Representação social da Covid-19 para a população de uma cidade de pequeno porte / Social representation of Covid-19 for the population of a small-sized city / Representación social del Covid-19 para la población de un pequeño pueblo

Objetivo: analisar a representação social da Covid-19 para a população geral de uma cidade de pequeno porte do Estado do Rio de Janeiro. Método: estudo qualitativo, apoiado na abordagem estrutural das representações sociais. Participaram 100 usuários de serviços de saúde. Os dados foram coletados por questionário sociodemográfico de evocações livres de palavras e roteiro de entrevista semiestruturada. Os dados foram analisados com o auxílio dos softwares Excel, EVOC 2005 e análise de conteúdo temático-categorial para contextualização das evocações respectivamente. Resultados: os termos do possível núcleo central foram: morte, sofrimento, cuidados, ansiedade-angústia e vacina. Na primeira periferia: medo e prevenção. À segunda periferia: informação-desinformação; desgoverno; ter-fé e proteção. A zona de contrate: doença; isolamento-social; dificuldades; catástrofe-mundial; desemprego e pandemia. Considerações finais: marcaram essa representação os impactos psicossociais negativos resultantes da desestruturação da vida e das mortes ocasionadas pela nova doença, no entanto o grupo aderiu as medidas de cuidados de proteção.

Objective: to analyze the social representation of Covid-19 among the general population of a small-sized city in the State of Rio de Janeiro. Method: Qualitative study, based on the structural approach of social representations. One hundred healthcare service users participated. Data were collected through a sociodemographic questionnaire, free word evocation, and a semi-structured interview guide. The data were analyzed using Excel software, EVOC 2005, and thematic-categorical content analysis for contextualization of the evocations, respectively. Results: the terms of the possible central core were: death, suffering, care, anxiety-distress, and vaccine. In the first periphery: fear and prevention. In the second periphery: information-misinformation; mismanagement; having faith and protection. The contrast zone: disease; social isolation; difficulties; global catastrophe; unemployment; and pandemic. Final considerations: this representation was marked by the negative psychosocial impacts resulting from the disruption of life and the deaths caused by the new disease; however, the group adhered to protective care measures.

Objetivo: analizar la representación social del Covid-19 para la población general de una pequeña ciudad del Estado de Río de Janeiro. Método: estudio cualitativo, basado en el enfoque estructural de las representaciones sociales. Participaron 100 usuarios de servicios de salud. Los datos se recolectaron mediante un cuestionario sociodemográfico con evocación libre de palabras y una guía de entrevista semiestructurada. Los datos fueron analizados utilizando lo software Excel y EVOC 2005 y análisis de contenido temático-categórico para contextualizar las evocaciones respectivamente. Resultados: los términos del posible núcleo central eran: muerte, sufrimiento, cuidados, ansiedad-angustia y vacuna. En la primera periferia: miedo y prevención. En la segunda periferia: información-desinformación; desgobierno; tener fe y protección. La zona de contraste: enfermedad; aislamiento-social; dificultades; catástrofe-mundial; desempleo y pandemia. Consideraciones finales: esta representación se caracterizó por los impactos psicosociales negativos derivados de la desestructuración de la vida y de las muertes causada por la nueva enfermedad, sin embargo, el grupo adhirió a las medidas de protección.

[Social media as platforms for the visibility of gender-based violence during the COVID-19 pandemic in Colombia]. / Redes sociales como escenarios para la visibilización de las violencias basadas en género durante la pandemia de covid-19 en Colombia.

The purpose of this research is to identify predominant problematizations in Colombian feminist Instagram accounts regarding gender-based violence during the first year of the COVID-19 pandemic. Employing a qualitative approach, a digital ethnography based on the principles of netnography was conducted as an alternative to detail the social worlds constructed from online groups. Fifty pieces of content from @lainsumisa and twenty pieces of content from @feministasenconstrucción, published between March 2020 and March 2021, were selected based on observations made within the online fieldwork framework. These were analyzed using discourse analysis techniques. The findings discuss the following emerging categories: unpaid household work, romanticized harassment, fatphobia, and the violation of Black and racialized women's rights. In this context, cyberactivism is presented as an opportunity for the emergence of collectives and support networks for women advocating for gender equality and their rights, towards questioning patriarchal ideas that jeopardize their well-being.

El propósito de esta investigación es identificar las problematizaciones predominantes en cuentas feministas colombianas de Instagram, sobre las violencias basadas en género durante el primer año de la pandemia de covid-19. Desde un enfoque cualitativo, se realizó una etnografía digital basada en los preceptos de la netnografía, como alternativa para detallar los mundos sociales construidos a partir de los grupos en línea. A partir de las observaciones realizadas en el marco del trabajo de campo en línea se seleccionaron 50 contenidos de @lainsumisa y 20 contenidos de @feministasenconstrucción, publicados entre marzo de 2020 y marzo de 2021, los cuales se analizaron mediante técnicas de análisis del discurso. Entre los hallazgos se discuten las siguientes categorías emergentes: el trabajo no remunerado en el hogar, el acoso romantizado, la gordofobia y la vulneración a las mujeres negras y racializadas. Al respecto, se plantea el ciberactivismo como una oportunidad para el surgimiento de colectivos y redes de apoyo para las mujeres que luchan por la equidad de género y por sus derechos, hacia el cuestionamiento de ideas patriarcales que atentan contra su bienestar.

Exchange rate instabilities during the Russia-Ukraine war: Evidence from V4 countries.

