COVID-19's intra-urban inequalities and social vulnerability in a medium-sized city

Background: Social conditions are related to the impact of epidemics on human populations. This study aimed to investigate the spatial distribution of cases, hospitalizations, and deaths from COVID-19 and its association with social vulnerability. Methods: An ecological study was conducted in 81 urban regions (UR) of Juiz de Fora from March to November 2020. Exposure was measured using the Health Vulnerability Index (HVI), a synthetic indicator that combines socioeconomic and environmental variables from the Demographic Census 2010. Regression models were estimated for counting data with overdispersion (negative binomial generalized linear model) using Bayesian methods, with observed frequencies as the outcome, expected frequencies as the offset variable, and HVI as the explanatory variable. Unstructured random-effects (to capture the effect of unmeasured factors) and spatially structured effects (to capture the spatial correlation between observations) were included in the models. The models were estimated for the entire period and quarter. Results: There were 30,071 suspected cases, 8,063 confirmed cases, 1,186 hospitalizations, and 376 COVID-19 deaths. In the second quarter of the epidemic, compared to the low vulnerability URs, the high vulnerability URs had a lower risk of confirmed cases (RR=0.61;CI95% 0.49-0.76) and a higher risk of hospitalizations (RR=1.65;CI95% 1.23-2.22) and deaths (RR=1.73;CI95% 1.08-2.75). Conclusions: The lower risk of confirmed cases in the most vulnerable UR probably reflected lower access to confirmatory tests, while the higher risk of hospitalizations and deaths must have been related to the greater severity of the epidemic in the city's poorest regions.

SARS-CoV-2 load in exhaled end-tidal breath fine aerosol condensates among acutely symptomatic COVID-19 cases

SARS-CoV-2 infectious virions have been reported in exhaled breath, but their source remains elusive: breath sampling systems used to date do not separate breath aerosols by size, fail to prevent salivary/fomite contamination, or aerosol size evolution before sample capture. We hypothesised that sampling end-tidal, oral exhaled breath condensate (EBC), after separating large droplets by inertial impaction 4cm from the lips, would quantify viral loads in distal lung-derived fine aerosols (FA). We used a collector (PBM-HALE ) that captures mechanically aerosolised viruses to sample adult participants for <30 min under informed consent;cases symptomatic for <5 days (n=30) or >5 days (n=12), positive by nasopharyngeal swab RT-PCR (Ct>=13.1), were sampled in clinical triage 'red zones', or COVID-19 wards with no mechanical ventilation or open windows. Salivary alpha amylase activity (Salimetrics LLC), or SARS-CoV-2 viral load (VIASURE SARS-CoV-2 (ORF1ab and N gene)) after QIAsymhpony DSP midi extraction, was quantified in 0.2mL FA EBC fractions. No salivary alpha amylase activity was detected in healthy participant FA EBC (>1:1,750 dilution of paired saliva vs assay detection limit (n=300)). No SARS-CoV-2 RNA was detected in FA EBC (1.18mL +/- 0.32 total volume) among any COVID-19 cases (Aug 2020-Jan 2022) at limits of detection of 120 genomes/mL FA EBC or 4.72 genomes/min exhalation. No pre-extraction spike-in control reaction inhibition was observed. No ambient contamination of the alveolar FA EBC was detected with this sampling device. The alveolar fraction of orally exhaled tidal breath lacks detectable SARS-CoV-2 viral load.

Experience in managing action research on hepatitis C survey in the prison community

We aimed to report the experience in managing action research on hepatitis C investi-gation in the prison community in the Triangulo Mineiro region, Minas Gerais, Brazil. The proposal was developed from March 2019 to March 2020, reaching 240 people to contain the spread of the disease through a survey, testing, and mo-nitoring of positive cases. We adopted intersecto-ral action with articulation between Universities, Medical Society, Teaching Hospital, and State Secretariat for Justice and Public Security. Strategies for the management of action research are descri-bed: study settings and stakeholders, registration and formalization of the activity, application of tests, and management of reagent inmates. We identified difficulties regarding the accommoda-tion of routines among the research team and the proper functioning of the penitentiary, which required extensive training between the parties and managerial articulations. We consider that the report collaborates with the organization of future research aimed at accessing this still invi-sible population, the prison community when it highlights the strategies adopted to conduct the research. Copyright © 2022, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.

