Covid-19 e impacto emocional em adultos: uma revisão sistemática

The Covid-19 pandemic unexpectedly changed people's lives. The interaction between people represented a risk of contracting the virus and information about infections and deaths became constant in the news. Thus, the objective of this review was to establish the factors that influenced the mental health of adult individuals during the months of March to August 2020, during the Covid-19 pandemic. The methodology used was the search in three databases, using descriptors and inclusion and exclusion criteria. The publications were analyzed in three stages: first, the selection was made by reading the titles; second, by reading the abstracts; and third, by reading the entire text. A total of 88 publications were found, of which 35 were selected to integrate this review. The publications were quite heterogeneous, as in relation to the country where the research was conducted as in the choice of participants. Regardless of the population sample, different levels of mental health impairment were reported; of these, anxiety, depression, stress and fear were the most prevalent. This review brings, therefore, the discernment that mental health should be considered in health analyzes, and is a crucial element for the elaboration of more effective strategic plans aimed at the population's health. Keywords: Pandemics; Coronavirus infections; Mental health.La pandemia de Covid-19 cambió inesperadamente la vida de las personas. La interacción entre personas representó un riesgo de contraer el virus y la información sobre infecciones y muertes se convirtió en una constante en las noticias. Así, el objetivo de esta revisión fue establecer los factores que influyeron en la salud mental de los adultos durante los meses de marzo a agosto de 2020, durante la pandemia de Covid-19. La metodología utilizada fue la búsqueda en tres bases de datos, utilizando descriptores y criterios de inclusión y exclusión. Las publicaciones se analizaron en tres etapas: primero, la selección se realizó mediante la lectura de los títulos; segundo, leyendo los resúmenes; y tercero, leyendo el texto completo. Se encontraron un total de 88 publicaciones, de las cuales se seleccionaron 35 para integrar esta revisión. Las publicaciones fueron bastante heterogéneas, tanto en relación al país donde se realizó la investigación como en la elección de los participantes. Independientemente de la muestra de población, se informaron diferentes niveles de deterioro de la salud mental; de estos, la ansiedad, la depresión, el estrés y el miedo fueron los más frecuentes. Esta revisión trae, por tanto, el discernimiento de que la salud mental debe ser considerada en los análisis de salud, y es un elemento crucial para la elaboración de planes estratégicos más efectivos dirigidos a la salud de la población. Palabras clave: Pandemia; Infección de coronavirus; Salud mental.A pandemia da Covid-19 de forma inesperada mudou a rotina das pessoas. A interação entre as pessoas representava risco de contrair o vírus e as informações sobre infecções e mortes passaram a ser constantes nos noticiários. Assim, o objetivo dessa revisão foi estabelecer os fatores que influenciaram a saúde mental de indivíduos adultos durante os meses de março a agosto de 2020, durante a pandemia da Covid-19. A metodologia utilizada foi a pesquisa em três bases de dados, utilizando descritores e critérios de inclusão e exclusão. As publicações foram analisadas em três estágios: primeiro a seleção foi feita pela leitura dos títulos; segundo, pela leitura dos resumos; e terceiro, pela leitura do texto na íntegra. Um total de 88 publicações foram encontradas, e dessas 35 foram selecionadas para integrar essa revisão. As publicações foram bastante heterogêneas, tanto em relação ao país onde as pesquisas foram realizadas quanto na escolha dos participantes. Independente da amostra populacional, distintos níveis de comprometimento da saúde mental foram relatados; desses, ansiedade, depressão, estresse e medo foram os mais prevalentes. Essa revisão traz, portanto, o discernimento de que a saúde mental deve ser considerada nas análises de saúde, e é elemento crucial para a elaboração de planos estratégicos mais efetivos visando a saúde da população. Palavras-chave: Pandemia; Infecção do coronavírus; Saúde mental

Eco-epidemiologia da leishmaniose tegumentar americana em Itabuna – Bahia – Brasil, 2001 a 2014

