ABSTRACT
Systemic lupus erythematosus (SLE) is a chronic multisystem auto-immune disease with extremely varied clinical manifestations and a complex pathogenesis. New insights in SLE about pathogenetic pathways, biomarkers, and data on clinical manifestations are progressively emerging, and new drugs and new therapeutic strategies have been proposed to improve the control of disease activity. Thus, this review is aimed to summarise the most relevant data about SLE emerged during 2021, following the previous annual review of this series. © Copyright Clinical and Experimental Rheumatology 2022.
ABSTRACT
The Covid-19 pandemic, decreed in March 2020 by the World Health Organization - WHO, generated a global crisis affecting various economic sectors of society, including tourism with a reduction in the Nominal Revenue of Tourism Characteristic Activities - ACTs, generating unemployment, concomitant to the period of implementation of the Labor Reform of 2017. The objective of this article is to know the dynamics of employment in ACTs during the Covid-19 pandemic, considered a period of exception in the national context, to understand if there were or not a deterioration in the labor vulnerability situation and on the work in tourism from the analysis of the types of contracts in force during the years 2020 and 2021 concerning workers in general. It was chosen as a methodological path the qualitative and quantitative analysis of the data collected in the New General Register of Employed and Unemployed - Novo Caged, by analyzing the balance of jobs in the ACTs, the profile of temporary and intermittent contracts from the variable gender in the mentioned period. Finally, the negative balance of jobs as a result observed in the first wave did not recover in the following period of the resumption of activities in the sector. As for precarious contracts, it was observed that these had a higher compound growth rate than those for an indefinite period, in which women were the majority.
ABSTRACT
Background: The COVID-19 pandemic, with its uncertainties, fears of contagion, mass lockdowns and containment measures, has dramatically impacted on people's everyday lives leading to an increased risk of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD). Despite evidence in general population and healthcare workers1,2, scant data emerged on vulnerable populations, such as of patients with chronic illness, particularly rheumatic and musculoskeletal diseases (RMDs)3,4, who also underwent difficulties in the management and treatment of their disorders. Objectives: To assess PTSD and post-traumatic stress symptoms in a sample of patients with RMDs, during the COVID-19 pandemic in Italy. Methods: PERMAS is a monocentric prospective observational study led by the Rheumatology Unit, the Psychiatric Clinic and the Institute of Management of the School of Advanced Studies. Patients with a RMD diagnosis, were consecutively enrolled from May 2021 to January 2022. During the visit, sociodemographic characteristics and psychopathological data were collected through online survey, whereas clinical data were collected by physician. The survey included the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale-Revised (IES-R), aimed to assess symptomato-logical PTSD and post-traumatic stress symptoms related to the impact of the COVID-19 pandemic. Results: A total of 194 eligible patients, with a mean age of 50.3±12.17 years, was included: 142 (73.19%) were females;112 (57.74%) patients reported connective tissue diseases (CTD), 63 (32.47%) arthritis and 19 (9.8%) vasculitis. A total of 33 (17%) subjects reported a symptomatological PTSD by means of the TALS-SR. The prevalence of Partial PTSD (defned by at least 2 out of the 4 criteria for DSM-5 diagnosis of the disorder) was 56.7%, with signifcant higher rates among females (90, 81.8%) with respect to males (20, 18.2%) (p=.013). Accordingly, a IES-R mean total score of 21.90 ±15.98 was found in the total sample and a gender difference emerged, with higher mean scores among females rather than males (23.42 ±16.26 vs 21.90 ±15.98, p=.031). Conclusion: The present fndings point out high prevalence rates of symptoma-tological PTSD among patients suffering from RMDs, highlighting the potentially traumatic burden of the COVID-19 pandemic in this particular population, especially among females, suggesting the need of further investigations to address tailored prevention and intervention strategies.
