Challenges of the COVID-19 pandemic: for a Brazilian research agenda in global health and sustainability

implicações da pandemia de COVID-19 na saúde mental e física dos estudantes do Curso de Medicina de uma Universidade da Região Metropolitana do Espírito Santo

Introdução: O primeiro caso reportado da infecção pelo novo coronavírus ocorreu na China, em dezembro de 2019. Dado o alastramento da doença, ocorreram modificações no estilo de vida, que associadas ao período de incertezas geraram impactos na saúde da população. Objetivo: Compreender as implicações da pandemia de COVID-19 na saúde mental e física dos estudantes do Curso de Medicina de uma universidade do Espírito Santo. Métodos: Estudo transversal de agosto de 2020 a janeiro de 2021, com abordagem quantitativa e qualitativa, com estudantes de Medicina de todos os períodos. Coleta de dados feita com questionário eletrônico, englobando dados sociodemográficos, econômicos, características individuais e familiares sobre o período prévio e concorrente à pandemia. Os programas Excel 2020 e OPENEPI foram utilizados para as análises. O estudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos, sob o número 4.224.502. Resultados: Foram avaliados 779 acadêmicos, a maioria do sexo feminino (61,6%), entre 20 e 24 anos (64,0%), nos dois primeiros anos do curso (46,5%), residentes em área urbana (98,1%), com uma a três pessoas em seu domicílio (65,0%) e sem vínculo empregatício (93,2%). Características da amostra durante a pandemia: necessidade de trancar matrícula (3,9%), preocupação constante com a família (73,9%), dificuldade de adaptação à educação a distância (76,0%), convívio familiar contínuo (84,5%), alterações do sono (54,9%), da prática de atividade física (60,3%) e do peso (71,0%), participação nos afazeres domésticos (77,9%), pressão psicológica (47,6%), alimentação (69,6%). As variáveis que sofreram modificações significativas entre os períodos prévio e concorrente à pandemia foram diminuição de renda (p=0,005), aumento do uso de medicamentos (p=0,0009) e do nível de estresse autopercebido (p≤0,0000001). Com relação ao desenvolvimento de dores no período da pandemia, apresentaram impacto: sexo feminino (p≤0,0000001), segundo ano do curso (p=0,001), preocupação constante com a família (p=0,000002), dificuldade de adaptação ao ensino a distância (p=0,002), alterações no sono (p=0,000003), atividade física (p=0,001), mudanças no peso (p=0,00007) e na alimentação (p=0,01). Para o desenvolvimento de distúrbios psíquicos durante a pandemia, as com maior significância foram sexo (p=0,004), preocupação constante com a família (p=0,005), sono (p=0,006) e alimentação (p=0,003). Conclusões: Modificações dos padrões de vida decorrentes da pandemia impactaram negativamente a saúde física e mental, tornando essencial que as instituições de ensino proporcionem ações de cuidado à saúde de estudantes.

Mental Health of Postpartum Women During the COVID-19 Pandemic: An Integrative Review

Objective: To identify and analyze the scientific evidence on the mental health of postpartum women during the COVID-19 pandemic. Method: This integrative review was carried out using the VHL, CINAHL, PubCovid, Scopus, and Web of Science databases, whose research question was “What is the scientific evidence on the mental health of postpartum women during the SARS-CoV-2 pandemic?” Results: Ten articles in English were included, identifying a higher frequency of cross-sectional research (n = 4), publications in November 2020 (n = 3), conducted in Italy (n = 3), with level VI evidence (n = 6). The study found that postpartum women feel depressed, lonely, and afraid; attention is drawn to the worsening risk of postpartum depression with significant prevalence values. It points out factors that negatively influence the mental health of this population in the current pandemic and discloses care measures. Conclusions: In addition to previous characteristics, socioeconomic conditions (e.g., living in highly infected areas, unemployment) and elements inherent to this pandemic (e.g., distance and fear of contagion) negatively influence the mental health of postpartum women. Means of dealing with the conditions imposed by the COVID-19 pandemic are available, such as relaxation techniques, physical exercise, and professional support. The relevance and need for research on this theme, mostly nationally, are highlighted.

Covid-19 and organisational development: important signs of a new pillar for sustainability

Purpose

The global pandemic has had a considerable effect on organisations’ performance and development and on the daily lives of the general population. This study aims to analyse the recent literature on the topics of Covid-19 and sustainability and proposes to rethink and redefine sustainability with the intersection of human health as a fourth sustainable pillar.

Design/methodology/approach

Using the Scopus and ISI Web of Science databases, 119 articles were analysed in detail and classified according to concepts and principles for achieving sustainable development, based on the Brundtland Report, 1987.

Findings

The results indicate a high number of publications in the social dimension, with a relevant proportion of studies in the health sector. This study allows us to conclude that all sectors of society are being affected by the pandemic. However, the enormous tension and the immediate impact felt by the health sector during the pandemic reflect directly on the population, and there are clear signs that in the medium and long term, instability and uncertainty in the environmental, economic and social dimensions will remain. In national health systems, monitoring, innovating in human resource management and investing in information technology can ensure organizations’ reliability and sustainability. The conclusion involves the suggestion of introducing health as a new pillar for sustainability to consolidate the basis and structure of the United Nations’ Sustainable Development Objectives. The use of fundamental concepts is necessary and must be aligned to reassess the results obtained in studies, in comparison with observational data.

Practical implications

The implications arising from the inclusion of health as a fourth pillar of sustainability are diverse. The need to build a new theoretical and conceptual framework for sustainability derives from the fact that health reflects the concern of many postulants in this field of practices. The determining or conditioning conditions of the observed effects of the pandemic by COVID-19, whether situated simply as factors and/or economic, environmental or social reflexes that precede them, requires a conceptual development that allows its approach, as a complex object, whose determinations are subject to variable degrees of uncertainty and diversity.

