The Effect of Telerehabilitation on Physical Fitness and Depression/Anxiety in Post-COVID-19 Patients: A Randomized Controlled Trial

Aim: The aim of this research was to evaluate the impact of a telerehabilitation program on physical fitness, muscle strength, and levels of depression and anxiety in post-COVID-19 patients. Methods: Thirty-two individuals recovered from COVID-19 (48.20±12.82 years) were allocated into either a telerehabilitation (TG n=16) or control (CG n=16) group. Physical fitness, handgrip strength, depression and anxiety levels were assessed before and after an 8-week intervention. Results: There was a significant improvement in muscle strength in both groups. Physical fitness significantly increased compared to the CG at the end of the intervention. Levels of anxiety and depression significantly decreased after the intervention when compared to the CG. Conclusion: Eight weeks of functional telerehabilitation training is a viable and efficient way to rehabilitate patients affected by COVID-19, as it improved physical conditioning and mental health. © 2023, University Library System, University of Pittsburgh. All rights reserved.

Anti-persistent adherence dynamic of the COVID-19 vaccines

This research explores the multifractal dynamics of time series of the daily number of vaccinees for COVID-19, considering six European countries (Belgium, Denmark, France, Germany, Greece and Italy) using the Multifractal Detrended Fluctuations Analysis (MF-DFA). We calculate the multifractal spectrum f(alpha) and apply a fourth-degree polynomial regression fit to estimate the complexity parameters that describe the degree of multifractality of the underlying process. We found that the multifractal dynamics of all these countries are characterized by strongly anti-persistent behavior (alpha (0) < 0.5) a lower degree of multifractality, and small fluctuations are dominant in the multifractal spectrum. From an immunization perspective, it means that a panorama that encompasses the population's behaviour is marked by the dynamics of anti-persistent adherence to COVID-19 vaccines. Our findings confirm that the period of immunization of the population that adhered to the vaccination campaigns is short and that the application of new doses of vaccines must obey this phenomenology to keep people safe. In addition, we used the multifractal efficiency coefficient to rank countries that are most proactive in developing campaigns that promote greater adherence and loyalty to COVID-19 vaccines. Our findings indicate that Germany, Belgium and France were more efficient than Greece, Denmark and Italy.

Analise Das Aquisicoes Publicas De Medicamentos Com Eficiencia Mito Ou Realidade: Relato De Experiencia De Uma Fundacao Publica

Introducao: Aquisicoes publicas de medicamentos sao um grande desafio para gestores, devem cumprir requisitos legais, transparencia, seguranca e eficiencia, diante da demanda de novas tecnologias e recursos escassos. Um processo licitatorio, inicia-se pela Selecao(o que comprar),planejamento(quanto e quando),modalidade de aquisicao(como).Estas informacoes vao compor o termo de referencia(TR)que deve explicitar de forma detalhada o objeto e cumprir as exigencias legais. Para proporcionar uma assistencia terapeutica segura e racional, o farmaceutico tem importante papel nesse contexto e precisa ter competencias, como: conhecimento tecnico, sanitario e regulatorios inerentes a compras publicas. Objetivo: Apresentar dados referentes as aquisicoes publicas de medicamentos pela Fundacao Saude(FSERJ) obtida atraves do Sistema Integrado de Gestao de Aquisicoes (SIGA). Metodologia: Foram extraidos dados de compras de medicamentos do SIGA no periodo de 01/2013-06/2022 pela equipe tecnica da COOPRL/SUBLOG, compilados e analisados em conjunto com a GERITI/DIRTA/FSERJ, para avaliar o impacto do desabastecimento de medicamentos que vem ocorrendo desde 2020 com a pandemia de COVID-19 e o papel da FSERJ no cenario macroeconomico e mercadologico no ERJ. Os dados foram: modalidades e valores de aquisicao, medicamentos da curva A, fornecedores, numero de processos e itens/TR, comparacao de valores/modalidade entre as Unidades Gerenciadoras do ERJ. Resultados: As compras de medicamentos pela FSERJ em 2022, aumentaram nos ultimos 6 meses em 50%, quando comparada a 2021, no entanto, manteve-se a regularidade de numero de processos, e isso deveu-se a entrada de 23 UPAS e 5 hospitais para Gestao da FSERJ. Com relacao a modalidade de aquisicao ha a predominancia do Pregao eletronico desde 2013. No entanto, em 2022 com 62% esta modalidade foi superada por Dispensa de licitacao (76%), o qual pode ser justificado pela dificuldade de pesquisa de mercado, aumento do numero de licitacoes desertas e fracassados decorrentes de elevados precos acima da CMED, interrupcao na producao, dependencia nacional de materia-prima da China, o que ocasionou o desabastecimento de medicamentos tais como SPGV, analgesicos, antibioticos e outros medicamentos comumente prescritos em UPAS e em hospitais geridos pela FSERJ. Observou-se a evolucao da FSERJ e a sua importancia no cenario atual de compras publicas de medicamentos, com 54% no ERJ. Foi feita analise de Pareto, dos 460 itens adquiridos,65 representam 80 % do valor, sendo rituximab o antineoplasico o de maior valor justificado pela gestao do HEMORIO, o qual e referencia para este tratamento no ERJ. Foi elencado o ranking de fornecedores o que permitira ampliar o poder de negociacao. Conclusao: O levantamento demostrou a importancia de planejar, o conhecimento tecnico e administrativo de todos os atores envolvidos nos processos de compras publicas e o quanto as informacoes podem impactar numa maior racionalizacao de recursos sobretudo no cenario atual. Copyright © 2022