Purpose: This study investigates the impact of the Russian Ruble on the Czech crown, Polish zloty, and Hungarian forint during the Russia-Ukraine war. The euro is used as a comparative base unit in the four exchange rate parities. The Euro was used since the Czech Republic, Hungary, Poland, and Russia maintain intensive economic relations with the Eurozone. At the same time, the Visegrad (V4) countries are geographically located in the European continent and are bordered by the Eurozone member states. Methods: The series stands in daily frequency and indicate the period from February 1, 2022, to February 1, 2023. To generate the results, the VAR impulse response function, variance decomposition, vector error correction model, and granger causality test were performed. Results: Even though Russia demanded that gas payments be made in Rubles, this fact did not affect the Czech crown, Polish zloty, and Hungarian forint. Due to the fact that gas payments for the V4 countries were agreed in Euros through German contractors. During this period, the strong influence of the Czech crown on the Polish zloty and the Hungarian forint is observed. Implications: From a policy perspective, the results provide indications for the national governments and regulatory bodies on the implications of the Russian ruble during this conflict. In short, our findings document that the instability of currency pairs is not only economic but also geopolitical. Energy dependence on autocratic states not only endangers national security but can set exchange rates in cardiac arrest. Moreover, the geographical proximity to the conflict zone tends to be decisive in the collapse of national currencies.

Miscelânea de sentimentos: reflexões de quem sobreviveu a covid-19 / Mixture of feelings: reflections of those who survived covid-19 / Mezcla de sentimientos: reflejos de quienes sobrevivieron al covid-19

O objetivo deste estudo foi compreender os sentimentos atribuídos à pandemia da COVID-19 por indivíduos que vivenciaram a doença. Trata-se de um estudo qualitativo que utilizou como referencial teórico o Interacionismo Simbólico e metodológico a Teoria Fundamentada nos Dados vertente construtivista, realizado em um município de médio porte situado na região noroeste do Paraná. A coleta de dados ocorreu no período de abril a novembro de 2021, por meio de entrevistas individuais mediadas por tecnologias. Os informantes foram 19 indivíduos hospitalizados pela COVID-19. A análise seguiu a codificação aberta e focalizada proposta pelo método. Os resultados demonstram como houve a ressignificação da pandemia da COVID-19 por indivíduos hospitalizados pela doença, sendo que este momento levou a uma maior valorização da vida e mudanças comportamentais. Conclui-se que os sentimentos revelaram uma nova percepção de vida diante do contexto da pandemia de COVID-19, com alterações de rotinas, sentimentos e readaptações, o que gerou o desenvolvimento de estratégias de enfrentamento.

The objective of this study was to understand the feelings attributed to the COVID-19 pandemic by individuals who experienced the disease. This is a qualitative study that used Symbolic and methodological Interactionism as a theoretical framework, the Data-Based Theory, constructivist aspect, carried out in a medium-sized municipality located in the northwest region of Paraná. Data collection took place from April to November 2021, through individual interviews mediated by technology. The informants were 19 individuals hospitalized by COVID-19. The analysis followed the open and focused coding proposed by the method. The results demonstrate how the COVID-19 pandemic was given new meaning by individuals hospitalized for the disease, and this moment led to a greater appreciation of life and behavioral changes. It is concluded that the feelings revealed a new perception of life, given the context of the COVID-19 pandemic, with changes in routines, feelings and readaptations, which generated the development of coping strategies.

El objetivo de este estudio fue comprender los sentimientos atribuidos a la pandemia de COVID-19 por parte de las personas que vivieron la enfermedad. Se trata de un estudio cualitativo que utilizó como marco teórico el Interaccionismo simbólico y metodológico, la Teoría Basada en Datos, vertiente constructivista, realizado en un municipio de mediano tamaño ubicado en la región noroeste de Paraná. La recolección de datos se realizó de abril a noviembre de 2021, a través de entrevistas individuales mediadas por tecnología. Los informantes fueron 19 personas hospitalizadas por COVID-19. El análisis siguió la codificación abierta y enfocada propuesta por el método. Los resultados demuestran cómo las personas hospitalizadas por la enfermedad dieron un nuevo significado a la pandemia de COVID-19, y este momento condujo a una mayor apreciación de la vida y cambios de comportamiento. Se concluye que los sentimientos revelaron una nueva percepción de la vida, dado el contexto de pandemia COVID-19, con cambios en rutinas, sentimientos y readaptaciones, que generaron el desarrollo de estrategias de afrontamiento.

A new emergency during the latest phase of the COVID-19 pandemic: access to healthcare services by patients with non-communicable diseases.

Background: The aim of our study was to investigate the impact of the COVID-19 pandemic on the healthcare and the disease management of patients affected by non-communicable diseases (NCDs), by exploring, specifically, the obstacles encountered in the access to healthcare services during the latest phase of the pandemic. Methods: This cross-sectional study was carried out among subjects attending the anti-SARS-CoV2 vaccination clinic in a Teaching Hospital of Southern Italy. To be included in the study, subjects had to be affected by at least one NCD, such as diabetes, hypertension, respiratory and heart diseases, renal and liver chronic conditions, immunodeficiency disorders due to cancer, or being kidney or liver transplant recipients. Results: Among the 553 subjects who completed the questionnaire, the 39.4% (95% IC = 35.3-43.6) experienced obstacles in the access to healthcare services in the six months prior to the enrollment. The most frequent canceled/postponed healthcare services were the visits for routine checks for NCDs (60.6, 95% IC = 53.9-67), control visits of more complex diseases as cancer or transplantation (17.3, 95% IC = 12.6-22.8), and scheduled surgery (11.5, 95% IC = 7.7-16.4). The patients who experienced canceled/postponed healthcare services were significantly more likely to suffer from 3 or more NCDs (p = 0.042), to be diabetics (p = 0.038), to have immunodeficiency disorders (p = 0.028) and to have consulted GP at least once (p = 0.004). Conclusion: Our results appear to be fundamental for guiding the choices of providers in order to concentrate organizational efforts to recover and reschedule missed appointments, where applicable, of the most fragile patients by virtue of age and chronic conditions.