Originality/value

This study aims to redefine the concept of sustainability, considering that health has become a public health emergency of international interest. Health affects the supply chain, cash flow, interferes with the educational format and interrupts the workforce’s routine, among other aspects, showing the true nature of its importance and its impact in all spheres (economic, environmental and social).

Gender and Race on the Frontline: Experiences of Health Workers in Brazil during the COVID-19 Pandemic

Studies on the differential effects of health emergencies have largely overlooked women health workers. Whilst the literature has shown the impact of Coronavirus disease-19 (COVID-19) on women and on healthcare workers, little research has considered the gendered effects of the health workforce. This article analyses the impact of COVID-19 on healthcare workers and working conditions in Brazil's public healthcare system, through consideration of gendered and racialized understandings of care and work. Data were taken from an online survey of 1,263 health workers, undertaken between September and October 2020, disaggregated by sex and by race in order to understand health workers' experiences of the pandemic in one of the countries most significantly affected by the crisis.

Zoonotic spillover: Understanding basic aspects for better prevention

The transmission of pathogens from wild animals to humans is called “zoonotic spillover”. Most human infectious diseases (60-75%) are derived from pathogens that originally circulated in non-human animal species. This demonstrates that spillover has a fundamental role in the emergence of new human infectious diseases. Understanding the factors that facilitate the transmission of pathogens from wild animals to humans is essential to establish strategies focused on the reduction of the frequency of spillover events. In this context, this article describes the basic aspects of zoonotic spillover and the main factors involved in spillover events, considering the role of the inter-species interactions, phylogenetic distance between host species, environmental drivers, and specific characteristics of the pathogens, animals, and humans. As an example, the factors involved in the emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic are discussed, indicating what can be learned from this public health emergency, and what can be applied to the Brazilian scenario. Finally, this article discusses actions to prevent or reduce the frequency of zoonotic spillover events.

Emerging complexities and rising omission: Contrasts among socio-ecological contexts of infectious diseases, research and policy in Brazil

In this article, we explore elements that highlight the interdependent nature of demands for knowledge production and decision-making related to the appearance of emerging diseases. To this end, we refer to scientific production and current contextual evidence to verify situations mainly related to the Brazilian Amazon, which suffers systematic disturbances and is characterized as a possible source of pathogenic microorganisms. With the acceleration of the Anthropocene's environmental changes, socio-ecological instabilities and the possibility of the emergence of infectious diseases merge into a background of a ´twin insurgency´. Furthermore, there is a tendency to impose economic hegemony in the current Brazilian context, corroborating discourses and pressures to a scientific simplification and denial. With this, we assert that developmental sectoral actions and monoculture of knowledge characterize an agenda of omission, that is, a process of decision making that indirectly reinforces ecological degradation and carelessness in the face of the possibility of the emergence and spreading of new diseases, such as COVID-19. Tackling the socio-ecological complexity inherent in the risk of the emergence of infectious diseases requires robust co-construction of scientific knowledge, eco-social approaches, and corresponding governance and sophisticated decision-making arrangements.

The pulmonary route as a way to drug repositioning in COVID-19 therapy

Introduction

The outbreak of the disease caused by the new coronavirus (COVID-19) has been affecting society's routine and its patterns of interaction worldwide, in addition to the impact on the global economy. To date, there is still no clinically effective treatment for this comorbidity, and drug repositioning might be a good strategy considering the established clinical safety profile. In this context, since COVID-19 affects the respiratory tract, a promising approach would be the pulmonary drug delivery.

Objective

Identify repurposing drug candidates for the treatment of COVID-19 based on the data of ongoing clinical trials and in silico studies and also assess their potential to be applied in formulations for pulmonary administration.

Method

A integrative literature review was conducted between June and July 2020, by extracting the results from Clinical Trials, PubMed, Web of Science and Science Direct databases.

Results

By crossing the results obtained from diverse sources, 21 common drugs were found, from which only 4 drugs presented studies of pulmonary release formulations, demonstrating the need for greater investment and incentive in this field.

Conclusion

Even though the lung is a target that facilitates viral infection and replication, formulations for pulmonary delivery of suitable drugs are still lacking for COVID-19 treatment. However, it is indisputable that the pandemic constitutes a concrete demand, with a profound impact on public health, and that, with the appropriate investments, it will give the pharmaceutical industry an opportunity to reinforce the pulmonary delivery field.

Brazil's Actions and Reactions in the Fight Against COVID-19 from January to March 2020

The outbreak of the novel coronavirus SARS-CoV-2 and the disease it causes, COVID-19, which emerged in 2019, was identified by the World Health Organization as a public health emergency of international concern. Brazil actively responded to contain the virus. This case study aims to examine Brazil's response to COVID-19 by investigating the country's actions and reflecting upon the outcomes throughout January and March 2020. The data collection strategy included gathering data from the country's intergovernmental organization's official website, epidemiological bulletins, and news reports, guided by intersectoral and interdisciplinary themes. Although the highest incidence rates were in the most rich and populated region in Brazil, it was the poorest region that had the highest case fatality rate. Nevertheless, Brazil took several non-pharmaceutical measures to control and mitigate the spread of the virus. However, the strategy seems to have failed to consider regional and social inequalities. The actions of the health minister were undermined by a conflicting discourse between the minister and the president. The outbreak of COVID-19 added an extra burden on the country's healthcare system and the existing economic crises; exacerbated the inherent social, political, and economic challenges; and exposed the country's contradictions.