An ecological study was carried out to investigate the sociodemographic and epidemiological profile, the frequency of cases, the epidemiological indicators and the eco-epidemiological aspects of American cutaneous leishmaniasis in Itabuna. The methodology used was the collection of secondary data (DATASUS - 2001 to 2014). From 2001 to 2014, 360 cases of American cutaneous leishmaniasis were reported in Itabuna. The data were analyzed using descriptive and inferential statistics. The average incidence of American cutaneous leishmaniasis in the municipality, from 2001-2014, was 12.1 cases/100.000 inhabitants. The results indicate that the most affected individuals were men of economically active age, with low education and residents in urban areas. Most cases were new and the most prevalent clinical form was cutaneous, being clinical and epidemiological confirmation criterion the most frequent. The ?2 test showed the existence of a significant difference between the population frequency and the frequency of cases of the disease. Epidemiological indicators showed spatial density, disease detection and the proportion of cases in the municipality. With regard to eco-epidemiological aspects, it was possible to establish that the recent occupation of peri-urban areas in the municipality, combined with environmental factors, such as climate, vegetation, accumulation of organic matter, seem to increase the population's vulnerability to epidemics. Keywords: Epidemiological profile. Vulnerable populations. Epidemiological determinants. Cutaneous leishmaniasis.Realizou-se estudo do tipo ecológico com o objetivo de investigar o perfil sociodemográfico e epidemiológico, a frequência de casos, os indicadores epidemiológicos e os aspectos eco-epidemiológicos da leishmaniose tegumentar americana em Itabuna. A metodologia usada foi o levantamento de dados secundários (DATASUS - 2001 a 2014). No período de 2001 a 2014 foram notificados 360 casos de leishmaniose tegumentar americana em Itabuna. Os dados foram analisados por meio de estatística descritiva e inferencial. A incidência média de leishmaniose tegumentar americana no município, de 2001-2014, foi de 12,1 casos/100.000 habitantes. Os resultados indicam que os indivíduos mais acometidos foram homens em idade economicamente ativa, com baixa escolaridade e residentes em área urbana. Os casos em sua maioria eram novos e a forma clínica mais prevalente foi a cutânea, sendo o critério de confirmação clínico-epidemiológico o mais frequente. O teste ?2 evidenciou a existência de diferença significativa entre a frequência populacional e a frequência de casos da doença. Os indicadores epidemiológicos mostraram a densidade espacial, a detecção da doença e a proporção de casos no município. No que se refere aos aspectos eco-epidemiológicos, foi possível estabelecer que a recente ocupação de áreas periurbanas no município, aliada a fatores ambientais, como clima, vegetação, acúmulo de matéria orgânica, parecem aumentar a vulnerabilidade da população a epidemias. Palavras-chave: Perfil epidemiológico. Populações vulneráveis. Determinantes epidemiológicos. Leishmaniose cutânea

Identification of candidate genes involved in Witches' broom disease resistance in a segregating mapping population of Theobroma cacao L. in Brazil

Background: Witches' broom disease (WBD) caused by the fungus Moniliophthora perniciosa is responsible for considerable economic losses for cacao producers. One of the ways to combat WBD is to plant resistant cultivars. Resistance may be governed by a few genetic factors, mainly found in wild germplasm. Results: We developed a dense genetic linkage map with a length of 852.8 cM that contains 3,526 SNPs and is based on the MP01 mapping population, which counts 459 trees from a cross between the resistant 'TSH 1188' and the tolerant 'CCN 51' at the Mars Center for Cocoa Science in Barro Preto, Bahia, Brazil. Seven quantitative trait loci (QTL) that are associated with WBD were identified on five different chromosomes using a multi-trait QTL analysis for outbreeders. Phasing of the haplotypes at the major QTL region on chromosome IX on a diversity panel of genotypes clearly indicates that the major resistance locus comes from a well-known source of WBD resistance, the clone 'SCAVINA 6'. Various potential candidate genes identified within all QTL may be involved in different steps leading to disease resistance. Preliminary expression data indicate that at least three of these candidate genes may play a role during the first 12 h after infection, with clear differences between 'CCN 51' and 'TSH 1188'. Conclusions: We combined the information from a large mapping population with very distinct parents that segregate for WBD, a dense set of mapped markers, rigorous phenotyping capabilities and the availability of a sequenced genome to identify several genomic regions that are involved in WBD resistance. We also identified a novel source of resistance that most likely comes from the 'CCN 51' parent. Thanks to the large population size of the MP01 population, we were able to pick up QTL and markers with relatively small effects that can contribute to the creation and selection of more tolerant/resistant plant material.</p

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Critical care admission following elective surgery was not associated with survival benefit:prospective analysis of data from 27 countries

Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10–5.21]; p &lt; 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally