The COVID-19 pandemic and plans for economic reopening in Brazil: a documental analysis

BACKGROUND: In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. In Brazil, the high rate of dissemination made it necessary to adopt restrictive measures nationwide with the discussion regarding the resumption of economic activities starting in April. In mid-December the country had 6,970,034 cases diagnosed and 182,799 deaths from COVID-19. OBJECTIVE: To analyze the content and characteristics of official documents, which guided the period of transition and resumption of economic activities in Brazil based on health indicators. METHODS: This is a documental research, carried out between May and July 2020, using official websites and publications from the state governments of the 27 federative units in Brazil as sources. In the study, only documents that used epidemiological and health indicators were included as determining criteria for decision making in relation to the easing, permanence or regression of social isolation measures adopted during the COVID-19 pandemic. FINDINGS: Plans, decrees and technical notes were identified for 18 Brazilian federal units. In most documents, the scientific team was made up exclusively of technicians (n = 10). The number of indicators found ranged from 2 to 11, being stratified into 5 categories: frequency and distribution of the disease; social and collective adherence; installed capacity or service profile; productive potential; and availability of supplies. MAIN CONCLUSIONS: Knowing governmental strategies, adopted in the easing of restrictive measures, in the face of the coronavirus (SARS-CoV-2) pandemic based on indicators and with the possibility of comparison between different federative units, provides subsidies for understanding the outcome of the disease by place of occurrence, allowing the construction of a panorama pathology in the country. The appropriation of the findings of this study by Brazil and other countries also serves as an instrument for reflection and planning of policies adopted during the COVID-19 pandemic