UNIVERSITY, HEALTH AND SOCIETY: A COMMITMENT IN TIMES OF CRISIS

This article presents the actions developed by higher education institutions in the State of Tocantins in the fight against the pandemic of the new coronavirus. This pandemic scenario reinforced the need for universities to be socially engaged with their surroundings, demanding that, through their teaching, research and extension activities, the knowledge produced in universities articulated with social demands, intensifying their relationship with society. and expanding the fulfillment of its social mission. The study also addresses the main emergency research and extension actions to face the coronavirus carried out by 110 federal institutions of higher education in the country. In particular, the activities developed by institutions located in the Northern Region of the country stood out. According to the data obtained, the Federal University of Tocantins and the Federal Institute of Tocantins showed too much involvement in dealing with the pandemic. Official data from the Ministry of Education indicate that even with teaching activities taking place remotely or partially in person, institutions have developed a range of actions focused on benefits for the population. The actions carried out sought to effect the social role of the institution and, as a result, there was a greater approximation of these institutions with the local community.

Sleep quality, alertness and mood state of day-night-shift university students during COVID-19 pandemic

Introduction: The sleep-wake rhythm irregularities can cause poor sleep quality and mood changes, such as increased fatigue and sleepiness in the students in consequence of the academic tasks and social life. Objective: The objective of this study was to verify the sleep quality, sleepiness, alertness state and mood state of the university students prior to the day-night-shift classes (online) during the COVID-19 Pandemic. Methods: One hundred sixty-eight university students of both sexes, with a mean age of 23.8±5.4 years, registered from the 2nd to the 7th period in three courses (Medicine, Nursing and Physiotherapy) of the two Brazilian private university in the day (n=90) and night-shift (n=78) were participated of this study. The measurements of sleep quality (Pittsburgh Sleep Quality Index - PSQI), sleepiness (Epworth Sleepiness Scale), alertness state (Karolinska Sleepiness Scale), mood state (Brazil Mood Scale - BRAMS), fatigue (FB) and vigor BRAMS domains (VB) were performed immediately prior to the classes online (day shift = 7h00;night shift = 19h00). The normality of the data was verified using the Kolmogorov-Smirnov test. The Mann-Whitney U test of independent samples was used to compare the variables between day-shift and night-shift university students. The size of the Cohen effect (ES) was estimated. The α-level for all analysis was set at ≤0.05. Results: The results showed there was a significant difference in sleep quality, fatigue mood domain, and alertness state between university students in the day and night shifts: sleep quality - PSQI (U= 2789.5;p=0.02;ES=0.46), alertness state - KSS (U= 2933.0;p=0.04, ES=0.48) and FB mood domain (U= 2877.0;p=0.05;ES=0.31). However, there was no difference in sleepiness (ESS) and Vigor mood domain (BRAMS) between day-shift and night-shift students. Therefore, the night-shift university students showed a significant worsening of the sleep quality, fatigue mood and alertness state compared to the day-shift students prior the classes. Conclusion: The results indicated that night-shift students were inattentive, fatigue, and sleepy prior to their academic activities (classes), in addition to presenting poor sleep quality (IQSP>5). Thereby, strategies implementation such as naps, restorative sleep, blue light therapy, and sleep hygiene are important to improve the alertness, attention, general health, and academic performance of the university students during the COVID-19 Pandemic.

