Background The COVID-19 pandemic has led to high levels of physical, psychological, and social stress among health care professionals, including postgraduate students in medical and multidisciplinary residencies. This stress is associated with the intense fear of occupational exposure to SARS-CoV-2, the virus known to cause COVID-19. These professionals are at risk of developing physical and mental illnesses not only due to the infection but also due to prolonged exposure to multidimensional stress and continued work overload. Objective This study aims to evaluate the prevalence of symptoms suggestive of mental disorders and burnout syndrome and determine the risk factors for burnout among postgraduate students in medical and multidisciplinary residencies in Brazil during the COVID-19 pandemic. Methods For this prospective cohort study with parallel groups, participants were recruited between July and September 2020 to achieve a sample size of at least 1144 participants. Research instruments such as Depression, Anxiety, and Stress Scale; Patient Health Questionnaire; Brief Resilient Coping Scale; and Oldenburg Burnout Inventory will be used to collect data. Data will be collected in 2 waves: the first wave will include data related to sample characterization and psychosocial evaluation, and the second wave will be launched 12 weeks later and will include an evaluation of the incidence of burnout as well as correlations with the potential predictive factors collected in the first wave. Additionally, we will collect data regarding participants’ withdrawal from work. Results The recruitment took place from July 29 to September 5, 2020. Data analyses for this phase is already in progress. The second phase of the study is also in progress. The final data collection began on December 1, 2020, and it will be completed by December 31, 2020. Conclusions We believe the findings of this study will help evaluate the impact of the COVID-19 pandemic on the mental health conditions of health professionals in Brazil as well as contribute to the planning and implementation of appropriate measures that can alleviate these mental health challenges. International Registered Report Identifier (IRRID) DERR1-10.2196/24298

Background In early 2020, the COVID-19 pandemic paralyzed the world and exposed the fragility of health systems in the face of mass illness. Health professionals became protagonists, fulfilling their mission at the risk of physical and mental illness. The study aimed to evaluate absenteeism indirectly related to SARS-CoV-2 infection in a large population of health care professionals. Methods An observational longitudinal repeated measures study was performed, including workers linked to 40 public university hospitals in Brazil. All causes of absenteeism were analyzed, focusing on those not directly attributed to COVID-19. Results for the same population were compared over two equivalent time intervals: prepandemic and during the pandemic. Findings A total of 32,691 workers were included in the study, with health professionals comprising 82.5% of the sample. Comparison of the periods before and during the pandemic showed a 26.6% reduction in work absence for all causes, except for COVID-19 and mental health-related absence. Concerning work absence related to mental health, the odds ratio was 39.0% higher during the pandemic. At the onset of the pandemic, there was an increase in absenteeism (all causes), followed by a progressive reduction until the end of the observation period. Interpretation Work absence related to mental illness among health care professionals increased during the COVID-19 pandemic, highlighting the need for health care managers to prioritize and implement support strategies to minimize absenteeism.

Background Since the beginning of the COVID-19 pandemic, health professionals have been working under extreme conditions, increasing the risk of physical and mental illness. We evaluated the prevalence of burnout and its associated factors among postgraduate student residents in health professions during the global health crisis. Methods Healthcare residents were recruited from all across Brazil between July and September 2020 through digital forms containing instruments for assessing burnout (Oldenburg Burnout Inventory (OLBI)), resilience (brief resilient coping scale (BRCS)) and anxiety, stress and depression (depression, anxiety and stress scale (DASS-21) and Patient Health Questionnaire (PHQ-9)). Additionally, the relationships between burnout and chronic diseases, autonomy and educational adequacy in the residency programme, personal protective equipment (PPE), workload and care for patients with COVID-19 were evaluated. The chi-square test, Student’s t test, Pearson’s correlation test and logistic regression were performed. Results A total of 1,313 participants were included: mean (standard deviation) age, 27.8 (4.4) years; female gender, 78.1%; white race, 59.3%; and physicians, 51.3%. The overall prevalence of burnout was 33.4%. The odds (odds ratio [95% confidence interval]) of burnout were higher in the presence of pre-existing diseases (1.76 [1.26–2.47]) and weekly work > 60 h (1.36 [1.03–1.79]) and were lower in the presence of high resilience (0.84 [0.81–0.88]), autonomy (0.87 [0.81–0.93]), and educational structure (0.77 [0.73–0.82]), adequate availability of PPE (0.72 [0.63–0.83]) and non-white race (0.63 [0.47–0.83]). Burnout was correlated with anxiety (r = 0.47; p < 0.05), stress (r: 0.58; p < 0.05) and depression (r: 0.65; p < 0.05). Conclusions We observed a high prevalence of burnout among residents during the COVID-19 pandemic. Individual characteristics and conditions related to the work environment were associated with a higher or lower occurrence of the syndrome.