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Background: Management of the health emergency caused by COVID-19 pandemic majorly disrupted the delivery of healthcare services to patients with chronic conditions like Systemic Autoimmune Diseases (SAD), both because resources were mainly channeled towards the care of infected patients, but also because patients tended to avoid seeking medical care for fear of becoming infected. PER-MAS is a 2-year project aimed at assessing the clinical, psychopathological, and socio-economic impact of COVID-19 in a cohort of patients with SAD. Objectives: To assess the impact of COVID-19 pandemic on drug withdrawal, disease fares and hospitalizations for disease exacerbation in a cohort of patients with SAD through an interim analysis of data from the PER-MAS project. Methods: A sample of 214 consecutive patients was recruited in a reference center for rare and complex autoimmune diseases from April 2021 to January 2022. Inclusion criteria were definite diagnosis of SAD (Connective Tissue Disease (CTD), Inflammatory Arthritis (IA) or Vasculitis), regular follow-up and at least 2 years of disease. Patients were asked to fill out an extensive self-administered questionnaire on disease activity and healthcare resource use during the pandemic (March 2020-moment of assessment). Pre-pandemic (March 2019-February 2020) and early pandemic (March 2020-February 2021) clinical data were recorded through retrospective chart review and patient interview. Results: At enrolment, 119 patients were affected by CTDs (55.6%), 71 by IA (33.18%), 24 by vasculitis (11.21%), with mean age 50.44± 12.97, and mean disease duration 11.17 ± 8.94. 30.37% took steroids, 39.7% hydroxy-chloroquine, 61.68% DMARDs, and 9.3% vasoactive drugs. Overall, disease course was similar in pre-pandemic and early pandemic phase: in the first period, rheumatologic condition was stable in 57.35% of patients, persistently active in 27.3% and 35.61% had ≥ 1 episode of disease exacerbation (mean 0.665±1.15, range 0-6);in the second period, 60.56% of patients was stable, 24.88% persistently active, and 39.44% had ≥1 exacerbation (mean 0.49 ±0.77, range 0-4). Mean number of visits (2.56±2.57 and 2.61±2.79), hos-pitalizations (0.168±0.698 and 0.14±0.473, p=0.6), number of patients with outpatient visits=0 (7.47 vs 7%), and number of patients with ≥ 1 hospital admission (10.28 vs 11.6%) were also similar, while the number of patients with hospital admissions for disease exacerbation was significantly higher in the second period (6.1 vs 11.21%, p=0.001). 170 patients completed the survey: from March 2020 to enrolment, 18.2% suspended ≥1 anti-rheumatic drug (6.25% of them for fear of contracting COVID-19 disease, 15.6% for difficulty in obtaining medications), 20% self-managed ≥ 1 disease exacerbation, and 40% had ≥ 1 telemedicine consult. From March to July 2020, 41.76% had their visit rescheduled (35.23% for hospital access restrictions, 5.3% for travel restrictions, 1.17% for fear). Conversely, only 14.7% of patients had their visit rescheduled (8.23% for hospital access restrictions, 4.7% for other reasons) from July 2020 to enrolment. Conclusion: In the early pandemic phase, overall disease course was similar to the pre-pandemic phase, but we observed an increase in the number of patients with ≥ 1 hospitalization for disease. Moreover, despite our efforts, patients reported a non-negligible rate of drug discontinuation for non-medical indication and difficulty to get access to rheumatologic consultation, highlighting the need of alternative organizational models in case of future pandemics.
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Background: Fatigue in SLE has a multifactorial origin and disease activity seems to contribute only minimally to its genesis. Therefore, non-pharmacological therapeutic strategies should also be considered in the management of fatigue. There is some evidence on the effectiveness of aerobic exercise programs in improving fatigue, without a negative impact on disease manifestations. Objectives: the aim of this study was to analyze fatigue and Health Related Quality of Life (HRQoL) in a monocentric cohort of patients with SLE, in a condition of stable remission or low disease activity, before and after a program of physical exercise, through the administration of validated Patient Reported Outcomes (PROs). Methods: this is a cross-sectional interventional study which included patients with SLE, aged between 18 and 55 years, in a condition of stable (≥12 months) remission (DORIS)1 or low disease activity (LLDAS)2. Patients enrolled had a FACIT score ≤40 in the previous 6 months. Patients with other possible causes of fatigue (e.g.: anemia, hypothyroidism, severe vitamin D defciency), active arthritis or physical disabilities were excluded. For each patient, demographics, comorbidities, treatment, clinical and laboratory data were collected. Disease activity was evaluated with the SELENA-SLEDAI and organ damage with the SLICC/DI. Each patient completed the following PROs before and after the interventional program: SF-36, FACIT-Fatigue, LIT, HADS. Due to the limitations related to the COVID-19 pandemic, the physical exercise sessions were carried out using the Google Meet digital platform. Patients were asked to participate to at least 70% of the lessons. The physical exercise program included moderate intensity aerobic exercises (muscle strengthening, joint mobility, breathing, static and dynamic stretching, balance and neuro-dynamics);workouts were performed 3 times a week, consisting of 60 minutes each. The program lasted for 12 weeks. Results: we enrolled 12 female patients, regularly followed at the Rheumatology Unit of Pisa;only 9 of them completed the study (mean age 38.56 ± 9.1 years;median disease duration 7 years (IQR 5,25-9,75)). 8/9 were in stable remission, while 1/9 was in LLDAS for the presence of leukopenia. 2/9 patients presented organ damage, one for cataract and one for renal insufficiency, while none presented damage in the musculoskeletal system. 33.3% of patients had fbromyalgia. 88.8% was on treatment with Hydroxy-chloroquine, 55.5% was on low dose steroids (2±1.9 mg/daily), 33.3% was on Mycophenolate Mofetil;only 1 patient was on Belimumab. All PROs showed a trend to improvement at the end of the 12-week program of physical activity (Table 1). We demonstrated a statistically signifcant improvement of: FACIT, LIT, depression score of the HADS and MCS of the SF-36. The items of role physical (RP), vitality (VT) and mental health (MH) of the SF-36 also showed a signifcant improvement. Conclusion: In a small cohort of SLE patients in remission but with severe fatigue, in the difficult context of COVID-19 pandemic, we demonstrated that an online program of physical exercise may determine a signifcant improvement of fatigue, perception of disease burden and mental health. In the context of a multidisciplinary management, fnding effective intervention programs to improve fatigue and HRQoL in SLE patients appears of utmost importance, with the fnal aim of improving patients' health status.
