The impact of the COVID-19 pandemic on oral biopsies in the Brazilian National Health System

Negative excess oral and pharyngeal cancer mortality in Europe during the early pandemic years

OBJECTIVE

The COVID-19 pandemic had direct and indirect effects on oral and pharyngeal cancer (OPC) mortality due to high COVID-19 mortality risk among cancer patients, and to the COVID-19 response that caused treatment delays and reduced routine visits. This study investigated the excess OPC mortality in Europe during the early pandemic years.

METHODS

Mortality and population data were gathered from the Eurostat database. The 2011-2019 mortality rates were used to estimate the 2020-2021 expected rates through joinpoint trend analysis. The excess mortality rates (observed minus expected mortality) with 95% confidence intervals (95 CIs) were assessed.

RESULTS

Statistically significant negative excess age-standardized and crude (age strata <65 and ≥65 years) OPC mortality rates in males and females, in the European Union (EU, 27 countries) and Europe were reported. The estimated OPC missing deaths in EU were 831 (95 CI, 630-985) and 1240 (95 CI, 1039-1394) in 2020 and 2021, respectively, with differences between sexes, age strata, and countries. The OPC deaths in the EU and Europe were 3.6% and 3.5% lower than expected.

CONCLUSION

Missing OPC deaths reported in Europe in 2020-2021 could be explained by changes in death certification of OPC patients who developed COVID-19, rather than a real OPC mortality decline.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic

OBJECTIVE

To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS).

METHODS

We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change.

RESULTS

Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods.

CONCLUSION

After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

The impact of the COVID-19 pandemic in Brazil: a study in tertiary dental care

The pandemic caused by coronavirus has resonated throughout different levels of health care in Brazil and, in this context, the present research aimed to evaluate this impact on tertiary dental care provided by the Unified Health System (SUS). Therefore, an ecological study was conducted with data obtained from the Hospital Information System processed by the Portal of the Department of Informatics of SUS. The sample consisted of patients of all sexes and age groups, whose Hospital Admission Authorizations (AIHs) were approved for dental tertiary care procedures from January 2015 to December 2020. Descriptive analyses and the ANOVA test with a significance level set at p < 0.05 were used. When the annual mean numbers of AIHs approved were evaluated, findings showed that on an average, the Southeast region authorized a higher number of procedures (p-value < 0.001), however, in the pandemic year (2020), a reduction of approximately 24.5% of these hospitalizations occurred throughout Brazil, with the Midwest being the region most affected (32.12%). A percentage increase occurred in the Surgical Treatment of Oral sinus/Oral nasal Fistula (16.1%), in addition to a significant decrease in performing procedures for Resection of Mouth Lesion (33.4%). In the pandemic year, there was a reduction of 14% in expenditures related to hospital services and 23.26% related to professional services. It was concluded that the data presented demonstrated a significant reduction in AIHs for tertiary dental care in the pandemic year.

Impact of the absence of dental support on cancer patients during COVID-19 pandemic: a cross-sectional study

Purpose

This study identifies the impact of the absence of dental support for patients with cancer whose clinical dental care was interrupted by the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Individuals with oncologic diseases were selected from a telephone list of a Clinical Research Center (CRC) that specialized in the care of patients with cancer at the Bauru School of Dentistry, University of São Paulo (FOB/USP). The convenience sample comprised 280 patients (aged > 18 years) with a history of cancer that underwent dental treatment at the FOB/USP CRC in 2019 and did not receive care in 2020 owing to the pandemic. The participants completed a questionnaire sent via email or a text messaging application. Individuals receiving treatment or who were already treated for cancer were divided into two groups for data tabulation. Statistical analyses were performed using Fisher’s and chi-square tests.

Results

Of the 280 patients, 104 answered the questionnaire, and 75 (72.1%) were women. Among the women, 45 (60.0%) were receiving antineoplastic treatment, and 30 (40.0%) had already been treated. Among the men, 15 (51.7%) were receiving antineoplastic treatment, and 14 (48.3%) had already been treated. Regarding oral problems that arose during the pandemic, dental pain when eating hot or cold food or drinks (57.0%), muscle pain (53.8%), and difficulties when chewing (51.0%) were the most common reported among patients. Furthermore, most individuals reported not having received any type of remote dental follow-up, before being contacted by our team, which could contribute to reducing these oral problems.

