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(searched for: (Violence against Health-Care Personnel: Lessons from COVID-19 Pandemic))
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, Aline Duarte Maranhão, Elias F. Melo
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, Volume 42, pp 676-678; doi:10.1055/s-0040-1719110

Abstract:
Dear Editor, We have read with great interest the Special Article from Romão et al.,[1] with recommendations from the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) regarding medical residency training during the coronavirus disease (
COVID
-
19
)
pandemic
. While it is clear in considering aspects of theoretical activities, it is less conclusive of how practical workload should be accomplished: can we participate in
COVID
-
19
care
while practicing obstetrics and gynecology (OBGYN)? We agree that there are major concerns of how the
COVID
-
19
pandemic
will impact the apprenticeship of the residents and, especially, women's
health
care
. We are aware of and respectful to all the necessary arrangements in dealing with the
COVID
-
19
pandemic
.[2] In Brazil, at least a third of OBGYN residents were relocated to deliver
care
to suspected or confirmed
COVID
-
19
patients.[3] Although it may represent OBGYN interrupted regular activities, it comes to our attention that the relocation of residents was simultaneous to important modifications in women's
health
care
in Brazil. First, women are afraid of seeking medical
care
and exposing themselves to SARS-CoV-2, therefore tending to underestimate their
health
condition and to delay arrival to medical facilities; they presume there is a great risk of viral infection. Second, quarantine and lockdown measures have restricted
health
care
to essential services, decreasing access to on-time diagnosis.
Health
personnel
were deviated from women's
health
facilities, including antenatal clinics, to help emergency services. Ultrasound and laboratory tests, which were never adequate, are now restricted to a bare minimum. Therefore, women are admitted to hospitals in worsened medical conditions; it seems that 10% of maternal deaths in Brazil this year are related to
COVID
-
19
.[4] Third, other
health
issues arise during the
pandemic
. To cite just a few, domestic
violence
, anxiety, and perinatal depression are rising in times of social isolation and emotional constraints.[5] [6] We understand that OBGYN are the leading professionals in women's integral
health
care
, and residents must take part on it. Finally, and of the uttermost importance, we still do not know how SARS-CoV-2 behaves in specific conditions of our field, such as in pregnancy[7] or oncology.[8] Therefore, we can still afford
COVID
-
19
care
while offering OBGYN
care
. In our view, the role of OBGYN
personnel
in taking
care
of women's
health
is irreplaceable. In times of
pandemics
, our role is to provide a safe environment for the continuity of our species, which is not a lesser endeavor. In this context, program directors and institutions should focus the efforts of OBGYN residents on activities for which they have the best training for, and in sectors where they can really help. For example, emergency obstetrical
care
, which is historically overburdened in terms of resource
personnel
. Many
lessons
can be learned from the
pandemic
as a whole, but in our field, we have a clear picture of how essential our work really is. Antenatal
care
, labor wards, OBGYN emergency rooms, and gynecological oncology procedures are still places for assistance and residency training. If there is less gynecological training during the
pandemic
,[3] residents must be replaced to obstetrics or oncology, which is in accordance with the FEBRASGO statement.[1] The pervasive feeling among some institutions that OBGYN is a common specialty is unequivocally wrong. We have a unique set of abilities which are simply indispensable. Obstetrics and gynecology
personnel
cannot be relocated without considerable impact on the quality of
care
. It is a waste of precious human resources to use the OBGYN workforce in the frontline of
COVID
when we have pressing needs in attending obstetrics emergencies and oncologic cases. Perhaps more lives will be wasted – or an increase of long-term sequelae for both mother and newborn[9] [10]–with this shift of
personnel
from where they are most effectively used to performing general
COVID
-
19
care
. Gynecological and perinatology
health
care
must be seen as essential areas of medical assistance and education. Residency training in 2020 has been challenging for residents, program directors, institutions and policy makers. Obstetrics and gynecology residents are skilled professionals and need to work as such. In Brazil, women's
health
is marked by inequalities of access and deliver of
care
, which impairs the maternal morbidity and mortality rate. Residency programs need to be in line with women's needs. Conflict of Interests The authors have no conflict of interests to declare. Text prepared by the members of the National Specialized Commission on Medical Residency and endorsed by the Scientific Board and Presidency of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO). Publication Date:31 October 2020 (online) © 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Thieme Revinter Publicações LtdaRio de Janeiro, Brazil
Ahmed M Abbas, Lobna Ahmed, Mark Mohsen Kamel, Sarah K. Fahmi
Journal of Biomedical Research & Environmental Sciences, Volume 1, pp 154-155; doi:10.37871/jbres1135

Abstract:
Violence
towards
healthcare
personnel
in hospitals is a widespread worrying phenomenon, and it is considered a mirror to
violence
in society in general [1]. There are many factors may share in this phenomenon as work overload, waiting times, and nurse-patient relations, responsibilities, environmental factors and patient-related factors [2].
AIDS and Behavior, Volume 24, pp 2995-2998; doi:10.1007/s10461-020-02932-z

Abstract:
The intersections between infectious diseases, including HIV and structural inequalities, cannot be overstated. HIV disproportionately impacts women [7] and is often concentrated in socially marginalized and disenfranchised communities [8].
COVID
-
19
is affecting women disproportionately; they are “essential workers" taking the strain as food service industry workers, janitors, cashiers, and stockers. Many live in densely populated areas that have no proper sanitation [7]. The social distancing and lockdown measures have impacted nearly 81% of the world’s labor force, mostly women [7]. According to the World Bank, almost 24 million fewer people will escape poverty in East Asia and the Pacific because of the financial impact of
COVID
-
19
in 2020 [9]. Already half of the world population cannot access
healthcare
services, and large numbers of households are poor because of
healthcare
costs [9]. The emergence of
COVID
-
19
may widen the gender inequality gap to an unprecedented level and threaten women’s
health
. For example, many HIV infected women will lack the essential antiretroviral therapy (ART) drugs, or pre-exposure prophylaxis (PreP) because of disruptions in the supply chain. As a consequence, many will develop an unsuppressed or uncontrolled viral load that will weaken the immune system making them susceptible to
COVID
-
19
[10].
COVID
-
19
will exceedingly impact women in SSA, who already face food security challenges [11]. One in every five people in Africa, nearly 250 million, did not have enough food before the
COVID
-
19
outbreak [12]. The long-term consequences are unknown; however, micronutrient deficiency and anemia are likely, which will worsen HIV/AIDS disease for HIV patients. Women are the caregivers and service providers who are 2.5 times more likely to do unpaid domestic work than men [13]. However,
COVID
-
19
responses have not been poverty or gender-sensitive to the needs of women [14, 15]. In LMICs, women are the frontline workers, community
health
workers, and community engagement
personnel
; they are easily susceptible to
COVID
-
19
infections. Without proper personal protective equipment (PPE), and as they work in environments with no water or sanitation, many of these workers could be exposed to
COVID
-
19
outbreaks [16]. Although recommendations and obligatory hand hygiene have been emphasized as requisite to avoid
COVID
-
19
[16], these recommendations are impervious to the social environments of the poor. Millions of people in the world have no access to clean water or soap; asking them to wash their hands to prevent infections is insensitive to the plight of the poor. Such recommendation parallel those made during the early days of HIV pertaining to safe sex practices. However, many populations could not afford condoms, and adequate guarantees were not put in place to acquire them [17]. The impact of
COVID
-
19
is undoubtedly felt unevenly across countries and regions [18]. Among the LMICs in sub-Saharan Africa,
COVID
-
19
could push these countries farther into a spiral of poverty, ravaging their already tenuous
health
systems [2, 5]. The vast global demand for PPEs, for example, exerts substantial competition and demand for them. There is a troubling rich/poor divide, disadvantaging many LMICs who lose out to the wealthier countries that outspend and outbid them, sometimes tripling the market price for PPEs [
19
]. Faced with such inequity gaps, many countries in Latin America and Africa are realizing unseen pre-existing inequities and cannot find enough materials and equipment to test for
COVID
-
19
and treat their populations [7]. The long-term impact on GDP, growth, and service delivery will be consequential as projections have already been revised downwards for most regions and countries [9] Sexual and reproductive
health
and rights (SRHR) are critical to women’s
health
[20]. Evidence awash indicating that providing contraception to women is one of the simplest ways to reduce poverty [21]. During the HIV outbreak, a significant limited reproductive
health
care
and family planning services were available to women. Resources to address the disease were diverted elsewhere [6]. In the era of
COVID
-
19
, disruptions in the manufacture and distribution of critical contraceptives might contribute to unwanted pregnancies [22] and sexually transmitted diseases like HIV. According to the United Nations, an unrelated crisis impacting women worldwide are the spikes in domestic
violence
due to
COVID
-
19
lockdowns [7]. Lockdowns and mandatory sheltering-in-place may be making
violence
in homes more frequent and severe as girls and women shelter in place with their abusers. Domestic
violence
and sexual abuse are significant correlates of HIV risk for women as
violence
has been identified as an independent risk factor for HIV infection [23]. Women who are abused may not ask their partner to use a condom, nor have the efficacy to say no to sex if their abusive partner does not want to use protection, which will put abused women at a higher risk for HIV. Additionally, women who are transgender and are living with HIV are disproportionately impacted by intimate partner
violence
[24], stay at home
COVID
-
19
orders could exacerbate their wellbeing. Following
COVID
-
19
, a renewed focus on reducing structural inequalities is needed to ensure that
health
is not a byproduct of privilege in any country or region. Adapting existing practices and schemes to benefit women can simultaneously reduce the viral spread of the infection [25]. For example, cash benefits using e-payments and in-kind transfers can improve economic security for women. Also, policies and programs should ensure dignified work opportunities that promote sustainable economic growth, inclusive workspaces, and decent wages for women to ensure their full economic participation. Particular attention should be paid to adolescent girls and young women and improve women’s empowerment by challenging norms that...
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