Epidemiological characteristics and dynamic transmissions of COVID-19 pandemics in Chinese mainland: A trajectory clustering perspective analysis.

BACKGROUND: The corona virus disease 2019 (COVID-19) pandemic has spread to more than 210 countries and regions around the world, with different characteristics recorded depending on the location. A systematic summarization of COVID-19 outbreaks that occurred during the "dynamic zero-COVID" policy period in Chinese mainland had not been previously conducted. In-depth mining of the big data from the past two years of the COVID-19 pandemics must be performed to clarify their epidemiological characteristics and dynamic transmissions. METHODS: Trajectory clustering was used to group epidemic and time-varying reproduction number (Rt) curves of mass outbreaks into different models and reveal the epidemiological characteristics and dynamic transmissions of COVID-19. For the selected single-peak epidemic curves, we constructed a peak-point judgment model based on the dynamic slope and adopted a single-peak fitting model to identify the key time points and peak parameters. Finally, we developed an extreme gradient boosting-based prediction model for peak infection cases based on the total number of infections on the first 3, 5, and 7 days of the initial average incubation period. RESULTS: (1) A total of 7 52298 cases, including 587 outbreaks in 251 cities in Chinese mainland between June 11, 2020, and June 29, 2022, were collected, and the first wave of COVID-19 outbreaks was excluded. Excluding the Shanghai outbreak in 2022, the 586 remaining outbreaks resulted in 1 25425 infections, with an infection rate of 4.21 per 1 00000 individuals. The number of outbreaks varied based on location, season, and temperature. (2) Trajectory clustering analysis showed that 77 epidemic curves were divided into four patterns, which were dominated by two single-peak clustering patterns (63.3%). A total of 77 Rt curves were grouped into seven patterns, with the leading patterns including four downward dynamic transmission patterns (74.03%). These curves revealed that the interval from peak to the point where the Rt value dropped below 1 was approximately 5 days. (3) The peak-point judgment model achieved a better result in the area under the curve (0.96, 95% confidence interval = 0.90-1.00). The single-peak fitting results on the epidemic curves indicated that the interval from the slow-growth point to the sharp-decline point was approximately 4-6 days in more than 50% of mass outbreaks. (4) The peak-infection-case prediction model exhibited the superior clustering results of epidemic and Rt curves compared with the findings without grouping. CONCLUSION: Overall, our findings suggest the variation in the infection rates during the "dynamic zero-COVID" policy period based on the geographic division, level of economic development, seasonal division, and temperature. Trajectory clustering can be a useful tool for discovering epidemiological characteristics and dynamic transmissions, judging peak points, and predicting peak infection cases using different patterns.

Estratégias de enfrentamento na Atenção Primária à Saúde na pandemia de Covid-19 em Minas Gerais, Brasil / Coping strategies in Primary Health Care in the COVID-19 pandemic in Minas Gerais, Brazil

RESUMO Objetivou-se analisar as ações da Atenção Primária à Saúde (APS) em resposta à pandemia de Covid-19 em municípios de Minas Gerais. Trata-se de um estudo quantitativo, observacional e transversal. A coleta de dados foi realizada mediante a aplicação de um questionário on-line, no qual participaram 278 secretários municipais de saúde do estado de Minas Gerais e/ou coordenadores da APS. A estrutura em saúde se demonstrou capaz de proporcionar o desenvolvimento de funções gerenciais com base em dados e informações ao longo da pandemia. Entre as ações de enfrentamento na população, estão o uso de protocolos, de máscaras, utilização de barreiras físicas, penalidade por aglomeração e recursos de telefonia para o esclarecimento de dúvidas sobre a Covid-19. Quanto às dificuldades de controle dessa doença pelos colaboradores na APS, foram citadas baixa remuneração profissional, precária organização do trabalho, demora dos resultados nos exames, subnotificação, falta de equipamentos e recursos tecnológicos. Conclui-se que inúmeras medidas e ferramentas adotadas para o controle da pandemia foram utilizadas pelas autoridades municipais. No entanto, apesar de os recursos tecnológicos, como o e-SUS, disponibilizarem dados epidemiológicos sobre a Covid-19, capazes de auxiliar no planejamento de ações em saúde, essas ferramentas necessitam de aperfeiçoamentos.

ABSTRACT The aim was to analyze Primary Health Care (PHC) actions in response to the COVID-19 pandemic in municipalities in Minas Gerais. This is a quantitative, observational, and cross-sectional study. Data collection was carried out through the application of an online questionnaire, in which 278 municipal health secretaries from the state of Minas Gerais and/or coordinators of PHC took part. The health structure proved to be capable of providing the development of management functions based on data and information throughout the COVID-19 pandemic. Among the actions to face the population are the use of protocols, masks, use of physical barriers, penalty for crowding, and telephony resources to clarify doubts about COVID-19. As for the difficulties in controlling this disease by employees in the PHC, low professional remuneration, poor work organization, delay in test results, underreporting, lack of equipment and technological resources were mentioned. It is concluded that the numerous measures and tools adopted to control the COVID-19 pandemic were used by municipal authorities. However, despite technological resources, such as the e-SUS, providing epidemiological data on COVID-19, capable of assisting in the planning of health actions, these tools need to be improved.