OS IMPACTOS DA DESINFORMAÇÃO SOBRE A TOXOPLASMOSE NA GRAVIDEZ: FORMAS DE TRANSMISSÃO, PREVENÇÃO E TRATAMENTO

Toxoplasma gondii (T. gondii) is an obligatory intracellular parasite whose life cycle involves cats as primary hosts and other mammals, including humans, as intermediate hosts. Transmission occurs mainly through the ingestion of contaminated food or contact with infected cat feces. The prevalence of toxoplasmosis varies globally, being more common in tropical regions and correlated with socioeconomic conditions. It is estimated that up to 30% of the world's population has been exposed to the parasite, and studies in Brazil indicate a significant prevalence among pregnant women. T. gondii infection during pregnancy can result in complications for the fetus, such as retinal disease, with consequences that may persist into adulthood. Diagnosis and treatment of congenital toxoplasmosis are essential to mitigate these adverse effects. This study conducted an integrative literature review, using the PICo strategy to investigate the impacts of misinformation on toxoplasmosis in pregnant women. The research was conducted in databases such as MEDLINE, LILACS, and Nursing Database, resulting in a selection of 13 articles for analysis. The results highlight the importance of T. gondii serology during prenatal care and regular monitoring of pregnant women to detect possible acute infections. Treatment, when necessary, should be promptly initiated to reduce vertical transmission and the severity of congenital disease. Furthermore, the lack of adequate preventive guidance for susceptible pregnant women underscores the need for capacity building of healthcare professionals to provide relevant hygienic and dietary information. In conclusion, toxoplasmosis during pregnancy represents a significant public health concern, requiring effective prevention measures and access to proper healthcare. Public awareness and investment in ongoing research are essential to reduce the incidence of congenital toxoplasmosis and ensure better outcomes for mothers and babies. Keywords: Toxoplasma gondii, toxoplasmosis, pregnancy, vertical transmission, prevention, treatment, maternal health.Toxoplasma gondii (T. gondii) es un parásito intracelular obligado cuyo ciclo de vida implica a los gatos como huéspedes primarios y a otros mamíferos, incluidos los humanos, como huéspedes intermedios. La transmisión ocurre principalmente a través de la ingestión de alimentos contaminados o el contacto con heces de gatos infectados. La prevalencia de la toxoplasmosis varía a nivel mundial, siendo más común en regiones tropicales y correlacionada con condiciones socioeconómicas. Se estima que hasta el 30% de la población mundial ha estado expuesta al parásito, y estudios en Brasil indican una prevalencia significativa entre mujeres embarazadas. La infección por T. gondii durante el embarazo puede provocar complicaciones para el feto, como enfermedad retiniana, con consecuencias que pueden persistir hasta la edad adulta. El diagnóstico y tratamiento de la toxoplasmosis congénita son fundamentales para mitigar estos efectos adversos. Este estudio realizó una revisión bibliográfica integrativa, utilizando la estrategia PICo para investigar los impactos de la desinformación sobre la toxoplasmosis en mujeres embarazadas. La investigación se llevó a cabo en bases de datos como MEDLINE, LILACS y la Base de Datos de Enfermería, lo que resultó en una selección de 13 artículos para su análisis. Los resultados destacan la importancia de la serología para T. gondii durante la atención prenatal y el monitoreo regular de las mujeres embarazadas para detectar posibles infecciones agudas. El tratamiento, cuando es necesario, debe iniciarse rápidamente para reducir la transmisión vertical y la gravedad de la enfermedad congénita. Además, la falta de orientación preventiva adecuada para mujeres embarazadas susceptibles subraya la necesidad de capacitar a los profesionales de la salud para proporcionar información relevante sobre higiene y dieta. En conclusión, la toxoplasmosis durante el embarazo representa una preocupación importante para la salud pública, que requiere medidas de prevención efectivas y acceso a atención médica adecuada. La concienciación pública y la inversión en investigación continua son fundamentales para reducir la incidencia de toxoplasmosis congénita y garantizar mejores resultados para las madres y los bebés.O Toxoplasma gondii (T. gondii) é um parasita intracelular obrigatório cujo ciclo de vida envolve gatos como hospedeiros primários e outros mamíferos, incluindo humanos, como hospedeiros intermediários. A transmissão ocorre principalmente pela ingestão de alimentos contaminados ou contato com fezes de gatos infectados. A prevalência da toxoplasmose varia globalmente, sendo mais comum em regiões tropicais e correlacionada com condições socioeconômicas. Estima-se que até 30% da população mundial já tenha entrado em contato com o parasita, e estudos no Brasil indicam uma prevalência significativa entre gestantes. A infecção por T. gondii durante a gestação pode resultar em complicações para o feto, como doença retiniana, com consequências que podem persistir até a idade adulta. O diagnóstico e tratamento da toxoplasmose congênita são essenciais para mitigar esses efeitos adversos. Este estudo realizou uma revisão integrativa da literatura, utilizando a estratégia PICo para investigar os impactos da desinformação sobre a toxoplasmose em gestantes. A pesquisa foi conduzida em bases de dados como MEDLINE, LILACS e Base de Dados de Enfermagem, resultando em uma seleção de 13 artigos para análise. Os resultados destacam a importância da sorologia para T. gondii durante o pré-natal e do monitoramento regular da gestante para detectar possíveis infecções agudas. O tratamento, quando necessário, deve ser iniciado prontamente para reduzir a transmissão vertical e a gravidade da doença congênita. Além disso, a falta de orientação preventiva adequada para gestantes suscetíveis ressalta a necessidade de capacitação dos profissionais de saúde para fornecer informações higiênicas e dietéticas pertinentes. Em conclusão, a toxoplasmose durante a gravidez representa uma preocupação significativa de saúde pública, exigindo medidas de prevenção eficazes e acesso a cuidados de saúde adequados. A conscientização pública e o investimento em pesquisa contínua são fundamentais para reduzir a incidência de toxoplasmose congênita e garantir melhores resultados para mães e bebês

Probióticos, prebióticos e simbióticos em uso clínico:Uma revisão sistemática/ Probiotics, prebiotics and symbiotics in clinical use:A systematic review

Objetivo: Este artigo objetiva revisar a literatura para coletar informações sobre os efeitos do consumo de probióticos, prebióticos e simbióticos, em condutas da prática clínica. Materiais e métodos: Utilizou-se o método de revisão sistemática, sendo pesquisados artigos científicos publicados no período de 2013 a 2018. Os trabalhos científicos foram pesquisados nas bases de dados: BIREME, LILACS, MEDLINE e PUBMED, utilizando os descritores: “probióticos”, “prebióticos” e “simbióticos” nos seguintes idiomas: inglês, espanhol e português. Além disso, foram excluídos do trabalho os artigos publicados há mais de 5 anos, tendo sido encontrados 15 artigos aptos para serem abordados. Resultados: Foram analisadas ao todo 15 artigos, e destes, em 1 foi estudado somente próbióticos, 4 estudaram probióticos e prebióticos, 4 compararam probióticos e simbióticos, 1 foi resultado de um painel de consenso de especialistas sobre a definição de prebiótico, 3 pesquisaram a abordagem das três intervenções, sendo um destes um protocolo para  revisão sistemética e metanálise, e 2 foram relacionados somente aos simbióticos. Conclusões: Apesar de vários estudos que comprovaram ou deram forte indício à terapêutica do uso de probióticos, prebióticos e simbióticos na prática clínica é necessário pesquisas mais aprofundadas para definição de diretrizes concretas e de melhor aplicabilidade

Condução de ações educativas em saúde bucal por acadêmicos de enfermagem com crianças da primeira infância: relato de experiência / Conduction of educational actions in oral health by nursing academics with children of early childhood: experience report

No contexto da educação em saúde bucal, processo a ser instituído desde a primeira infância, a participação do enfermeiro é essencial por ser atribuído a ele o cuidado cotidiano com a saúde oral e por ser ele um profissional que propicia a criação de espaços educativos em saúde na escola. O estudo objetivou relatar a experiência de acadêmicos de Enfermagem na condução de ações educativas em saúde bucal com crianças da educação infantil. Trata-se de relato de experiência, desenvolvido na Escola de Educação Infantil Francisca Arruda de Pontes (Redenção – CE), no período de janeiro a agosto de 2018.  O relato resultou de encontros presenciais de acadêmicos do Curso de Enfermagem da Universidade da Integração Internacional da Lusofonia Afro-Brasileira (UNILAB) com crianças do infantil IV e V e seus professores. Os encontros envolveram a condução, pelos acadêmicos, de ações educativas voltadas à saúde bucal, as quais contemplaram desde a elaboração de desenhos à narração de histórias, confecção de mural e apresentação de teatro de fantoche. Para o tema conceito de saúde bucal e repercussão sistêmica, a percepção dos acadêmicos foi de que parte das crianças e professores conhecia o assunto abordado, incluindo a influência da saúde bucal sobre a saúde geral. Sobre os constituintes da cavidade oral, foi inesperado o conhecimento apresentado pelas crianças sobre cada um desses componentes. Em relação aos agentes causadores de doenças bucais, as crianças foram capazes de definir, identificar e “diagnosticar” a cárie entre seus amigos de turma. Sobre as doenças bucais, observou-se o desconhecimento das crianças sobre a gengivite, periodontite e halitose. Conclui-se que as ações educativas em saúde bucal conduzidas pelos acadêmicos de Enfermagem permitiram o aprendizado das crianças e professores, além dos próprios estudantes, quanto aos diferentes temas abordados. As metodologias usadas no processo revelaram o conhecimento das crianças sobre a maior parte dos assuntos retratados, além de terem proporcionado a problematização, discussão e reflexão de aspectos relacionados à saúde bucal. Para os acadêmicos, essa experiência colaborou positivamente com a sua formação acadêmica, profissional e de sujeito social.RESUMONo contexto da educação em saúde bucal, processo a ser instituído desde a primeira infância, a participação do enfermeiro é essencial por ser atribuído a ele o cuidado cotidiano com a saúde oral e por ser ele um profissional que propicia a criação de espaços educativos em saúde na escola. O estudo objetivou relatar a experiência de acadêmicos de Enfermagem na condução de ações educativas em saúde bucal com crianças da educação infantil. Trata-se de relato de experiência, desenvolvido na Escola de Educação Infantil Francisca Arruda de Pontes (Redenção – CE), no período de janeiro a agosto de 2018.  O relato resultou de encontros presenciais de acadêmicos do Curso de Enfermagem da Universidade da Integração Internacional da Lusofonia Afro-Brasileira (UNILAB) com crianças do infantil IV e V e seus professores. Os encontros envolveram a condução, pelos acadêmicos, de ações educativas voltadas à saúde bucal, as quais contemplaram desde a elaboração de desenhos à narração de histórias, confecção de mural e apresentação de teatro de fantoche. Para o tema conceito de saúde bucal e repercussão sistêmica, a percepção dos acadêmicos foi de que parte das crianças e professores conhecia o assunto abordado, incluindo a influência da saúde bucal sobre a saúde geral. Sobre os constituintes da cavidade oral, foi inesperado o conhecimento apresentado pelas crianças sobre cada um desses componentes. Em relação aos agentes causadores de doenças bucais, as crianças foram capazes de definir, identificar e “diagnosticar” a cárie entre seus amigos de turma. Sobre as doenças bucais, observou-se o desconhecimento das crianças sobre a gengivite, periodontite e halitose. Conclui-se que as ações educativas em saúde bucal conduzidas pelos acadêmicos de Enfermagem permitiram o aprendizado das crianças e professores, além dos próprios estudantes, quanto aos diferentes temas abordados. As metodologias usadas no processo revelaram o conhecimento das crianças sobre a maior parte dos assuntos retratados, além de terem proporcionado a problematização, discussão e reflexão de aspectos relacionados à saúde bucal. Para os acadêmicos, essa experiência colaborou positivamente com a sua formação acadêmica, profissional e de sujeito social. Palavras-chave:  Educação em Saúde Bucal; Criança; Educação Infantil; Estudantes de Enfermagem

ATLANTIC ANTS: a data set of ants in Atlantic Forests of South America

International audienc

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable