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Revista Bioetica ; 30(2):391-404, 2022.
Article in Portuguese | Scopus | ID: covidwho-1951699


Facing COVID-19 caused many problems in the healthcare field, due to the rise in the intensive care demand. To solve this crisis, caused by the scarcity of resources of high complexity, decision-making has been guided by prognostic scores;however, this process includes a moral dimension, although less evident. With na integrative review, this article sought to reflect on the reasonability of using severity indicators to define the allocation of the scarce resources in healthcare. We observed that the work carried out on resource scarcity situations causes moral overload, converging to the search for standard and objective solutions, such as the use of prognostic scores. We conclude that their isolated and indiscriminate use is not ethically acceptable and deserves cautious evaluation, even in emergency situations, such as COVID-19. © 2022, Conselho Federal de Medicina. All rights reserved.

Cadernos de Saude Publica ; 36(11), 2020.
Article in Portuguese | CAB Abstracts | ID: covidwho-1496621


Nowadays, the concept of vulnerability occupies a central space in debates about the health of indigenous peoples on a global scale, and is also widely referred to in discussions about the dissemination of the COVID-19 pandemic. This concept is present in the National Health Care Policy for Indigenous Peoples in Brazil 2, in line with the perspective of the social determinants of health. In this interpretive scheme, which is so central to public policies in many countries around the world, and also in Brazil, any and all harm that affects human populations involves, to some extent, biological aspects, but the main determinants of illness and death of populations are seen as primarily linked to ethnic, political and socioeconomic inequalities. But in the case of the health of indigenous peoples, arguments are sometimes put forward that are anchored in what we could call the other "face of the coin" of the concept of vulnerability. That's when the notion is based, predominantly - or completely, on arguments linked to genetic determination. Here, we want to comment on a recently published article in PLoS One by Leal et al. which, it seems to us, is particularly illustrative of an emphasis that, mistakenly, gives second place to the perspective of social determinants in the field of health in indigenous peoples. It is a specific study on risk factors for tuberculosis, but it can be used as an example of a given way of doing (or not doing) science, with direct implications for care practices and health policies.

Journal of Thoracic Oncology ; 16(3):S285-S286, 2021.
Article in English | EMBASE | ID: covidwho-1159457


Introduction: The first patient with COVID-19 in Portugal was diagnosed on March 2. There was a lack of knowledge concerning the risks of COVID-19 infection in lung cancer patients, prognostic factors, the influence of cancer treatments and cure criteria. Treatments and consultations were readjusted in order to maintain the ones that increase patients’ survival, while reducing the risks of SARS-CoV-2 infection. International and national “guidelines” were followed, but each hospital had its own strategies to reduce COVID-19 risk. Purpose: The Portuguese Lung Cancer Study Group launched a survey in order to study the early impact of COVID-19 in lung cancer patients, changes in treatments and the way of implementation of COVID-free circuits. Methods: A survey was sent to lung cancer doctors of all the Portuguese hospitals. Results: At the data cut-off, information from twenty one hospitals was collected, corresponding to about 66% (n=3.446) of each year new diagnoses of lung cancer in Portugal. In March and April there was a reduction in newly lung cancer diagnosed patients while comparing with 2019: in March, 86% had a reduction;in April, 90% of the hospitals reported a reduction and it was greater than 40% in eight hospitals (38%). About 62% of the doctors considered less referral from primary care as a cause, and 33% delayed biopsies or other imaging exams. The most difficult exams to obtain were CT guided biopsies and EBUS for 48%. The majority of the hospitals (57%) were also referral for COVID-19 patients’ treatment. In 48% of the lung cancer treating departments’ there were doctors reallocated to COVID-19 treatment areas. In 48% the assistance teams were divided into teams that weren’t previously working together. The majority of doctors (90%) reported having individual protection equipment available. Hospitals performed teleconsultation (100%), and, in seven hospitals (33%), more than half of the consultations were done using communication technology. All the hospitals were able to perform SARS-CoV-2 testing. It was done before every cycle of chemotherapy in 90% of the hospitals. In the majority (67%) it was only performed before day D1, in D1 and D8 chemotherapy protocols. About 19% reported changes in prescription of adjuvant chemotherapy and in maintenance chemotherapy, 33% increased the prescription of oral chemotherapy, 33% changed the periodicity, 29% reported reduction in inclusion in clinical trials. In 33% there was an earlier end of chemotherapy in ECOG2 and vulnerable patients. In 38% the prescription of G-CSF (Granulocity-colony stimulating factor) increased, being used for prophylaxis if the risk of febrile neutropenia was more than 10-15%. The periodicity of consultations was changed for patients under TKI treatment in 86%, and 67% hospitals reported changes in immune checkpoint inhibitor treatment schedule. In 29% oral drugs could be delivered at patients’ home. All the patients admitted for surgery were tested for SARS-CoV-2, and 86% performed SARS-COV-2 testing before radiotherapy. Conclusion: Portuguese hospitals responded to the sudden need of creation of COVID-free circuits, change protocols and even teleconsultation. With a larger follow up we will study the late consequences of COVID-19 pandemic in lung cancer diagnosis and treatment. Keywords: COVID-19, survey, Portuguese Lung Cancer Study Group