Evaluating the influence of static management on individuals' oral health.

PURPOSE: This study aimed to evaluate the effect of static management on individuals' oral health-related quality of life (OHRQoL) according to the dynamic zero-COVID policy in China. METHODS: The digital questionnaire conducted with three sub-questionnaires was sent to 700 patients who accepted treatment at the Department of Stomatology, 363 Hospital. Data on demographic characteristics, the Oral Health Impact Profile-14 and willingness to invest in oral health were collected from the 658 completed questionnaires. According to the state of individuals' lives, participants were divided into two groups: a static management group (Group 1) and a nonstatic management group (Group 2). The scores of the Oral Health Impact Profile-14 and willingness to invest in oral health were compared between these two groups using IBM SPSS Statistics. RESULTS: The results showed that individuals undergoing static management reported better OHRQoL. Meanwhile, they also presented lower willingness to invest money and dental visits in oral health. Furthermore, according to the results of the logistic regression analysis, aging acts as a negative correlation factor for the OHRQoL of people undergoing static management, while the willingness to invest money and dental visits in oral health is defined as a positive predictor for OHRQoL. CONCLUSION: Static management effects the OHRQoL of individuals. Aging and WTIOH in money and dental visits are related the individuals' OHRQoL during static management.

Topic evolution and sentiment comparison of user reviews on an online medical platform in response to COVID-19: taking review data of Haodf.com as an example.

Introduction: Throughout the COVID-19 pandemic, many patients have sought medical advice on online medical platforms. Review data have become an essential reference point for supporting users in selecting doctors. As the research object, this study considered Haodf.com, a well-known e-consultation website in China. Methods: This study examines the topics and sentimental change rules of user review texts from a temporal perspective. We also compared the topics and sentimental change characteristics of user review texts before and after the COVID-19 pandemic. First, 323,519 review data points about 2,122 doctors on Haodf.com were crawled using Python from 2017 to 2022. Subsequently, we employed the latent Dirichlet allocation method to cluster topics and the ROST content mining software to analyze user sentiments. Second, according to the results of the perplexity calculation, we divided text data into five topics: diagnosis and treatment attitude, medical skills and ethics, treatment effect, treatment scheme, and treatment process. Finally, we identified the most important topics and their trends over time. Results: Users primarily focused on diagnosis and treatment attitude, with medical skills and ethics being the second-most important topic among users. As time progressed, the attention paid by users to diagnosis and treatment attitude increased-especially during the COVID-19 outbreak in 2020, when attention to diagnosis and treatment attitude increased significantly. User attention to the topic of medical skills and ethics began to decline during the COVID-19 outbreak, while attention to treatment effect and scheme generally showed a downward trend from 2017 to 2022. User attention to the treatment process exhibited a declining tendency before the COVID-19 outbreak, but increased after. Regarding sentiment analysis, most users exhibited a high degree of satisfaction for online medical services. However, positive user sentiments showed a downward trend over time, especially after the COVID-19 outbreak. Discussion: This study has reference value for assisting user choice regarding medical treatment, decision-making by doctors, and online medical platform design.

Which type of fear of cancer progression contributes to the quality of life of Romanian cancer patients during the COVID-19 pandemic?

Introduction: Fear of cancer progression (FoP) is one of the most frequently reported unmet needs invoked by the majority of cancer patients, which may significantly impair the quality of life (QoL) of patients. The major objective of the present cross-sectional study was to investigate the specificities of the relationship between different dimensions and intensity of FoP and different aspects of patients' QoL during the COVID-19 pandemic in Romania. Methods: A nationwide sample of 330 participants completed a survey, including measures of demographic characteristics, medical variables, QoL, and FoP. Multivariate General Linear and Hierarchical Regression Models were conducted in order to assess the relationship between variables. Result: Our results indicate that less than a quarter of the sample experienced low, between 63 and 70% moderate, and 15% high levels of FoP. Our results also indicate that anxiety/worry related to the possibility of progression of the disease, and loss of independence produced significant differences with large effect sizes in all the dimensions of QoL. Discussion: Our results indicate that besides affective reactions, the fear of cancer survivors to lose independence, not being able to attend to their own lives, seems to be a considerable threat, especially in the context of Romanian health system which has difficulties in offering qualitative psychosocial care for cancer patients. The idea that patients will have to rely on others and may not function well independently, not being able to attend to their own lives, seems to be a considerable threat, next to the experienced affective reactions per se.

Repercussões da pandemia de COVID-19 nos serviços de saúde para pessoas com deficiência: relato dos profissionais de reabilitação / Repercussions of the COVID-19 pandemic on health services for people with disabilities: report from rehabilitation professionals / Repercusiones de la pandemia de COVID-19 en los servicios de salud para personas con discapacidad: relato de los profesionales de la rehabilitación

Resumo: Diversos processos que permeiam a assistência à saúde, incluindo a reabilitação, precisam de brevidade para ser iniciados ou não podem ser interrompidos. Sendo assim, estes passaram por importantes adaptações durante a pandemia de COVID-19. Porém, não se sabe ao certo como os equipamentos de saúde adaptaram suas estratégias e quais foram os resultados. O estudo investigou como os atendimentos em reabilitação foram afetados durante a pandemia e quais foram as estratégias para a manutenção dos serviços prestados. Entre junho de 2020 e fevereiro de 2021, realizaram-se 17 entrevistas semiestruturadas com profissionais de saúde da área da reabilitação do Sistema Único de Saúde (SUS), que atuam em um dos três níveis de atenção, nas cidades de Santos e São Paulo, Estado de São Paulo, Brasil. Os discursos foram gravados, transcritos e analisados por meio da análise de conteúdo. Os profissionais relataram mudanças organizacionais em seus serviços, com a interrupção inicial dos atendimentos e, posteriormente, com a adoção de novos protocolos sanitários e o retorno gradativo dos atendimentos presenciais e/ou a distância. As condições de trabalho foram diretamente impactadas, pois houve necessidade de dimensionamento, capacitação, ampliação de carga horária, além da sobrecarga de trabalho e do esgotamento físico e mental dos profissionais. A pandemia determinou uma série de mudanças nos serviços de saúde, por vezes descontínuas, com a suspensão de inúmeros serviços e atendimentos. Alguns atendimentos presenciais foram mantidos, apenas para os pacientes que apresentavam risco de agravo em curto prazo. Medidas sanitárias preventivas e estratégias de continuidade dos atendimentos foram adotadas.

Abstract: Several healthcare processes, including rehabilitation, require prompt initiation and cannot be interrupted. Therefore, these processes underwent important adaptations during the COVID-19 pandemic. However, it is not fully known how healthcare facilities adapted their strategies and what the results were. This study investigated how rehabilitation services were affected during the pandemic and what strategies were employed to maintain the provided services. From June 2020 to February 2021, 17 semi-structured interviews were conducted with healthcare professionals working in rehabilitation services from the Brazilian Unified National Health System (SUS), who work at one of the three levels of care, in the municipalities of Santos and São Paulo, state of São Paulo, Brazil. The interviews were recorded, transcribed, and analyzed via content analysis. The professionals reported organizational changes in their services, with the initial interruption of appointments and, subsequently, the adoption of new sanitary protocols and the gradual return to in-person and/or remote appointments. Working conditions were directly impacted, as there was a need for staffing, training, increased workloads, as well as physical and mental exhaustion among professionals. The pandemic caused a series of changes in healthcare services, some of which were interrupted due to the suspension of numerous services and appointments. Some in-person appointments were maintained exclusively for patients who presented a risk of short-term deterioration. Preventive sanitary measures and strategies for continuity of care were adopted.

Resumen: Diversos procesos que impregnan la asistencia a la salud, incluida la rehabilitación, deben iniciarse con prontitud o no pueden interrumpirse. Por lo que estos sufrieron importantes adaptaciones durante la pandemia de COVID-19. Sin embargo, no se sabe con certeza cómo las instalaciones de salud adaptaron sus estrategias y cuáles fueron los resultados. El estudio investigó cómo se vieron afectados los servicios de rehabilitación durante la pandemia y cuáles fueron las estrategias para mantener los servicios prestados. Entre junio del 2020 y febrero del 2021, se realizaron 17 entrevistas semiestructuradas con profesionales de la salud del área de rehabilitación del Sistema Único de Salud (SUS), que actúan en uno de los tres niveles de atención, en las ciudades de Santos y São Paulo, estado de São Paulo, Brasil. Los discursos se grabaron, se transcribieron y se analizaron mediante análisis de contenido. Los profesionales relataron cambios organizacionales en sus servicios, con la interrupción inicial de la atención y, posteriormente, con la adopción de nuevos protocolos sanitarios y el regreso gradual de la atención presencial o a distancia. Las condiciones de trabajo se vieron directamente afectadas, ya que fue necesario el dimensionamiento, la capacitación, la ampliación de la carga horaria, además de la sobrecarga de trabajo y del agotamiento físico y mental de los profesionales. La pandemia determinó una serie de cambios en los servicios de salud, en ocasiones discontinuos, con la suspensión de numerosos servicios y atenciones. Se mantuvieron algunas atenciones presenciales, solo para los pacientes con riesgo de agravamiento a corto plazo. Se adoptaron medidas sanitarias preventivas y estrategias de continuidad de las atenciones.

Trajetórias assistenciais de usuários com COVID-19: das medidas preventivas à reabilitação / Trayectorias asistenciales de usuarios con el COVID-19: de las medidas preventivas a la rehabilitación / Care trajectories of COVID-19 patients: from preventive measures to rehabilitation

O objetivo deste trabalho é analisar as trajetórias assistenciais, relativas ao uso e acesso às redes de atenção à saúde (RAS), de usuários diagnosticados, internados e em reabilitação decorrente da COVID-19. Foi realizado estudo avaliativo, qualitativo, com base em entrevistas com usuários, no Município de Niterói, Rio de Janeiro, Brasil. As trajetórias assistenciais, a partir da análise temática, foram reconstituídas em três momentos que expressam as experiências com a rede de saúde e apoio durante a pandemia: medidas de prevenção, apoio e diagnóstico; a experiência da internação; cuidados, reabilitação e apoio pós-COVID-19. Os resultados apontam que a principal fonte de informação sobre a doença foram os telejornais; as medidas preventivas de higienização, as mais adotadas; e a família foi a principal rede de apoio. Não houve tempos de espera para internação no hospital municipal de referência. A internação foi muito bem avaliada em função do acolhimento, cuidado multiprofissional, visitas virtuais e contato diário do médico com os familiares. Identificou-se, porém, "vácuo assistencial" pós-alta, com ausência de seguimento pela atenção primária à saúde (APS) e demais serviços públicos. Foi frequente a busca espontânea por planos populares e pagamento direto para acesso aos serviços especializados no pós-COVID-19, até a implantação do serviço de reabilitação. Em síntese, trajetórias assistenciais solitárias e descontínuas de indivíduos e famílias revelam diversos desafios ao sistema de saúde, entre os quais a garantia de acesso e coordenação dos cuidados pela APS, ampliação da oferta de serviços públicos especializados e de reabilitação em redes, alinhados aos princípios do cuidado humanizado, além da manutenção das medidas de apoio social.

Este artículo tiene por objetivo analizar las trayectorias asistenciales de usuarios diagnosticados, hospitalizados y en rehabilitación por el COVID-19 en cuanto al uso y acceso a las redes de atención a la salud (RAS). Se realizó un estudio cualitativo, evaluativo, a partir de entrevistas con usuarios en el municipio de Niterói, Rio de Janeiro, Brasil. A partir del análisis temático, las trayectorias asistenciales se reconstituyeron en tres momentos que expresan las experiencias con la red de salud y de apoyo durante la pandemia: las medidas de prevención, apoyo y diagnóstico; la experiencia de hospitalización; y los cuidados, rehabilitación y apoyo post-COVID-19. Los resultados muestran que los telediarios fueron la principal fuente de información sobre el COVID-19. Las medidas preventivas más adoptadas fueron las de higiene. La familia fue la principal red de apoyo. No hubo tiempo de espera para el ingreso en el hospital municipal de referencia. La hospitalización fue muy bien evaluada debido a la recepción, atención multidisciplinaria, visitas virtuales y contacto diario del médico con los familiares. Se identificó un "vacío asistencial" posterior al alta, sin seguimiento por parte de la atención primaria de salud (APS) y otros servicios públicos. Hubo una frecuente búsqueda espontánea de planes populares y pago directo para acceder a servicios especializados post-COVID-19 hasta la implementación del servicio de rehabilitación. Por lo tanto, las trayectorias asistenciales solitarias y discontinuas de individuos y familias revelan varios desafíos para el sistema de salud, entre ellos la garantía de acceso y coordinación de la atención por parte de la APS, la ampliación de la oferta de servicios públicos especializados y la rehabilitación en redes, combinada con los principios de cuidado humanizado, además del mantenimiento de las medidas de apoyo social.

This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niterói, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures; hospitalization; post-COVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge "care vacuum" was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.

EPIDEMIOLOGICAL ANALYSIS OF FRACTURES IN THE PREVIOUS PERIOD AND DURING THE QUARANTINE OF COVID-19.

Objectives: Our aim was to compare the epidemiology of surgically treated fractures during the pandemic period with previous years without the pandemic. Methods: This was a retrospective study with data collection that included patients hospitalized and operated for fractures between March 24th and June 23rd in 2018, 2019 and 2020. Results: A total of 879 patients were registered, resulting in a total of 965 fractures. During the COVID-19 pandemic, 234 patients were registered, representing 26.62% of the total, and in the period before the pandemic, 645 patients were registered, 73.38% of the total. Conclusion: We observed a proportional increase in high-energy trauma in the social isolation period and patient's average age. The other changes found in the study had no statistical difference. Level of Evidence IV, Case Series.

Objetivos: Comparar a epidemiologia das fraturas tratadas cirurgicamente durante o período de contingência causado pela pandemia com os intervalos respectivos de anos anteriores. Métodos: Foram incluídos todos os pacientes com diagnóstico de fratura em qualquer seguimento do corpo, exceto coluna vertebral e face, que foram internados e operados entre 24 de março e 23 de junho de 2018, 2019 e 2020 em dois hospitais referência para tratamento de trauma na grande São Paulo. Os dados foram obtidos a partir da avaliação retrospectiva de prontuários médicos. Levou-se em consideração epidemiologia das fraturas, mecanismo de trauma e dados demográficos dos pacientes tratados no período de contingência em comparação com a média dos três anos anteriores (período controle). Resultados: Foram avaliados 879 pacientes e 965 fraturas. Durante a pandemia pelo coronavírus foram registrados 234 pacientes, enquanto a média do período controle foi de 322,5 pacientes. Em relação ao mecanismo de trauma, houve um significativo aumento do trauma de alta energia em comparação ao período controle. Conclusão: Verificou-se uma diminuição na incidência de fraturas tratadas cirurgicamente nos hospitais avaliados. No entanto, houve uma elevação na taxa de trauma de alta energia no período de isolamento social. Essa alteração demonstra que mudanças no fluxo das cidades podem impactar na demanda hospitalar e que a pandemia influenciou direta e indiretamente os órgãos de saúde. Nível de Evidência IV, Série de Casos.

Participation' goals of Community- based organizations in the COVID-19 pandemic based on capacity gaps: A cross-sectional study.

BACKGROUND: There have been criticisms that local authorities develop disaster planning independently, which led to less sensitiveness and responsibility of community-based organizations (CBOs). Disasters planning should incorporate into CBOs' management processes. This study aims to set goals of a community-based plan based on preparedness capacities that CBOs need to have in the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study used a prevalidated and reliable questionnaire assessing (CBOs). The tool assesses preparedness in the field of planning, training, and infrastructure. Forty CBOs met the inclusion criteria as assisting or cooperating agencies during the COVID-19 pandemic. Then, key informants, who simultaneously have been working in the health system and CBOs, prioritized low-scale items that have shown capacity gaps according to effects on the vulnerable group, sustainability, and capability of the health system. Descriptive statistics performed using SPSS18 software (SPSS Inc., Chicago, USA). RESULTS: The results showed that the preparedness of CBOs was weak in the field of planning, training, and infrastructure. Besides, overlaps of CBOs' resources and covering the clients' medical needs in the COVID-19 pandemic were the most priority that needs to be intervened. CONCLUSION: Providing medical needs by CBOs require legal legitimacy assigned by health authority, especially in epidemic-prone diseases. In addition, assigning a coordinator to set a priority list and mutual agreements authoried by health departments can solve the problem of overlapped resources. Therefore, functional roles of CBOs in the pandemic should focus mostly on resource allocation and the medical needs of clients to set goals and functional objectives.

A Shift in SARS-CoV-2 Omicron Variant's Entry Pathway Might Explain Different Clinical Outcomes.

Globally, SARS CoV-2 omicron variant has led to a notable increase of COVID-19 diagnoses, although with less severe clinical manifestations and decreased hospitalizations. The omicron wave swelled faster than previous waves, completely displacing the delta variant within weeks, and creating worldwide concern about final, successful pandemic control. Some authors contend that symptoms associated to omicron differ from 'traditional' symptoms and more closely resemble those of the common cold. One major COVID-19 symptom frequent with other variants-loss of taste and smell-is rarely present with omicron. This may be of interest, since it has also been suggested that direct SARS-CoV-2 invasion into the brainstem through the olfactory nerves by transsynaptic pathways could provide one explanation for the acute respiratory distress syndrome refractory to treatment. Brainstem infection by SARS-CoV-2 can severely damage the respiratory center, triggering functional deviations that affect involuntary respiration, leading to acute respiratory distress syndrome refractory to treatment, the main cause of death in COVID-19 patients. A shift in the omicron SARS-CoV-2 entry pathway from cell-surface fusion, triggered by TMPRSS2, to cathepsin-dependent fusion within the endosome, may affect transmission, cellular tropism and pathogenesis. Therefore, we can hypothesize that this entrance modification may impact transmission from the olfactory nerve to the brainstem through transsynaptic pathways. A decrement of the virus's direct invasion into the brainstem could diminish respiratory center dysfunction, reducing acute respiratory distress syndrome and the need for mechanical ventilation.

Recent Traumatic Episode Protocol EMDR Applied Online for COVID-19-Related Symptoms of Turkish Health Care Workers Diagnosed with COVID-19-Related PTSD: A Pilot Study.

Background: This study investigates the effect of the online Eye Movement Desensitization and Reprocessing Recent Traumatic Episode Protocol on posttraumatic stress disorder, anxiety, depression, and burnout symptoms in healthcare workers diagnosed with pandemic-related post-traumatic stress disorder. Methods: The study included healthcare workers who applied to psychiatry outpatient clinics due to the psychiatric symptoms that developed related to the pandemic and who were diagnosed with post-traumatic stress disorder. The Beck Anxiety Inventory, Impact of Event Scale-Revised to evaluate the symptoms of post-traumatic stress disorder (avoidance, intrusion, and hyperarousal), Maslach Burnout Inventory, and Beck Depression Inventory were used for the assessment. The tests were administered 3 times (pre-treatment, post-treatment, and at 1-month follow-up). Results: This study included 14 healthcare workers diagnosed with post-traumatic stress disorder; 2 (14.3%) physicians, 2 (14.3%) nurses, 4 (28.6%) other-healthcare workers/medical staff, and 6 (42.8%) other healthcare workers/non-medical staff. There was a significant decrease in Impact of Event Scale-Revised total score, the intrusion and hyper-arousal sub-scores between T1 and T2 (P = .018; P = .005; P = .0005, respectively) and between T1 and T3 (P < .001; P < .001; P < .001, respectively), but there was no difference between T2 and T3 (P = .89). A significant difference was found in repeated measurements of both Beck Depression Inventory [P < .001] and Beck Anxiety Inventory [P < .001] scores. There was a significant difference in emotional exhaustion, one of the subscales of Maslach Burnout Inventory (P = .09). However, there was no significant difference in depersonalization (P = .48) and personal accomplishment (P = .66). Conclusions: Recent Traumatic Episode Protocol appears to be capable of reducing symptoms of anxiety, depression, intrusion, and hyperarousal symptoms of post-traumatic stress disorder and emotional exhaustion when symptoms that developed are related to the pandemic in healthcare workers.

Maintenance of Self-Care Activities During COVID-19 Lockdown in Patients with Type 2 Diabetes That Received a Comprehensive Care Program Training.

Introduction: In 2020, several countries established a global emergency state. Lockdowns restricted people's lifestyles and daily activities to prevent coronavirus spread. These measures hindered diabetes mellitus control and lifestyle changes. This study aims to evaluate if attending a multidisciplinary program before the pandemic helped maintain a good metabolic state, lifestyle modifications, and mental health in patients with diabetes mellitus during the COVID-19 lockdown. Methods: Patients included in this study attended a multidisciplinary program, with <5 years of diagnosis of type 2 diabetes, without disabling complications, between 18-70 years old. The complete lockdown occurred from February 27, 2020, to May 31, 2020. The first patient (non-COVID) to return to the center for face-to-face consultation was in March 2021. Consultations in 2019 were face-to-face and changed to a virtual modality during 2020. We analyzed metabolic, lifestyle, mental health, and diabetes education parameters. Results: A total of 133 patients with type 2 diabetes mellitus were included with complete information in visits before and during the lockdown. Metabolic parameters and self-care measures (nutrition plan, foot evaluation, and self-glucose monitoring) evaluated on our patients had no change during the lockdown. We found a significant increase in the time patients spent sitting during the day (p<0.05). Barriers to exercise increased during lockdown, being joint pain (3.8% to 12.0%, p<0.01) and lack of time to exercise (4.5% to 7.5%, p=0.33) being the most common. There was no significant difference in symptoms of anxiety and depression, quality of life, and empowerment. Conclusion: A multidisciplinary diabetes mellitus program, including diabetes education for self-care activities, positively impacts patients, maintaining good outcomes despite lockdown difficulties.

Comparison of public health measures taken during Spanish flu and COVID-19 pandemics: A Narrative Review.

The similarity of the consequences of COVID-19 reminded us of the destruction caused by the Spanish flu over a century ago and led us to find similarities in the way the two pandemics were handled. PRISMA Guideline was followed for a systematic search to identify eligible published articles. Information about the public health measures adopted during both the pandemics was taken from literature. It was found that there are parallels between the two pandemics in terms of general unpreparedness, attitudes of the community and government, and various policy issues. All the measures implemented in 2020 were the same as those implemented in 1918-1919, with the same trend, uncertainty, early relaxing, and rapid reversals. Even from a scientific standpoint, all the elements were already known. All the issues such as social isolation, intra-family spread, personal protective equipment, medicine types (quinine, aspirin, anti-inflammatories, etc.), immunization requirements, and so on had already been addressed. No doubt, we do have technology today at our disposal for managing the spread of the disease and even spread awareness among people much easily. We also have taken many steps forward in the world of globalization, which make the progression and spread of the pandemic very fast as well. Both factors tend to counter each other and hence make timely public health intervention as important (if not more) today as it was yesterday. When possible, approaches and goals should be found on scientific facts and include ethical input. Finally, we must take careful notice of past local and national lessons to avoid repeating the mistakes done in the past. The development of a strategy ahead of time that includes all levels of government health infrastructure and outlines clear lines of duties and functions is critical. The main objective of this article was to compare the public health measures undertaken during the pandemic of Spanish Flu and the pandemic of COVID-19, and assess the similarities and differences in the public health measures taken during these pandemics. The correlation of the public health measures and the outcomes was assessed and the implication of this article was to be pandemic-ready in the future.

Lived Experiences of Patients Receiving Hemodialysis during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network.

Background: Hemodialysis patients have faced unique challenges during the COVID-19 pandemic. They face high risk of death if infected and have unavoidable exposure to others when they come to hospital three times weekly for their life-saving treatments. The objective of this study was to gain a better understanding of the scope and magnitude of the effects of the pandemic on the lived experience of patients receiving in-center hemodialysis. Methods: We conducted semi-structured interviews with 22 patients who were undergoing dialysis treatments in five hemodialysis centers in Montreal from November 2020 to May 2021. Interviews were transcribed and then analyzed using thematic content analysis. Results: Most participants reported no negative effects of the COVID-19 pandemic on their hemodialysis care. Several patients had negative feelings related to forced changes in their dialysis schedules, and this was especially pronounced for indigenous patients in a shared living situation. Some patients were concerned about contracting COVID-19, especially during public transportation, whereas others expressed confidence that the physical distancing and screening measures implemented at the hospital would protect them and their loved ones. Some participants reported that masks negatively affected their interactions with health care workers, and for many others, the pandemic was associated with feelings of loneliness. Finally, some respondents reported some positive effects of the pandemic, including use of telemedicine and creating a sense of solidarity. Conclusions: Patients undergoing hemodialysis reported no negative effects on their medical care but faced significant disruptions in their routines and social interactions due to the COVID-19 pandemic. Nevertheless, they showed great resilience in their ability to adapt to the new reality of their hemodialysis treatments. We also show that studies focused on understanding the lived experiences of indigenous patients and patients from different ethnic backgrounds are needed in order reduce inequities in care during public health emergencies.

AP-HP Health Data Space (AHDS) to the Test of the Covid-19 Pandemic.

Sharing observational and interventional health data within a common data space enables university hospitals to leverage such data for biomedical discovery and moving towards a learning health system. OBJECTIVE: To describe the AP-HP Health Data Space (AHDS) and the IT services supporting piloting, research, innovation and patient care. METHODS: Built on three pillars - governance and ethics, technology and valorization - the AHDS and its major component, the Clinical Data Warehouse (CDW) have been developed since 2015. RESULTS: The AP-HP CDW has been made available at scale to AP-HP both healthcare professionals and public or private partners in January 2017. Supported by an institutional secured and high-performance cloud and an ecosystem of tools, mostly open source, the AHDS integrates a large amount of massive healthcare data collected during care and research activities. As of December 2021, the AHDS operates the electronic data capture for almost +840 clinical trials sponsored by AP-HP, the CDW is enabling the processing of health data from more than 11 million patients and generated +200 secondary data marts from IRB authorized research projects. During the Covid-19 pandemic, AHDS has had to evolve quickly to support administrative professionals and caregivers heavily involved in the reorganization of both patient care and biomedical research. CONCLUSION: The AP-HP Data Space is a key facilitator for data-driven evidence generation and making the health system more efficient and personalized.