Elective procedures were temporarily suspended several times over the course of the pandemic of COVID-19. Monthly data from the Unified Health System (SUS) were used for the period between January 2008 and December 2020 and the interrupted time series method was used to estimate the effect of the pandemic on the number of elective surgeries and elective procedures that were not performed. Considering a 9-month period, a reduction of 46% in the number of elective procedures carried out in the SUS could be attributed to COVID-19, corresponding to about 828,429 elective procedures cancelled, ranging from 549,921 to 1,106,936. To a full recovery of pre-pandemic performance, SUS would need to increase about 21,362 hospital beds, ranging from 12,370 to 36,392 hospital beds during a 6 month-period. This effort would represent an increase of 8.48% (ranging from 4.91 to 14.45%) in relation to the total number of SUS’s hospital beds in 2019. As a result, the pandemic will leave a large number of elective procedures to be carried out, which will require efforts by health agencies to meet this demand.

Background: Since the beginning of the COVID-19 pandemic, health professionals have been working under extreme conditions, increasing the risk of physical and mental illness. We evaluated the prevalence of burnout and its associated factors among postgraduate student residents in health professions during the global health crisis. Methods : Healthcare residents were recruited from all across Brazil between July and September 2020 through digital forms containing instruments for assessing burnout (Oldenburg Burnout Inventory (OLBI)), resilience (brief resilient coping scale (BRCS)) and anxiety, stress and depression (depression, anxiety and stress scale (DASS-21) and Patient Health Questionnaire (PHQ-9)). Additionally, the relationships between burnout and chronic diseases, autonomy and educational adequacy in the residency programme, personal protective equipment (PPE), workload and care for patients with COVID-19 were evaluated. The chi-square test , Student’s t test, Pearson’s correlation test and logistic regression were performed. Results : A total of 1,313 participants were included: mean (standard deviation) age, 27.8 (4.4) years; female gender, 78.1%; white race, 59.3%; and physicians, 51.3%. The overall prevalence of burnout was 33.4%. The odds (odds ratio [95% confidence interval]) of burnout were higher in the presence of pre-existing diseases (1.76 [ 1.26–2 .47]) and weekly work > 60 h (1.36 [1.03–1.79]) and were lower in the presence of high resilience (0.84 [0.81–0.88]), autonomy (0.87 [0.81–0.93]), and educational structure (0.77 [0.73–0.82]), adequate availability of PPE (0.72 [0.63–0.83]) and non-white race (0.63 [0.47–0.83]). Burnout was correlated with anxiety (r = 0.47; p < 0.05), stress (r: 0.58; p < 0.05) and depression (r: 0.65; p < 0.05). Conclusions : We observed a high prevalence of burnout among residents during the COVID-19 pandemic. Individual characteristics and conditions related to the work environment were associated with a higher or lower occurrence of the syndrome.

BACKGROUND The coronavirus (SARS-CoV-2) epidemic was first identified in Wuhan, China, at the end of 2019, and spread across the world in a fast and disordered manner. Because of the pandemic, health professionals, including residents in medicine and other health specialties, began working under intense physical and psychological pressure daily and were exposed to a greater risk of developing mental disorders and psychological distress. OBJECTIVE This study evaluated the prevalence of symptoms indicative of mental disorders such as depression, anxiety and stress among postgraduate students who were residents in medicine and other health specialties during the COVID-19 pandemic in Brazil and identified possible associated predisposing factors. METHODS This was a cross-sectional study that included postgraduate students in medical and other health residency programmes in Brazil. The recruitment period was from July 29 to September 5, 2020. Epidemiological and clinical data, including evaluations of psychological and affective aspects, following a predefined protocol, were collected after the participants filled out an electronic form via the Microsoft Forms platform. RESULTS In total, 1,313 medical and other health residents participated in the study. The Depression, Anxiety and Stress Scale-21 (DASS-21) identified depression, anxiety and stress in 51.3%, 53.4% and 52.6% of the participants, respectively. Based on the Brief Resilient Coping Scale (BRCS), 61.9% of the participants had low resilience. A total of 60.9% of the residents had high scores on the Patient Health Questionnaire 9‐item depression module (PHQ-9). CONCLUSIONS We found a high prevalence of symptoms of depression, anxiety and stress among medical and non-medical residents during the COVID-19 pandemic in Brazil. Mental disorders are complex in nature, and the particular academic environment of residency, altered by the need to care for patients with COVID-19, can be a potential stressor and be associated with the high prevalence of these symptoms among residents. INTERNATIONAL REGISTERED REPORT RR2-10.2196/24298

BACKGROUND The COVID-19 pandemic imposes a high degree of physical, psychological and social stress on health professionals, including postgraduate students in medical and multidisciplinary residencies. This stress is associated with the intense fear of occupational exposure to the virus. These professionals are at risk of becoming physically and mentally ill not only due to the infection but also due to prolonged exposure to multidimensional stress and continued work overload. OBJECTIVE This study aims to evaluatethe prevalence of symptoms that indicate mental disorders and burnout syndrome, as well as to determine risk factors for burnout among postgraduate students in medical and multidisciplinary residencies in Brazil during the COVID-19 pandemic. METHODS This will be a prospective cohort study with parallel groups. Recruitment will take place from July to August/2020. The research instruments that will be used are theDepression, Anxiety and Stress Scale (DASS-21), the Patient Health Questionnaire (PHQ-9), the Brief Resilient Coping Scale and the Oldenburg Burnout Inventory (OLBI).Two wavesof data collection will occur: the first wavewill includeddata related to sample characterization and psychosocial evaluation; the final wave will occur 12 weeks later and will include an evaluation of the incidence of burnout as well as correlations with the potential predictive factors collected in the first wave. Additionally, dataregarding work withdrawal will be collected. RESULTS The project has data collection in progress. Recruitment started on July 29, 2020. Analysis of the results will begin after the initial inclusion of all participants CONCLUSIONS The Force Fellow Study is run by the University of Brasília to evaluate the prevalence of symptoms that are suggestive of mental disorders and exhaustion syndrome (burnout) among postgraduate students of medical and multidisciplinary residencies in Brazil, as well as to determine the predictors of burnout during the COVID-19 pandemic. CLINICALTRIAL The study is registered in the Research Ethics Committee from the Medical School (CEP/FM) of the University of Brasília (CAAE: 33493920.0.0000.5558).

RESUMO Introdução: O objetivo deste trabalho foi relatar um caso de tuberculose com manifestações neurológicas pouco frequentes, em paciente em situação social vulnerável, usuário de drogas, com má adesão ao tratamento. Desenvolvimento: Paciente do sexo masculino, 32 anos, de etnia indígena, previamente hígido, usuário de drogas, que abriu quadro de perda ponderal, sudorese noturna e fraqueza em membros inferiores sem sintomas pulmonares, evoluindo no período de 3 meses com paraplegia, retenção urinária e fecal. Durante investigação foi evidenciado um quadro de tuberculose disseminada na apresentação de tuberculose pulmonar associada às formas extrapulmonares de tuberculose (tuberculomas intracerebral, intracerebelar e intramedular). Iniciado esquema específico para tuberculose apresentando melhora importante da paraplegia e recuperação total das funções esfincterianas. Teve alta para manter seguimento na Atenção Primária por 1 ano, porém abandonou tratamento após 7 meses e há relato de uso diário e abusivo de drogas. Considerações  finais: Este caso enfatiza como a vulnerabilidade social gera uma susceptibilidade clínica, enfrentada pelas pessoas acometidas pela tuberculose e consumo de drogas ilícitas.   Palavras-chave: Tuberculose; tuberculoma intramedular; tuberculoma intracraniano; Usuários de Drogas; Vulnerabilidade Social   ABSTRACT   Introduction: The objective of this study was to report a case of tuberculosis with infrequent neurological manifestations, in a patient in a vulnerable social situation, drug user, with poor adherence to treatment. Development: A 32-year-old male patient of indigenous ethnicity, previously healthy, drug user, who developed weight loss, night sweats and weakness in the lower limbs without pulmonary symptoms, evolving within 3 months with paraplegia, urinary and fecal retention. During investigation, a picture of disseminated tuberculosis was evidenced in the presentation of pulmonary tuberculosis associated with extrapulmonary forms of tuberculosis (intracerebral, intracerebellar and intramedullary tuberculomas). A specific regimen for TB was started, and progressed with significant improvement in paraplegia and full recovery of sphincter functions. He was discharged to maintain treatment in Primary Care for 1 year, but abandoned treatment after 7 months and reported daily and abusive drug use. Final Considerations: This case emphasizes how social vulnerability generates a clinical vulnerability faced by people affected by tuberculosis and the consumption of illicit drugs.   Keywords: Tuberculosis; intramedullary tuberculoma; intracranial tuberculoma; Drug users; Social vulnerability