Conclusion

It is impossible to say whether the absence of dental support in cancer patients during the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on oral issue rates.

O impacto da pandemia de covid-19 na assistência à saúde mental de usuários de álcool nos Centros de Atenção Psicossocial

Resumo A preocupação com o consumo prejudicial de álcool está na interseção da pandemia com a saúde mental. Mudanças nos padrões de consumo durante a crise sanitária têm sido documentadas no Brasil e internacionalmente. Este estudo avaliou o impacto da pandemia nos procedimentos a usuários de álcool no Brasil, por meio dos registros dos Centros de Atenção Psicossocial (CAPS). Selecionaram-se dados de janeiro de 2019 a dezembro de 2020, com discriminação por macrorregião geográfica, sexo, idade e raça/cor. Realizou-se análise descritiva, cálculo da variação percentual e distribuição em séries temporais. A análise comparativa apontou redução nos procedimentos no início da pandemia (-52,4%), com diferenças entre sexo e faixa etária. Observou-se diferenças entre macrorregiões, com pior resultado no Norte do país (-70,1%). O segundo semestre de 2020 apresentou retomada nos procedimentos, porém em quantidade aquém do realizado no ano anterior (-41,7%). Houve aprofundamento das desigualdades já existentes, especialmente com a queda mais elevada nas macrorregiões mais pobres, com maior fragilidade na rede de saúde mental. Dada a magnitude do álcool como problema de saúde pública e o papel central dos CAPS, ressalta-se a necessidade de instituir políticas e programas de saúde visando minimizar o impacto da pandemia na redução da assistência psicossocial.

Advances and weaknesses of the work process of the oral cancer care network in Brazil: A latent class transition analysis

OBJECTIVE

To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas-CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality-PMAQ, in 2014 and 2018.

METHOD

This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes' changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services.

RESULTS

The model with four LS was chosen. The four LS were named: 1.'Most indicators inadequate for OC care' (the worst); 2. 'Most indicators suitable for OC care' (the best); 3. 'CEO with a poor relation with Primary Health Care (PHC) services'; and 4. 'CEO with a poor relation with tertiary hospital services'. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory.

CONCLUSIONS

There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality.

Impacts of the COVID-19 epidemic on the department of stomatology in a tertiary hospital: A case study in the General Hospital of the Central Theater Command, Wuhan, China

Objective

The impact of the worldwide COVID‐19 pandemic on the dental community is evident. Dental education programmes and academic activities have suffered from the ramifications of the pandemic. This study aimed to depict the impacts of the COVID‐19 epidemic on the clinical services and academic activities in the department of stomatology of a tertiary hospital in Wuhan, China.

Methods

We obtained historical data of the Department of Stomatology from the Health Information System of the General Hospital of Central Theater Command, Wuhan, China between January 2018 and June 2020. Mean, standard deviation and median with interquartile range were used to summarize the variables. Line plots were used to illustrate the temporal trend. The Kruskal‐Wallis equality‐of‐populations rank test was used to compare the difference between groups.

Results

A significant decrease was noted in the monthly average number of patients seeking outpatient services for the year 2020, which were decreased by two‐thirds from 2018 to 2020. The number of emergency cases also decreased significantly by 57.6% in 2020. The monthly number of teaching hours decreased from 3.8 ± 1.5 in 2018 and 4.7 ± 1.4 in 2019 to 1.7 ± 1.9 in 2020. The number of interns also decreased by more than 77.0% in 2020.

Conclusions

The impacts of COVID‐19 in the stomatology clinic were significant with notable decreases in clinical services and education offered to the stomatology students. There is a need to find solutions to keep as many dental professionals as needed remaining on the frontline of oral health care.

Excess mortality by specific causes of deaths in the city of São Paulo, Brazil, during the COVID-19 pandemic

BACKGROUND

To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic.

METHODS

Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method.

RESULTS

COVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17-1.42) and women (SMR 1.2, 95% CI 1.06-1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67-2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years.

CONCLUSION

There was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.