COVID-19 and its coping strategies among the residents of the Mario Lago Settlement, Ribeirao Preto, State of Sao Paulo

The objective of this study was to describe the health situation regarding the pandemic of COVID-19 and its coping strategies among residents of the Mario Lago Settlement, belonging to the Fazenda da Barra Sustainable Development Project (PDS) located in Ribeirao Preto, state of Sao Paulo. This is a cross-sectional, descriptive, survey-type study with stratified random sampling. A total of 158 residents, aged between 18 and 84 years, were interviewed between October 26, 2021, and January 28, 2022. The results obtained expose a situation of social vulnerability of its population, in which only 23.4% of the interviewees reached high school, and 95.6% have a family income of up to three minimum wages. Among the study participants, 17.1% tested positive for a COVID-19 test, and 42.4% reported that the pandemic significantly decreased household income, while 3.8% were left without income. In order for the settled populations to be better prepared for future crises such as the one caused by the COVID-19 pandemic, it is necessary to continue the actions already taken by the social and popular movements in the countryside and ensure the maintenance and development of social support networks.

RNA INTERFERENCE IS THE BASIS OF HUMAN ANTIVIRAL DEFENSE

Comparative analysis of antiviral protective mechanisms in protozoa and RNA interference of multicellular organisms has revealed their similarity, also providing a clue to understanding the adaptive immunity. In this article, we present the latest evidence on the importance of RNA-guided gene regulation in human antiviral defense. The role of neutralizing antibodies and interferon system in viral invasion is considered. The new concept has been introduced, i.e., antiviral protection of any living organism is based on the intracellular RNA-guided mechanisms. Simple and effective defense against viruses is that spacer segment of the viral DNA is inserted into the cellular chromosomes. Upon re-infection, the RNA transcript of the spacer directs nuclease enzymes against the foreign genome. This is a really adaptive immune defense that any cell potentially possesses. In humans, the interferon system provides an additional tool for early suppression of viral infections which shifts the cells to the alert regimen, thus preventing further spread of infection. The main task of the human central immune system is to maintain integrity and combat foreign organisms. Accordingly, a suitable index of acquired antiviral immunity should be a presence of specific spacer markers in DNA samples from reconvalescent persons, rather than detection of neutralizing antibodies, B and T memory cells. This article is addressed primarily to general medical community, and its practical conclusions are as follows: 1. Presence or absence of specific antibodies to SARS-CoV-2 is not a prognostic sign of the disease. Detection of specific antibodies in blood simply reflects the fact that the person has contacted with the viral agent. Absence of antibodies does not mean a lack of such contact, and the persons with high titers of specific antibodies are not protected from re-infection with SARS-CoV-2. 2. PCR testing: The PCR results may remain "false positive” in those subjects who have had COVID-19, if the genetic material is taken from the site of initial virus contraction (mainly, nasopharynx). In our opinion, negative PCR tests for COVID-19 in blood plasma and urine will be a more correct index for the absence of the disease, even with positive PCR tests from the nasopharyngeal samples. 3. It is necessary to draw attention of general practitioners to potential usage of retinol in prevention and treatment of COVID-19, given the importance of RLR receptors in recognition of viral RNAs and positive experience of vitamin A administration in measles, another dangerous viral disease. © 2022, SPb RAACI.

COVID-19 pandemic: what are the countries with low cases of COVID-19 doing right?