Addressing Barriers to Immunization Against Acute Respiratory Infectious: A Qualitative Synthesis

RATIONALE: The COVID-19 pandemic highlighted the need for population adherence to recommended prevention and control measures for acute respiratory infections. This study aims to summarize and evaluate the evidence on barriers for populational adherence to vaccine to prevent acute respiratory infections. METHODS: A qualitative evidence synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols statement and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. An electronic search was performed in three databases (MEDLINE [Ovid], Embase [Ovid], and PsycINFO) from their inception to the present. We included studies published in Portuguese, English and Spanish that used both qualitative data collection and analysis methods. We also included studies that used mixed methods, when used qualitative methods of analysis. Risk of bias of the included studies was assessed using the Critical Skills Appraisal Programme (CASP). The certainty of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research (GRADECERQual) approach. The best-fit framework approach was followed as the strategy for data analysis and synthesis. Data were synthesized using adapted dimensions from the 'The Health Belief Model' (HBM) and the 'Behaviour Change Wheel' (BCW). RESULTS: Thirteen studies were included. The studies were related to influenza, H1N1, invasive pneumococcal disease, pertussis, and other acute respiratory infections. Most studies were assessed as having appropriate methological rigour. Regarding the confidence in the evidence of the thirteen findings, identified from the thirteen included studies, four were we graded four as high confidence certainty of evidence, four as moderate, three as low and two as very low certainty of evidence. The findings were presented within the six identified themes of the being two of the HBM model (perceived susceptibility and perceived barriers) and four of the COM-B model (social opportunity, automatic motivation, psychological capability and reflective motivation). CONCLUSIONS: Several factors can be considered barriers to implementing adequate populational adherence to immunization against respiratory infectious diseases: misperceptions on vaccination costs, lack of knowledge about the disease and its severity, lack of personal and environmental susceptibility, general misperceptions about vaccines (including their production, testing, and distribution protocols) and vaccine availability. In addition, other cultural and personal backgrounds can also be considered a leading cause: fear, lack of public awareness, inconvenience to take vaccination, unfortunate experiences in the past, and other misperceptions about efficacy, risks, side effects, among others.

Healthcare-associated infections: a threat to the survival of patients with COVID-19 in intensive care units.

BACKGROUND: Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU). METHODS: This retrospective cohort study included patients with severe COVID-19 hospitalized in the ICU of four hospitals in the city of Curitiba, Brazil. Patients with COVID-19 who died during ICU hospitalization were compared with those who were discharged. A second analysis compared patients who developed HAI in the ICU with those who did not. Multiple logistic regression models were used to control for confounders. RESULTS: In total, 400 patients were included, and 123 (31%) patients developed HAI. The most common HAI was lower respiratory tract infection (67%). Independent risk factors for death were: age [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.43-2.15; P<0.0001]; clinical severity score (OR 2.21, 95% CI 1.70-2.87; P<0.0001); renal replacement therapy (OR 12.8, 95% CI 5.78-28.6; P<0.0001); and HAI (OR 5.9, 95% CI 3.31-10.5; P<0.0001). A longer interval between symptom onset and hospital admission was protective against death (OR 0.93, 95% CI 0.88-0.98; P=0.017). The only independent factors associated with HAI were high C-reactive protein and low PaO2/FiO2 ratio. CONCLUSIONS: No factors that could point to a high-risk group for HAI acquisition were identified. However, age, dialysis and HAI increased the risk of death in ICU patients with severe COVID-19; of these, HAI is the only preventable risk factor.

Ponto de Partida: A political theater in the military dictatorship

In this interview, the actor Antonio Petrin (1938) comments his participation in the cast of the first staging of the play Ponto de Partida (1976), an important Brazilian musical, written by Gianfrancesco Guarnieri (1934-2006) and directed by Fernando Peixoto (1937-2012). It is a play that sought to allude to the death of journalist Vladimir Herzog (1937-1975), tortured and murdered by the State during the military dictatorship in Brazil (1964-1985). In May 2021, given the health crisis caused by the new coronavirus (COVID-19), the interview was conducted through a video call.

CRIANÇAS COM SÍNDROME RESPIRATÓRIA AGUDA GRAVE (SRAG) CONFIRMADA EM HOSPITAL DE REFERÊNCIA PEDIÁTRICA EM BELO HORIZONTE, MINAS GERAIS

Introdução: Descrever o perfil epidemiológico de crianças com infecção confirmada por SRAG internadas no Hospital Infantil João Paulo II (HIJPII), referência em doenças infectocontagiosas, entre março de 2020 e agosto de 2021. Método: Trata-se de um estudo realizado pelo Núcleo de Vigilância Epidemiológica Hospitalar (NUVEH) do HIJPII, utilizando os dados das fichas de notificação de SRAG, Este estudo foi aprovado pelo Comité de Ética em Pesquisa da FHEMIG sob parecer: 4.312.966. Resultados: Entre março de 2020 e agosto de 2021, 2702 crianças internaram no HIJPII e foram notificados com SRAG. Foram realizados 2269 testes RT-PCR para SARS-CoV-2, 1026 pacientes realizaram teste rápido de antígeno e/ou fizeram o painel viral na Fundação Ezequiel Dias. A etiologia viral foi identificada em 692 crianças: 278 (40,2%) positivos para vírus sincicial respiratório (VSR), 174 (25,1%) positivos para rinovírus, 164 (23,7%) positivos para SARS-CoV2, 34 (4,9%) positivos para influenza A e/ou B, e 5,9% foram positivos para outros vírus (25 bocavirus, 3 parainfluenza, 13 adenovírus e 1 coronavírus sazonal). O diagnóstico de VSR foi realizado por RT-PCR em 72% e teste rápido de antígeno em 28%. SARS-CoV-2 foi detectado por RT-PCR em 81% e por teste rápido de antígeno em 19%. A idade variou entre 15 dias de vida e 18 anos, mas 72,9% eram menores de 6 anos, 55,5% do sexo masculino, 82% moravam em Belo Horizonte ou na região metropolitana. Entre as manifestações clínicas mais frequentes foram febre, tosse, diarreia, esforço respiratório, cianose e saturação menor que 95%. Nos casos mais graves as crianças tinham comorbidades, as mais frequentes: displasia broncopulmonar, doença neurológica crônica não progressiva, obesidade, anemia falciforme e cardiopatia. A letalidade por SRAG no HIJPII no período foi de 20,5% (4 crianças com SARS-CoV-2 e uma criança com VRS);entretanto apenas 29,4% dos óbitos por SRAG tiveram a etiologia viral identificada por não terem coletado painel viral. Conclusão: Os resultados encontrados reforçam a necessidade da realização do painel viral, para melhorar os dados da Vigilância Epidemiológica. Sua solicitação foi reduzida na pandemia, devido ao alto número de internações e necessidade de leitos, optou-se por realizar testes rápidos. Entretanto, como no HIJPII estão disponíveis testes rápidos apenas para VRS, SARS-CoV-2 e influenza, muitas crianças com SRAG ficaram sem identificação viral.

Towards an Adaptive Software Architecture for Archetype-Based Healthcare Applications

Self-adaptation gives software systems the ability to adjust their behavior or structure in changing environments such as the health software domain. However, adaptability significantly complicates software implementation and brings great challenges to software engineering. This paper proposes an Adaptive Healthcare Software Architecture (AHSA), which is based on international health standards and offers at-runtime adaptation. Three components (Dynamic Linker, Runtime Locator, and Autonomous Component) have been specified to compose AHSA. A tool called AdaptiveHIS has also been developed to dynamically generate AHSA components, and this generation is exemplified through an algorithm. Within two real-world COVID-19 pandemic healthcare scenarios, an assessment compared the adaptability of AHSA and other software architectures built using state-of-art tools. Results based on the level of system adaptability metric respectively showed that AHSA offered 20% and 72% more adaptability in the two real-world scenarios. IEEE

Telehealth by clinical pharmacists for patients with diabetes mellitus at an urban federally qualified community health center