Acidente Vascular Encefalico Isquemico Associado a Plaquetopenia Apos Vacinacao Para Covid-19

Objetivo: Relatar caso de Trombocitopenia Trombotica Imune induzida por Vacina (VITT) ocorrido na cidade de Uberaba - MG. Resultado: Paciente, 22 anos, admitida no dia 14/04/22 em Pronto Atendimento (PA) da cidade de Uberaba devido quadro de cefaleia, febre e plaquetopenia. Pela suspeita de dengue, foi internada em Unidade de Terapia Intensiva, onde realizou AngioTC de cranio, sem evidencia de tromboses ou sangramentos. Dado inicio de recuperacao plaquetaria e estabilidade clinica, recebeu alta hospitalar dois dias apos. Os testes laboratoriais para dengue foram negativos. Entretanto, retornou ao PA depois de 8 dias devido a rebaixamento do nivel de consciencia, com exame de imagem evidenciando isquemia em lobo parietal esquerdo com transformacao hemorragica. Propedeutica laboratorial mostrava plaquetopenia moderada, dimero D elevado (12.670) e hipofibrinogenemia. Dada a informacao sobre historico de vacinacao com Astrazeneca 10 dias antes de abertura do quadro, foi levantada suspeita de VITT e iniciada terapia com imunoglobulina humana e corticoide em dose imunossupressora, e solicitada pesquisa de anticorpos Antifator-4-Plaquetario (anti-F4P). A anticoagulacao foi contraindicada devido a gravidade do sangramento em sistema nervoso central e previsao de possivel abordagem cirurgica. Apesar da terapia instituida, paciente evoluiu com novas complicacoes tromboticas em outros sitios (pulmonar e membro inferior) e novas areas de isquemia em sistema nervoso central associado a sangramento, culminando no obito 6 dias apos a readmissao. Posteriormente, o resultado do anti-F4P foi liberado como reativo em altos titulos (IgG: 2996, IgM + IgA + IgG: 2631 sendo o valor de referencia menor que 0,4), preenchendo assim os criterios diagnosticos para VITT. Discussao: Durante a pandemia de COVID-19, em resposta ao crescente numero de casos e mortes, e ao consequente impacto economico e social resultante, vacinas foram desenvolvidas e administradas em campanhas de vacinacao no mundo inteiro. Neste contexto, efeitos colaterais raros associados a vacina comecaram a ser observados. Dentre eles, destaca-se a VITT, a qual e uma condicao rara e grave, descrita quase exclusivamente apos a AstraZeneca-Oxford e Johnson & Johnson, sem predominio entre os sexos, e com maior risco relatado em individuos mais jovens. O principal mecanismo fisiopatologico descrito, assim como ocorre na trombocitopenia induzida por Heparina (HIT), e o desenvolvimento de anticorpos contra o fator-4-plaquetario, porem a forma como a vacina induz esta resposta imunologica ainda nao e bem compreendida. Clinicamente apresenta-se como uma coagulopatia que se desenvolve 5 a 30 dias apos a vacinacao, com trombose venosa e/ou arterial, plaquetopenia, D-dimero elevado e hipofibrinogenemia, alem da presenca de anti-F4P. O tratamento assemelha-se ao de HIT, baseando-se em modulacao da resposta autoimune e anticoagulacao (opcoes sem heparina). A paciente descrita apresentou todos os criterios definidores de VITT. Conclusao: A VITT e uma entidade de identificacao recente, com poucos casos descritos em literatura, e, portanto, com fisiopatologia, clinica e arsenal terapeutico ainda em estudo. Os estudos evidenciam alta taxa de mortalidade, principalmente em pacientes que evoluem com complicacoes hemorragicas. A divulgacao de casos clinicos visa enriquecer o conhecimento disponivel sobre esta condicao e ressaltar a importancia da suspeicao precoce e instituicao de terapia direcionada. Copyright © 2022

Non-fever COVID-19 Detection by Infrared Imaging

This study proposed an infrared image-based method for febrile and non-febrile people screening to comply with the society needs for alternative, quick response, and effective methods for COVID-19 contagious people screening. The methodology consisted of: (i) Developing a method based on the face infrared imaging for early COVID-19 detection in people with and without fever;(ii) Recruiting 1206 emergency room (ER) patients to develop an algorithm for general application of the method, and (iii) Testing the method and algorithm effectiveness in 2558 cases (RTqPCR tested for COVID-19) from 227,261 workers evaluations in five different countries. Artificial intelligence was used with a convolutional neural network (CNN) to develop the algorithm that took face infrared images as input and classified the tested individuals into three groups: fever (high risk), non-febrile (medium risk), and without fever (low risk). The results showed that suspicious and confirmed COVID-19 (+) cases characterized by temperatures below the 37.5 °C fever threshold were identified. Also, average forehead and eye temperatures greater than 37.5 C were not enough to detect fever similarly to the proposed CNN algorithm. Most RT-qPCR confirmed COVID-19 (+) cases found in the 2558 cases sample (17 cases/89.5%) belonged to the CNN selected non-febrile COVID group. The COVID-19 (+) main risk factor was to be in the non-febrile medium-risk group, compared with age, diabetes, high blood pressure, smoking and others. In sum, the proposed method was shown to be a potentially important new tool for COVID-19 (+) people screening for air travel and public places in general. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Identifying Requirements and Quality Attributes from the Point of View of Users of Mobile Digital Libraries

Due to the COVID-19 pandemic there has been a significant growth in the adoption of online educational resources, including mobile digital libraries. Thus, several quality attributes have been indicated by both industry and academy for designing useful and usable digital libraries. Nonetheless, we are not aware of a complete list of requirements that could be met to develop high quality digital libraries in the mobile context. In this paper, we try to meet this gap by identifying features that digital libraries should provide. To do so, we carried out an analysis of 20 Brazilian mobile digital libraries in the market, identifying requirements that provide functionalities for users. Also, we analyzed app comments from the top rated and least rated mobile digital libraries apps, to extract quality attributes. In all, we identified 14 requirements through the analysis of the applications and 49 quality attributes considering the opinions on users’ comments. The list of requirements and quality attributes is useful to understand the users’ expectations and understand what to maintain or remove when designing and developing a mobile digital library. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Forecasting the COVID-19 Space-time Dynamics in Brazil with Convolutional Graph Neural Networks and Transport Modals

One of the major challenges imposed by the SARS-CoV-2 pandemic is the lack of pattern in which the virus spreads, making it difficult to create effective policies to prevent and tackle the pandemic. Several approaches have been proposed to understand the virus behavior and anticipate its infection and death curves at country ans state levels, thus supporting containment measures. Those initiatives generalize well for general extents and decisions, but they do not predict so well the trajectory of the virus through specific regions, such as municipalities, considering their distinct interconnection profiles. Specially in countries with continental dimensions, like Brazil, too general decisions imply that containment measures are applied either too soon or too late. This study presents a novel scalable alternative to forecast the numbers of case and death by SARS-CoV-2, according to the influence that certain regions exert on others. By exploiting a single-model architecture of graph convolutional networks with recurrent networks, our approach maps the main access routes to municipalities in Brazil using the modals of transport, and processes this information via neural network algorithms to forecast at the municipal level ans for the whole country. We compared the performance in forecasting the pandemic daily numbers with three baseline models using Mean Absolute Error (MAE), Symmetric Mean Absolute Percentage Error (sMAPE) and Normalized Root Mean Square Error (NRMSE) metrics, with the forecasting horizon varying from 1 to 25 days. Results show that the proposed model overcomes the baselines when considering the MAE and NRMSE (p ˂0.01), being specially suitable for forecasts from 14 to 24 days ahead. Author

DISPUTING FOOD SYSTEMS: RESPONSES OF SOCIAL MOVEMENTS TO THE COVID-19 PANDEMIC

In this paper, we discuss how rural activism in Brazil reacted to the Covid-19 pandemic. We analyze actions of the four main family farming and peasants’ organizations in Brazil along the initial seven months of the pandemic, from March to September 2020: National Confederation of Men and Women Workers in Family Farming in Brazil (Contag), National Confederation of Men and Women Rural Farmer Workers and Family Farmers (Contraf-Brasil), Small Farmers Movement (MPA) and Landless Workers Movement (MST). Data sources are the news published on each organization’s websites. In order to understand how the pandemic impacted some of their preexisting practices, we propose a typology composed of five forms of action: donation, advocacy, alternative markets, direct action and informational action © Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado

Machine Learning-Based Security Solutions for Healthcare: An Overview

The eruption of chronic diseases such as COVID-19 has re-emphasized the need for people all over the world to have access to urgent healthcare. The latest pandemic has shown the flaws in the conventional healthcare system, namely that hospitals and clinics alone are incapable of dealing with such a crisis. Smart and integrated wearables are one of the main technologies that favor modern healthcare solutions (Godi, B., Viswanadham, S., Muttipati, A.S., Prakash Samantray, O., Gadiraju student, S.R.: E-Healthcare Monitoring System using IoT with Machine Learning Approaches. In: 2020 International Conference on Computer Science, Engineering and Applications (ICCSEA). pp. 1–5. IEEE, Gunupur, India (2020). https://doi.org/10.1109/ICCSEA49143.2020.9132937 ). These wearables can now gather data on an unparalleled scale thanks to advancements in the Internet of Things (IoT). Healthcare is among many fields that have been transformed by IoT, with the Internet of Medical Things (IoMT) systems being introduced as an IoT branch. Patients with chronic diseases can be monitored remotely using IoMT systems. As a result, it can offer prompt diagnostics to patients, potentially saving their lives in the event of an emergency. However, protection in these vital systems is a major issue that has arisen as a result of their widespread use. This paper presents an overview of the technologies that are being used on IoMT as well as some security problems found in the literature. This survey will give an insight to the readers regarding the importance of security in healthcare and the different machine learning methods used to address that issue. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Proposal for a Low-Cost Personal Protective Equipment (PPE) to Protect Health Care Professionals in the Fight Against Coronavirus

The global situation caused by a coronavirus in 2020 has become an unprecedented health crisis. Since 1918, during the Spanish flu, Brazilian society haven’t seen a pandemic disease. Among the many individuals exposed to the virus, health care professionals are essential workers who fight the disease. However, due to the lack of previous investments in the public health sector in Brazil, several obstacles are evident, such as the reduced number of Personal Protective Equipment (PPE) available for healthcare professionals who have direct contact with those affected by the disease. Therefore, undergraduate students and professors from UFPA (Universidade Federal do Pará—Federal University of Pará) Biomedical Engineering program course mobilized to create solutions to this problem through the study and production of a low-cost face shield model, which proved to be essential in helping professionals, in addition to engaging several students in the social causes. Similar initiatives like this took place in states in southeastern Brazil, through the making of PPE in 3D printers from PLA (polylactic acid) or ABS (Acrylonitrile Butadiene Styrene) filaments, which can take hours to be ready. Therefore, the present study presents a handmade model to promote higher cost–benefit and shorter manufacturing time. To measure how this PPE proposed here affected the daily work of these professionals, this study performed a feedback form focused on the professionals who used the handmade model. Also, a comparison between the 3D printed versus the handmade model was done. The study showed that 69.5% of the respondents, which were professionals working in the health field, felt more protected with the handmade face shield. Finally, for this research, it is possible to say that the handmade faceshields have proven to be effective, providing confidence when used by the research participants. © 2022, Springer Nature Switzerland AG.

In the midst of the Coronavirus pandemic in Brazil, watch out for snowmen in the north and northeast regions! Post-truth under discussion

This article incorporates part of the results of an ongoing master's research, and it discusses fake news and the post-truth phenomenon in the context of the COVID-19 pandemic in Brazil. We have analyzed the danger of misinformation and its use as a political strategy by Eduardo Pazuello. In June 2020, the Brazil's interim Health Minister justified the considerable number of coronavirus deaths in the North and Northeast regions by arguing that the climate in these regions was related to the winter in the northern hemisphere. We have adopted the cartographic method to follow up the dissemination of memes in the social media networks Facebook and Twitter. We have also evaluated the comments posted on the official Facebook page of the Ministry of Health in answer to Pazuello's statement, whether in support or in objection. The analyzed memes and Facebook comments demonstrate there are groups of internet users which support Pazuello, while others make fun of his attempt to redefine the Earth's equator as a mean of explaining the large number of deaths due to COVID-19 in the North and Northeast regions of Brazil. In times of pandemic, we believe it is crucial to bring forth media literacy and education, in order to debunk the kind of speech pronounced by Pazuello, which seeks to justify social chaos with falsehood, thus highlighting the inefficiency of Brazil's public policies responses to COVID-19. © Praksis 2021.

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.

Telomere length: biological marker of cellular vitality, aging, and health-disease process

The aging process occurs due to the decline of vital physiological functions and adaptability of the body, being influenced by genetics and lifestyle. With advances in genetics, biological aging can be calculated by telomere length. Telomeres are regions at the ends of chromosomes that play a role in the maintenance and integrity of DNA. With biological aging, telomere shortening occurs, causing cellular senescence. Several studies show that shorter telomeres are associated with acute and chronic diseases, stress, addictions, and intoxications. Even in the current COVID-19 pandemic, telomere shortening is proposed as a marker of severity in individuals infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On the other hand, healthy lifestyle habits increase telomere length and balance of various cellular functions, preventing diseases.