As of the 17th of September in 2021, the number of confirmed cases of COVID-19 over the world had reached 227.7 million, with around 8.2 million of those instances being reported in Africa and the island nations of the Atlantic and Pacific. The development of the COVID19 pandemic in Africa and other countries across the world has been significantly different from the first apocalyptic forecasts researchers in the scientific community provided. This is the case both in terms of the pandemic itself and its impact. This report investigates the factors - such as the political will to address COVID-19 through immediate and severe actions, collaborative leadership, and historical experience with infection disease outbreaks - that are responsible for the low reported cases of infections and deaths in two regions of the world: Africa and the island countries of the Atlantic and Pacific. In Africa, the political will to address COVID-19 through immediate and severe actions was high, and collaborative leadership was prevalent. Despite the fact that they have handled the pandemic in an effective way, vaccination continues to be a major worry because only a tiny fraction of the population in each of these locations has received at least one dose of vaccine. The healthcare systems in the countries located throughout these regions are in a poor shape, and an outbreak of a highly infectious coronavirus variety has the potential to overwhelm the already frail healthcare system and wreak havoc on these global regions. It is recommended that the leadership of these regions turn their attention inward and develop a collaborative strategy for the production of vaccines on a local level. Additionally, it is recommended that these regions make improvements to their healthcare systems so that they are adequately prepared to deal with the next major public health emergency. Copyright © 2022 The Authors.

COVID-19 mRNA Vaccine Degradation Prediction By Using Deep Learning Algorithms

The worldwide coronavirus (COVID-19) pandemic has accelerated substantially in the 2020, necessitating a global collaborative from various entities to create and speed vaccine development to prevent illnesses and deaths. Because of its fast development, high efficiently, safe administration, and low-cost production, messenger RNA (mRNA) has emerged as a significant technology in this epidemic. However, due of the inadequate in vivo distribution of mRNA, its chemical qualities make it difficult to use the vaccine. As a result, the goal of this study is to create and construct a sequence deep model that will be used to predict the degradation rate of the COVID-19 mRNA vaccine using five reactivity values for each place in the mRNA sequence. The probability degradation rate with/without magnesium at pH10 and 50°C was one of four of these values. The fifth reactivity value shows the likelihood of the RNA sample's secondary structure. The numerical and categorical properties of the deep learning model are the most important. Categorical features are referred from the structures, sequences, and predicted loop of the mRNA sequence, while numerical features are extracted via mathematical computations. 6 models of bidirectional layers models (LSTM, GRU, LSTM+GRU (L_GRU), GRU+LSTM (G_LSTM), LSTM+GRU+LSTM (L_G_LSTM), and GRU+LSTM+GRU (G_L_GRU) give trustworthy projected outcomes because it comprises five reactivity values and validate by mean columnwise root mean square error (MCRMSE). The MCRMSE results are then used to evaluate the performance. The stronger the prediction model, the smaller the values are. The best-fitting model is L_G_LSTM with the MCRMSE difference of 0.007 will be implemented into a Graphical User Interface (GUI) prediction system. © 2022 IEEE.

Vaccine education to the rescue of students in the COVID-19 revolution

The COVID-19 has been observed as the Fifth Industrial Revolution (5IR) which has naturally advanced education five/ten years ahead of digitalisation. The COVID-19 revolution has obliged everyone to be a student needing to be educated about national lockdowns, personal hygiene practices, digital technologies, and vaccines. This study intended to explore lessons learned by higher education institution (HEI) students in Eswatini, Lesotho, the Republic of South Africa, and Zimbabwe during the COVID-19/5IR which helped them to complete their PhD studies. Using purposive with convenience sampling, this study selected twenty most accessible PhD students. The pragmatic paradigm, participatory action research (PAR), and natural identity were used to frame this study in order to guide reflective activities, Zoom focus-group discussions, and semi-structured interview data-generation methods. Findings indicated that students achieved good education on personal hygiene practices and digital technologies that assisted them to effectively deal/continue with their studies. However, education on vaccines remained a major concern because participants believed that the world was treating symptoms of COVID-19 by vaccinating humans more than dealing with the source/s of the virus before it affected humans. Consequently, this study recommends a good education that balances personal, societal, and professional needs in order to understand natural identities.