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Public budgets are essential for the achieving government policies. In times of the Covid-19 pandemic, sectors of the economy such as tourism, have been drastically affected. To back up the sector, the Brazilian government has used the argument of protecting companies and preserving employment to use an extraordinary credit of R$ 5 billion for the Tourism General Fund (Fungetur). However, few of the available resources have been contracted. In this sense, this article has as its general objective to analyse the challenges of implementation of this line of credit with particular attention to the performance of such public policy in the state of Rio de Janeiro. To this end, an exploratory and descriptive research was carried out. Regarding the methodological aspects, in the bibliographical review we have relied on secondary data such as legislation, articles, livecasts and reports on the subject. In a complementarily manner, an interview was held with the representative of the Regional Governance Unit (IGR) Costa do Sol. The study revealed the complexity of public policy for tourism funding set up to rescue the sector under crisis. Among the main barriers it was verified the existence of bureaucratic difficulties to access Fungetur's resource, unattractive interest rate in comparison to other available loans on the banking system, and a few accredited financial agents (AFC) ready to operate with the resource. The purpose of this research is to collaborate for the discussion of the use of additional claims and associated risks in an absence of studies and analyses highlighting the cost-benefit ratio, the criteria for the distribution of resources, guarantees, and implementation processes.
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Tourism has been the object and subject of different scholars in recent decades. Studies and research are concerned with a thematic diversity, from more traditional themes to the most recent ones which were incorporated due to globalization, the emergence and development of technologies associated with entrepreneurship, and innovation. This study is part of a set of other studies carried out within the scope of the research project funded by CNPq (National Council for Scientific and Technological Development), which relates the development of governance and developed destination in collaboration with several Brazilian and foreign higher education institutions. This motivated the analysis of scientific publications on tourist destinations in Brazil and their relationship with development, in the period prior to the Sars-Cov-2 pandemic (COVID-19). The article adopted a qualitative approach and secondary data, specifically the scientific publications of the specialized database Scientific Periodicals Electronic Library (Spell).The result revealed that scientific production in the field of tourism development in the country has evolved in quality, but is still restricted, a fact inferred by the small number of articles found on the researched topic, mainly on methodologies and indicators for the development of tourist destinations.
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This article analyzes the impact of the Covid-19 pandemic on tourist flows and the on carioca tourism economy and seeks to understand its meanings for society, considering the complex mechanism that characterizes the phenomenon of tourism. The spatial cutout delimits the Rio de Janeiro municipality, for which tourism has its importance revealed not only by its highest classification on the Brazilian Tourism Map, but also for bringing together important products and flows on a national and international scale, in order to sample the climate of tensions and uncertainties that the pandemic panorama has provided in Brazilian tourism. The qualitative analysis is complemented by quantitative data, documentary analysis and semi-structured interviews, cutting out the years 2019 and 2020. The findings have pointed out several conflicts in the conduction of the health crisis, with serious impacts on tourism. The discussion is divided into two parts: (i) the background of Rio de Janeiro municipality and its territorial turistic trajectory and economic in the last three decades until contemporary, when we experience a pandemic with an intense impact on tourism and;(ii) the analysis of the impacts of the health crisis on tourism in Rio. It should be noted that Rio de Janeiro, as a tourist destination, suffered impacts due to the closing of companies, cancellation of events and interruption of flows due to the restriction instituted by decrees. In the municipal sphere, the State acted to mitigate the impacts, while the companies innovated on services and operations, which can point out about the new configuration of the touristic destination.