Service or Program: Clinical pharmacist services are an integral part of patient care for many high risk patients with diabetes mellitus in the underserved populations that the Edward M. Kennedy Community Health Center (EMKCHC) serves. Clinical pharmacist telehealth services were developed during the COVID-19 pandemic since nonemergent onsite visits were halted. Visits were predominantly conducted by 3 pharmacists via telephone. The effectiveness of managing patients with uncontrolled type 2 diabetes mellitus (DM) via telehealth was evaluated retrospectively. Justification/Documentation: Most literature related to pharmacists providing telehealth in patients with diabetes is from the Veterans Administration Healthcare System and is primarily in rural populations. Although services at EMKCHC were developed in response to the COVID-19 pandemic, the problem of access to care is broader. Often patients miss appointments because of work, childcare, and/or transportation issues, and telehealth may improve accessibility. The effectiveness of telehealth visits in patients with A1cs 8% or higher will be measured by: (1) number of patients reached, (2) number of appointments completed, (3) number, type, clinical impact and economic impact of interventions, 4 change in A1C from baseline, and 5 percent of patients at A1C goal and/or FBS 80-130 post-telehealth appointments. Also, potential associations between baseline characteristics and efficacy measures will be evaluated. Adaptability: Similar remote services could be offered by pharmacists at other CHC's managing DM in underserved populations. Pharmacists offering telehealth services will require secure remote electronic access to medical charts in a private location where protected health information can be contained. Significance: DM telehealth appointments by pharmacists could be used to improve access to care in CHC organizations. This evaluation also describes the complexity of diabetes care that can be managed by clinical pharmacists via telehealth.

COVID-19 lethality in Brazilian States using information theory quantifiers

In this paper, we presented an overview diagnosis consider the time series of daily deaths by COVID-19 in the Brazilian States using Bandt &Pompe method (BPM) to estimate the Information Theory quantifiers, more specifically the Permutation entropy (Hs) and the Fisher information measure (Fs). Based on the Information Theory quantifiers, we build up the Shannon-Fisher causality plane (SFCP) to promote insights into the COVID-19 temporal evolution inherent in the phenomenology associated with the number of daily deaths well as their respective locations along the SFCP. Moreover, we apply Hs and Fs to elaborate on the rank of the Brazilian States’ real situation, considering the number of daily death due to COVID-19 based on the complexity hierarchy. The Brazilian States that are located in the middle region of the two-dimensional plane (Hs x Fs), such as Amapá (AP), Roraima (RO), Acre (AC), and Tocantins (TO) are characterized by a less entropic and low disorder, which implies in high predictability of the COVID-19 lethality. While, the Brazilian States that are located in the lower-right region, such as Ceará (CE), Bahia (BA), Pernambuco (PE), and Rio de Janeiro (RJ), are characterized by high entropy and high disorder, which leads to low predictability of the COVID-19 lethality. Given this, our results provide empirical evidence that the permutation entropy is a powerful approach to predicting infectious diseases. Dynamic monitoring of permutation entropy can help policymakers to take more or less restrictive measures to combat COVID-19. © 2021 IOP Publishing Ltd.

Covid-19 and fake news: analysis of the veryfyed news at the website "Fact or fake"

This work analyzed the publications in the Fact or Fake section, located on the G1 page. For this, 9 categories of analyzes were created: coronavirus prophylaxis and cure, vaccine, xenophobia, true videos in the false context, theory that the virus was predicted in the past, political, panic, social isolation and others. From the analysis, it was concluded that 86 news items were found in a period of 60 days. In addition, it is clear that although technological resources and the internet greatly facilitate access to all types of information, checking this information is increasingly necessary. This situation further reinforces the importance of the journalist and the role of the Gatekeeper.

Fake news and oral healthcare

Fake news is a recurrent issue in healthcare. Dentistry is not immune to its influence. Patients might find it more convenient to use the Internet to learn more about their oral and dental problems. However, online content may often be misleading and potentially harmful. The advent of COVID-19 has exacerbated the problem. Here, we present simple actions to empower dental professionals against the proliferation of fake news. Understanding the implications of our online activity is important for professionals and our patients. © 2020 George Warman Publications. All rights reserved.

PRIMARY HEALTH CARE AND COVID-19: CHALLENGES FOR UNIVERSITIES, HEALTH WORKERS AND MANAGERS

Objective: to describe the experience of the primary health care support group of the Nursing Committee to Combat COVID-19 in a capital of northeastern Brazil. Method: collection of information in health units about physical structure, action plans, care flows and workforce, between March and May 2020. Results: problems identified in 46 units, such as: weaknesses in health surveillance;physical structure to assist users with and without respiratory symptoms;inadequacy of personal protective equipment;removal of professionals infected with SARS-CoV-2;insufficient capacity building for the demands. The following were made available to the units: technical-scientific support materials, virtual spaces of debates, referral of labor demands, materials to adapt routines of services and recommendations for higher instance of municipal health management. Final considerations: precarious conditions of Primary Health Care imply the disorganization of adequate response in times of health emergencies. © 2022 Universidade Federal da Bahia. All rights reserved.