Stock Market Performance of the US Hospitality And Tourism During the Covid-19 Pandemic

In this study, the stock market performance of the travel and leisure industry during the COVID-19 pandemic is investigated by use of the three-regime Markov switching model. The analysis employs daily data for six subsectors (airlines, gambling, hotels, leisure services, restaurants and bars, as well as travel and tourism) for the US from January 2018 to November 2021. Estimation results provide strong evidence of regime switching behavior with wide differences across subsectors during the course of the COVID-19 pandemic. A longer duration of high volatility characterizes the airline and leisure services indices. These sectors exhibit the most pronounced downturn that was not fully recovered in November 2021. In contrast, the period of high volatility in the restaurant, gaming, and hotel industries is relatively short, and stock market performance recovers almost to the general trend. Of all subsectors, restaurants and bars experience the shortest duration of high volatility, limited to the second quarter of 2020. The stock market indices for the travel and tourism industry (mainly car rentals) are also highly volatile, but this pattern was observed already before the pandemic.

Examining Effects of a Physical Activity Intervention on Exercise Capacity and Cardiovascular Function Among Patients With Lymphoma and Breast Cancer Undergoing Treatment

Introduction. Patients receiving serial outpatient infusion treatment for lymphoma or breast cancer (BC) with potentially cardio-toxic chemotherapeutic regimens may experience declines in left ventricular ejection fraction (LVEF) and exercise capacity. This study sought to determine if a physical activity intervention (PAI) administered during cancer treatment could attenuate deterioration of exercise capacity and LVEF. Methods. Across two NCI funded cancer centers, we randomized (2:1) 34 participants to a homebased PAI or healthy living education intervention (HLI) within 6 weeks of initiating curative therapies for stage I-IV Hodgkin's, non-Hodgkin's lymphoma, or stage I-III BC (NCT01719562). Training programs were tailored by treatment and functional status and adapted for remote delivery during COVID-19. Exercise capacity was determined via cardiopulmonary exercise test (peak VO2 [ml/kg/min]) and LVEF (%) was determined by magnetic resonance imaging at baseline, 3, and 6 months. Separate linear mixed-effects regression models controlling for baseline values examined changes in peak VO and LVEF by time and treatment group. Results. Demographics were similar between the two arms (PAI vs. HLI, 52.4 [16.3] vs. 56.8 [12.7] years of age [SD];69% vs. 75% white;and 57.7% vs. 50% female). Peak VO 2increased at 3 (+1.15 ml/kg/min [CI: -1.46 - 3.77]) and 6 months (+3.88 ml/kg/min [CI: 0.79 - 6.96]) in the PAI arm, while the HLI arm increased slightly at 3- (+0.67 ml/kg/min [CI: -5.14 - 6.48]) but not 6 months (-0.83 ml/kg/min [CI: -5.99 - 4.33]). LVEF declined slightly at 3 months in the PAI (-2.29% [CI: -4.83 - 0.25]) but not HLI arm (3.05.% [CI: -2.49 - 8.60]), while at 6 months, the PAI arm had returned to baseline LVEF (-0.58% [CI: -4.30 - 3.14]) and the HLI arm declined slightly (-1.76% [CI: -7.23 - 3.71]). Conclusions. This pilot RCT suggests the importance and utility of home-based physical activity during cancer treatment in protecting against expected declines in exercise capacity and LVEF. These results highlight the need for larger randomized trials that examine the effects of lifestyle interventions administered during treatment to improve quality of life and to support long term cardiovascular health in cancer survivors.

Spike Proteins Increase Endothelial Calcium via TRPV4

Introduction: Endothelial dysfunction plays a central role in the pathogenesis of acute respiratory distress syndrome (ARDS) with COVID-19. Transient receptor potential vanilloid 4 (TRPV4), a cation channel ubiquitously expressed, can regulate inflammatory cytokines that play key roles in in acute lung injury/ARDS. However, it is unknown whether spike proteins can affect TRPV4 activity and related Ca2+]signaling in pulmonary microvascular endothelial cells. Hypothesis: We hypothesized that spike protein causes activation of TRPV4 channels, resulting in increases in intracellular Ca2+], may lead to pulmonary endothelial dysfunction. Method(s): Intracellular Ca2+]concentrations in human lung microvascular endothelial cells (HLMECs) were measured by calcium imaging in the presence of SARS CoV-2 Spike protein S1, receptor-binding domain (RBD) of S1, or protein S2 with or without co-incubation of the selective TRPV4 antagonist (HC-067047). Result(s): The intracellular Ca2+]concentration of HLMECs was significantly increased when incubated with S1 (1, 10nM) or S1 RBD (1, 10nM) for 12, 24, 48 hours, relative to control or S2 (p<0.05, respectively, Fig. A, B). Co-incubation of HC-067047 (500nM) significantly attenuated Ca2+]intracellular influx upon treatment with S1 (10nM, 24 hours, p<0.05) or S1 RBD (10nM, 24 hours, p<0.05) (Fig. C). TRPV4 sensitive current density was significantly increased when incubated with S1 (10nM) or S1 RBD (10nM) for 24 hours (p<0.05 vs. control, respectively, Fig. D-G), whereas co-incubated with HC-067047 (500nM) significantly reversed the S1 (10nM, 24 hours, p<0.05) or S1 RBD (10nM, 24 hours, p<0.05) induced increases of TRPV4 sensitive current density (Fig. D-G). Conclusion(s): The of SARS CoV-2 Spike protein S1 and S1 RBD caused the activation of TRPV4 channels, resulting in increased intracellular Ca2+], may lead to pulmonary endothelial dysfunction. (Figure Presented).

Constitutions vs. COVID-19: CrowdLaw as an Alternative in Crisis and Recovery

Coronavirus has activated the main constitutional mechanisms set in place to face exceptional circumstances in all countries that can be considered consolidated democracies. Constitutional systems make it possible for constituent powers to limit fundamental rights that are the cornerstone for the full exercise of citizenship in a democracy. Thus, for example, lockdowns and limitations on gatherings, de iure and de facto, limit or eliminate the right to assembly. Exception—constitutional instruments, that also allow for the transfer of parliamentary functions to the Executive power, are mostly designed, and many times thought to be exclusively used in extreme circumstances: wars or natural disasters that have an immediate impact on millions of people (causing death, the loss of the home or massive displacement, etc.). In these cases, it is assumed that parliaments and citizens must enter survival mode, and because of that, there is no reason to think that any type of citizen participation is possible. However, despite the gravity of COVID-19, the situation does not conform to the pattern I have just described. Most citizens, surely those that tend to participate in the ordinary democratic process, have been able to adapt their lives to the confines of their own homes thanks to civic responsibility and technology: work, education, socialization, shopping, etc. If this is so, why has the decision-making process not been able to adapt to the COVID pandemic? Furthermore, if citizen input is essential to control the situation and social distancing is a must, why is technology not the cornerstone of citizen's data recollection? This work analyzes the existing constitutional framework and the main governmental measures (norms and actions) adopted, in order to detect in which stages (out of the five basic policy and law-making stages) citizen participation could have been integrated, and how CrowdLaw might have helped to make participation more effective, and if CrowdLaw can help palliate the constitutional impact resulting from a pandemic, particularly in regard to the exercise of citizen participation, and in improving the quality and effectiveness of any measure that has been adopted. I argue that constitutional norms are compatible with CrowdLaw because they do not rule out the activation of CrowdLaw procedures neither in normal nor in exceptional circumstances. © 2022 Association for Computing Machinery.

Multisystem Inflammatory Syndrome in Adults (Mis-a) after Covid-19 Infection

INTRODUCTION: Multisystem Inflammatory Syndrome was first described in children (MIS-C) after COVID-19 infection, it is characterized by gastrointestinal symptoms, shock, fevers, elevated inflammatory markers, and systolic dysfunction. A few similar presentations have also been reported in young adults designated as Multisystem Inflammatory Syndrome Adult type (MIS-A). Often, due to multi-organ involvement, extensive testing is undertaken with no yield of a clear etiological factor. We present a case of a 23-year-old male who was admitted into the Critical Care Unit for Encephalopathy with multi-organ dysfunction. DESCRIPTION: A 23-year-old male with a medical history of Williams-Campbell syndrome complicated by severe bronchiectasis and obstructive lung disease requiring 2 liters of oxygen at baseline, presented to the hospital with severe Encephalopathy, notably, he tested positive for COVID-19 one month before presentation with no increase in oxygen requirements until hospital presentation. Vitals were otherwise stable. Initial lab values were significant for an elevated AST of 6,620, ALT of 9,540, Creatinine of 4.71, Troponin-I of 3,913, CRP of 19.2, IL-6 of 22.1, and Ammonia of 171. Further investigative workup, including imaging, did not reveal a clear etiology for his presentation. An Echocardiogram however showed left ventricular dysfunction with an ejection fraction of 41%. Management included: broad-spectrum antibiotics which were discontinued after negative infectious workup, steroids for a suspected exacerbation of his lung condition, lactulose, and CRRT being initiated due to worsening renal function which was attributed to cardiac dysfunction leading to Acute Tubular Necrosis. MIS-A was eventually suspected as a diagnosis of exclusion considering the recent history of COVID-19 infection. Steroids were continued leading to gradual improvement of lab values. DISCUSSION: With COVID-19 continuing to make an impact, it is essential to be cognizant of various presentations and sequela. There have been multiple reports of different kinds of sequela, such is our case of MIS-A for which a long steroid taper is the mainstay of treatment. We want to raise awareness in the medical community of the possible consequences of COVID-19 infection such as MIS-A.

Impact of Mask Mandate Timing on Community Transmission of SARS-CoV-2 in the St. Louis Metropolitan Area

Background. Mask mandates have been a widely used public health tool during the COVID-19 pandemic, but how to optimize their impact in the setting of concurrent but spontaneous population-level behavior changes due to rising case counts is not known. This study aimed to examine how earlier or later mask mandate implementation in the context of spontaneous behavior change would have affected transmission of SARS-CoV-2 and severe COVID-19 outcomes in the St. Louis, Missouri area. Methods. Our model utilized aggregated hospitalization and death data for St. Louis city and county residents admitted to nearly all hospitals in the metropolitan area. We first fit a real-life model to estimate changes in transmission after the July 3, 2020 mask mandate, and then created counterfactual scenarios in which 1) 10%, 25%, and 50% of the changes were attributed to the mandate (as opposed to spontaneous behavior change) and 2) the mandate was implemented 3 or 7 days earlier, or 7 or 14 days later. We used an SEIR (Susceptible-Exposed-Infectious-Recovered) model framework and fit models in R. Results. Assuming that 50% of increased masking was due to the mandate, implementing a mandate 7 days earlier was associated with a reduction from 12,685 (IQR: 10,463-16,560) to 12,294 (10,296-15,205) cumulative hospitalizations by September 30, while a 2-week delay was associated with an increase to 13,277 (10,808-17,908) hospitalizations. Trends were similar, but with reduced magnitude, when assuming that 10% or 25% of increased masking was due to the mandate (Figure). Depending on whether 10%, 25%, or 50% of increased masking was due to the mandate, implementing the mandate 1 week early was associated with a return to baseline (June 26) hospital census 1-7 days earlier, while delaying the mandate by 2 weeks led to a 2-12 day delay in return to baseline. Hospital census and cumulative deaths in the real-life (baseline) model and under 12 counterfactual scenarios which vary mask mandate timing (3 or 7 days earlier, or 7 or 14 days delayed) and percentage of increase in masking that is attributed to the mask mandate (Panels A-B: 10%, Panels C-D: 25%, and Panels E-F: 50%). As more of the increase in masking is attributed to the mandate, the costs of delaying the mandate and the benefits of earlier implementation increase. While differences in hospital census are most apparent several weeks after the mandate, differences in deaths gradually become more apparent over time. Conclusion. Impact of a mask mandate depends on both timing and percent of increased masking that is attributed to the mandate. Implementing a mandate even a few days earlier is associated with fewer cumulative hospitalizations and earlier return to baseline, but the overall duration of implementation is slightly longer. Given wide variations in public behavior, locally-tailored models are essential for estimating the impact of interventions and informing the local public health response.

Biphenyl furanocoumarin compounds inhibit SARS-CoV-2 spike pseudovirus infection by binding ACE2

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), is a highly infectious disease with a significant impact on global public health security, and the development of effective antiviral drugs is warranted. In this study, based on HEK293 membrane chromatography (CMC) model that overexpresses angiotensin-converting enzyme 2 (ACE2), we screened six compounds with long retention time on ACE2h/CMC, namely BU-1 to BU-6, from the biphenyl furanocoumarin compounds previously synthesized by our team. The binding properties of the screened compounds to ACE2 were investigated by frontier analysis. Cytotoxicity assay, virtual molecular docking assay and pseudo-viral invasion assay were used to examine the affinity and potential antiviral activity of the selected compounds towards ACE2 protein. The virtual molecular docking results showed that BU-1, BU-2 and BU-5 could form significant hydrogen bonds with hotspot amino acid residues on the ACE2 receptor. And BU-1, BU-2 and BU-5 significantly inhibited the ability of SARS-COV-2 pseudovirus to enter ACE2h cells. Therefore, BU-1, BU-2 and BU-5 have the potential to be used as lead compounds for further modification to develop more effective anti-SARS-CoV-2 drugs. Copyright © 2023 The Royal Society of Chemistry.

Initial Psychotic Episode in a Patient with an Inborn Error of Cobalamin Metabolism Methylcobalamin Type cblG Deficiency: A Case Report

Background: The relationship between neuropsychiatric disorders and cobalamin deficiency is well known, but little information is available on psychiatric complications of inborn errors of intracellular cobalamin metabolism. These patients present with developmental delay, seizures, dementia and psychosis, causing elevated levels of homocysteine and intrinsic vitamin B12 deficiency (Watkins, 2011). In this report, we describe the manifestations and successful psychiatric treatment of a patient with an inborn error of cobalamin metabolism. Case: Mr. W is a 23-year-old male with cobalamin G defect, who was hospitalized for encephalopathy and hallucinations. Notable past medical history includes chronic kidney disease, seizures, intellectual disability, and hypothyroidism. He has no significant past psychiatric history. Due to the COVID-19 pandemic, the patient was increasingly isolated. Psychosis began with disorganized thoughts, progressing to delusions and eventually both auditory and visual hallucinations. Other notable exam findings include blunted affect and psychomotor retardation. Homocysteine levels were elevated from baseline. Cerebrospinal fluid showed elevated protein levels with the presence of 3-0-meythldopa. Risperidone was initiated, then switched to olanzapine due to reported side effects with persistence of psychosis. He was switched from olanzapine to aripiprazole after cross-titration and optimized on aripiprazole 10mg nightly, leading to a resolution in his psychiatric symptoms. Discussion(s): Mr. W's increased isolation may have led to increased stress, which has been associated with high levels of homocysteine in the literature (Gun Kang, 2005). Elevated homocysteine is reported in individuals with neuropsychiatric disorders (Moustafa, 2014). Additionally, high levels of homocysteine are linked with inflammatory bio-makers (Li, 2015). Aripiprazole and risperidone have been shown to decrease inflammatory biomarkers in patients with psychosis (Juncal-Ruiz, 2018). Conclusion(s): Patients with inborn errors of cobalamin metabolism have increased levels of homocysteine, which is associated with an inflammatory response and neuropsychiatric disorders. We recommend that psychosis in patients with an inborn error of cobalamin metabolism be initially treated with risperidone, and aripiprazole as a second-line treatment. Learning Objectives: 1. Describe the relationship between metabolic cobalamin deficiency and psychosis. 2. Question the role of transient biomarker elevation and psychosis. 3. Assess the treatment considerations for patients with metabolic cobalamin deficiency. References: 1. Watkins, D. & Rosenblatt, D. S. Inborn errors of cobalamin absorption and metabolism. American Journal of Medical Genetics 2011:157:33-44. 2. Gun Kang, M. et al. Job stress and cardiovascular risk factors in male workers. Preventive Medicine 2005;40:583-588. 3. Moustafa, A. et al. Homocysteine levels in schizophrenia and affective disorders-focus on cognition. Front Behav Neurosci 2014;8:343. 4. Li, T. et al. Serum Homocysteine Concentration Is Significantly Associated with Inflammatory/Immune Factors. PLOS ONE 2015;10:e0138099. 5. Juncal-Ruiz, M. et al. Comparison of the anti-inflammatory effect of aripiprazole and risperidone in 75 drug-naive first episode psychosis individuals: A 3 months randomized study. Schizophrenia Research 2018;202:226-233. Copyright © 2022

