por Covid-19 trariam maiores prejuízos para esses pacientes, tal feito, pode ter corroborado para redução do valor total gasto. Além disso, notou-se aumento dos gastos por paciente, concordando com outros estudos, onde notou-se o aumento dos custos por baixa produtividade de medicamentos, equipamentos, entre outros. Todavia, a diferença entre a média de permanência dos pacientes analisados neste estudo, difere do relatório do INCA, haja vista, que o tempo médio de permanência dos pacientes oncológicos do relatório, manteve-se estável, em cerca de 7,63 dias e do estudo reduziu para 7 dias. Sobre a redução da taxa de morte, pode-se relacionar-se também a redução do número de internações. É válido salientar também, que estes resultados podem denotar uma redução da assistência à saúde. Conclusão: Pode-se concluir que durante o período avaliado na pesquisa, houve redução significativa no número de internações de pacientes portadores de Linfoma não-Hodgkin. No entanto, ocorreu discreto aumento nos gastos com esses pacientes, o que pode-se inferir relação com a realocação de leitos em hospitais, para destinação exclusiva para pacientes com Covid-19. Ademais, observou-se redução na média de tempo de permanência e também na taxa de mortalidade.

Risks of infection by COVID-19 by waste collectors: reflections in the light of Jean Watson

The objective was to reflect on the risks of infection by Sars-CoV-2 in the exercise of the role of waste collectors and their safety through preventive actions via health guidelines under the theoretical perspective of Jean Watson. The content presented reflects on the risks of infection by Sars-CoV-2 to which waste pickers are subject on two categorical lines, namely: "The National Solid Waste Policy in force in Brazil and insecurity regarding Sars-CoV-2" and "Actions to prevent Sars-CoV-2 infection through health guidelines associated with the daily life of waste pickers from the theoretical perspective of Jean Watson". It is concluded that the risks to which collectors are subject in their professional practice are minimized through the use of personal protective equipment and by washing and sanitizing hands, but the awareness of these individuals about the importance of adopting preventive measures in an appropriate manner it must be carried out through health guidelines anchored in the Theory of Transpersonal Care, as this presents its development from the subject to the subject.

Ethical dilemmas during the COVID-19 pandemic

This article aims to reflect on the ethical dilemmas faced by health professionals, patients and family members during the COVID-19 pandemic. The pandemic raised ethical issues in health caused by the lack of material and human resources and the fear of the unknown. Patients and family members were also affected by social distancing in hospitalization and mourning. Health profissionals faced ethical dilemmas that raise questions about the duty to assist patients and the guarantee of personal safety, dealing with the challenge of acting ethically amid work overload and insecurity of the context. The family and patients face a scenario of adaptation of health care with the lack of technologies that allow feelings of care in the face of the need for distancing, including in the process of farewell rituals of the late. Investments in health can thus drive changes in care, in compliance with social justice and respect for human dignity. © 2022, Conselho Federal de Medicina. All rights reserved.