Risk and Prospective Returns: The Case of European and Asian Financial Markets

The paper examines the use of different GARCH type models to capture the impact of normal movement and the impact during a crisis (e.g., Covid pandemic) for capturing the volatility of randomly selected stock markets in European and Asian countries. This case is based on daily data from DAX - Germany, IBEX- Spain, CAC - France, BEL - Belgium, ATX - Austria, SZSE - China, NIKKEI - Japan, KOSPI - South Korea, IKSE - Indonesia, and HANG SENG - Hong Kong. It is found that GARCH is the most robust model to estimate volatility even during a crisis period;EGARCH demonstrates persistence in volatility and capturing leverage effects;EGARCH also remains the best quality model, apart from the symmetric model. Further, the models captured difference in magnitudes of European and Asian stock markets with different volatility movement patterns. Some Asian markets showed more adverse performance than European markets during the same time-period creating differences in asset pricing, risk magnitudes and prospective returns. The study demonstrates the relative effect on asset prices and changes in values of investors and determines the parameter for risk and returns in Europe and Asia.

NHS WALES FACING FINANCIAL DIFFICULTY: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

NHS leaders have told governments what UK and Welsh funding priorities should be in future budgets as fears grow some Welsh NHS organizations will not break even this financial year. According to a new paper by the Welsh NHS Confederation, government needs to review the long-term funding model for health and social care because without further investment, patient experience and quality of care will suffer. NHS leaders say funding priorities should include the ongoing costs of Covid-19, recovery of care services, the backlog in elective care and the maintenance of NHS estates -- including reducing carbon emissions. The rising cost of healthcare was blamed on Covid-19, a growing and ageing population, developments in medical technology, increases in energy prices, pay and price inflation, pharmaceutical developments, and recruitment and retention challenges, while both demand on, and expectations of, the NHS continue to increase.

The impact of the COVID-19 pandemic on Austrian agriculture and forestry: representative telephone survey among farmers

This study quantified the consequences of the Covid-19 pandemic for the agricultural sector and derived long-term options to make agricultural and forestry enterprises more resilient. Almost one in five farm households had at least one person affected by a SARS-CoV-2 infection by March 2021. The psychological stress in farming families was comparable to that in the population as a whole. Economically, negative impacts of the pandemic clearly outweighed the positive ones, with large differences among farm sectors. Around one in four farms considered strategic changes in consequence of the Corona crisis, with direct marketing being the most frequent strategy in this context. Austrian farmers consider their farms quite crisis-proof, although they heavily depend on public funds and respondents rated their cuts as the greatest potential threat. Finally, the study suggests that the impact of the Corona crisis on Austrian agriculture and forestry was still manageable, at least until March 2021, and motivated farmers to make isolated adjustments only.

Overview of the training course for the development of public health center directors implemented by the National Institute of Public Health

The training course for public health center directors is one of the National Institute of Public Health (NIPH) training courses . This course is designed to help local government officials who do not meet the qualifications for public health center directors as stipulated in the Enforcement Order of the Community Health Law to meet the requirements for appointment. Over the past 20 years, a total of 360 people has taken the course. This training course has been conducted face-to-face, but it is now being conducted online due to the COVID-19 pandemic. This report aims to review the history of this training course and outline its prospects.

Prevalence of Iron-Deficiency Anemia in Infants Living in Rural Areas and the Factors that Influence it in the Pandemic COVID-19 Era

BACKGROUND: Iron-deficiency anemia (IDA) is caused by inadequate intake of iron or impaired erythrocyte formation due to chronic blood loss. AIM: This study aimed to obtain data on the prevalence of iron deficiency and IDA in the pandemic COVID-19 era and to investigate the relationship of infant nutritional status, maternal education, maternal occupation, maternal parity, and family income with the prevalence of iron deficiency and IDA in infants 9-12 months at the Cempaka Banjarbaru Community Health Center. METHOD(S): A cross-sectional analytic descriptive approach was used with a consecutive sampling technique to conduct this study. The sample consisted of 50 infants between 9 and 12 months old that had completed blood count and peripheral blood smear at measles immunization in May-September 2020 at the Cempaka Banjarbaru Community Health Center. RESULT(S): The results showed that the prevalence of iron deficiency, IDA, and hemolytic anemia was 16%, 28%, and 22%, respectively. Meanwhile, the data analysis was conducted using Chi-square and Fisher's exact test. The results showed a significant relationship between family income factors and the prevalence of iron deficiency and IDA (p = 0.023). CONCLUSION(S): Infants at the age of 9-12 months need to have a complete blood count examination to detect an earlier iron deficiency and IDA. Copyright © 2022 Harapan Parlindungan Ringoringo, Imanuella Yessy Natalia, Roselina Panghiyangani, Edi Hartoyo, Rahmiati Lao.

New perspectives of experiential tourism: an exploratory analysis of live virtual tours during the COVID-19 outbreak

Purpose>This paper aims to find out if it is possible to consider live virtual tours, in the connotation assumed during the COVID-19 outbreak, as experiential tourism products. The paper focuses on Holbrook's “four Es” (“experience”, “entertainment”, “exhibitionism” and “evangelising”) to study the experience of live virtual tours.Design/methodology/approach>This article develops an exploratory analysis and presents a content analysis of 1052 reviews of 108 live virtual tours posted on TripAdvisor and Viator.Findings>The findings show that live virtual tours are perceived as experiences, all “four Es” are covered and two more sub-categories emerge.Research limitations/implications>The analysis is limited to the perception of tourists that are confident with the technology, to a small sample and a period of travel restrictions due to the COVID-19 outbreak.Practical implications>Live virtual tours create a new segment, which “travels from home”. This does not preclude tourists from deciding to physically visit the places seen virtually.Originality/value>Research on the analysis of the reviews of live virtual tours has not yet been carried out.

An Unusual Case of ANCA Associated Vasculitis (AAV) After a COVID-19 Vaccine

Introduction: COVID-19 vaccines have been related to immune mediated adverse events and recently some case reports of AAV precipitated after either RNA or viral vector vaccines have been reported. Case Description: A 83 year old woman with past records of polymyalgia rheumatica (2017) treated with low dose prednisone, was admitted to our hospital because of malaise, hyporexia and weight loss in the context of urinary symptoms. These started since the second COVID-19 Pfizer- BioNTech vaccine dose administred 3 months ago. Initial blood test revealed anemia, acute kidney injury (serum creatinine 1.7mg/dl), leucocytosis and elevated CRP. Urinalysis showed microhematuria and mild proteinuria in the context of a positive urine culture. She had normal kidneys on ultrasonography. Diuretics and antibiotics were started, but few days after renal function continued worsening (sCr 4,3 mg/dl) with an active sediment. For this reason, immunology tests were ordered with positive high MPO-ANCA antibodies. Hence, a kidney biopsy was performed showing 11 normal glomeruli but severe arteritis in two small-middle sized arterioles with fibrinoid necrosis. Steroids and Rituximab were given as induction therapy with good renal response. Discussion(s): AAV after COVID-19 vaccine administration has been reported previously, and it could be related to its molecular mimicry and immune crossreaction. Most of them were typical forms of pauci-immune crescentic glomerulonephritis, but none with isolated vascular damage. Although cases reported appeared shorter time after vaccine administration, our patient was on low dose prednisone which may explain a subacute onset of the disease. Moreover, she clearly presented constitutional sypmtoms ever since the second vaccine dose was administred. Finally, although the efficacy and safety of the COVID-19 vaccines have been demonstrated, particular attention should be paid to patients with known or suspected autoimmune diseases.