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Brant LCC, Pinheiro PC, Passaglia LG, de Souza MFM, Malta DC, Banerjee A, Ribeiro ALP, Nascimento BR. Cardiovascular mortality in Brazil during the COVID-19 pandemic: a comparison between underlying and multiple causes of death. Public Health 2023; 224:131-139. [PMID: 37776607 DOI: 10.1016/j.puhe.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has differentially impacted cardiovascular disease (CVD) mortality worldwide. Causes of death misclassification may be one of the reasons. We evaluated the impact of the pandemic on CVD mortality in Brazil, comparing underlying causes (UCs) and multiple causes (MCs) of death. STUDY DESIGN Ecological time-series study. METHODS An ecological, time-series study was conducted analysing age-standardised death rates for CVD, from epidemiological week (EW) 10/2020 to 39/2021, using data from the Mortality Information System, Brazil. CVD was defined using the International Classification of Diseases (ICD-10) coding, if reported as UC or MC of death. Observed and expected data (mean for the same EW, 2017-2019) were compared. Risk ratios (RiRs) were analysed, and 95% confidence intervals (CIs) were calculated. RESULTS Age-standardised mortality rate for CVD as UC of death was 165.8 (95%CI: 165.4-166.3) per 100,000 inhabitants, similar to what was expected (165.6/100,000, 95%CI: 165.2-166.1, RiR = 1.00). There was increased out-of-hospital mortality (RiR = 1.18; 95%CI: 1.17-1.19) and deaths of ill-defined causes (RiR = 1.43; 95%CI: 1.42-1.44). The increase in out-of-hospital deaths was more pronounced in the North (RiR = 1.33; 95%CI 1.30-1.36) region, with a less resilient health system. Conversely, as MCs of death, there was a 10% increase in CVD mortality (observed: 243.2 [95%CI: 242.7-243.7], expected: 221.6 [95%CI: 221.1-222.1] per 100,000). An increase also occurred in the North and Central West regions (RiR = 1.16; 95%CI: 1.15-1.18), among men (RiR = 1.11; 95%CI: 1.11-1.12) and individuals aged ≥60 years (RiR = 1.11; 95%CI: 1.10-1.11). CONCLUSIONS During the pandemic, mortality rates for CVD as MCs of death increased in Brazil, whereas as UC mortality rates did not change. Higher out-of-hospital mortality, misclassification, and competing causes of death may explain this pattern.
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Affiliation(s)
- L C C Brant
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - P C Pinheiro
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - L G Passaglia
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - M F M de Souza
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Vital Strategies, São Paulo, SP, Brazil
| | - D C Malta
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - A Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - A L P Ribeiro
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - B R Nascimento
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Serviço de Hemodinâmica do Hospital Madre Teresa, Belo Horizonte, MG, Brazil
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Caputo EL, Feter N, Pinto RNC, Delpino FM, Cassuriaga J, da Silva CN, Leite JS, Jerônimo JS, da Silva SDP, Reichert FF, Rombaldi AJ, da Silva MC. Care seek behavior for low back pain in southern Brazil during the COVID-19 pandemic: a panel data analysis. BMC Musculoskelet Disord 2023; 24:466. [PMID: 37287010 DOI: 10.1186/s12891-023-06538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, people with low back pain (LBP) might have avoided seeking care for their pain. We aimed to investigate how the COVID-19 pandemic has affected LBP care seeking behavior among adults. METHODS Data from four assessments of the PAMPA cohort were analyzed. Participants who reported experiencing LBP during wave one both before and during social restrictions (n = 1,753 and n = 1,712, respectively), wave two (n = 2,009), and wave three (n = 2,482) were included. We asked participants about sociodemographic, behavioral, and health factors and outcomes related to LBP. Poisson regression analyses were conducted, and data are presented as prevalence ratios (PR) and respective 95% confidence interval (95%CI). RESULTS Overall, care seeking behavior decreased by half in the first months of restrictions, from 51.5% to 25.2%. Although there was an increase in care seeking behavior observed in the other two assessments (nearly 10 and 16 months after restrictions), it was insufficient to reach pre-pandemic levels. In the first months of restrictions, a similar scenario was observed for specific care, such as general practitioner and exercise professional care, with proportions of pre-pandemic levels reached after 10 and 16 months. Women were more likely to seek care for LBP 10 and 16 months after restrictions (PR 1.30 95%CI 1.11; 1.52, PR 1.22 95%CI 1.06; 1.39, respectively). Also, those participants who worked, were physically active, and reported pain-related disability and high pain levels were more likely to seek care at all time points assessed. CONCLUSION Overall, care-seeking behavior for LBP significantly decreased in the first months of restrictions and increased in the following months; however, this behavior remained lower than pre-pandemic levels.
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Affiliation(s)
- Eduardo L Caputo
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil.
- School of Physical Education, Federal University of Pelotas, Luís de Camões Street, 625, Pelotas-RS, Pelotas, 96055-630, Brazil.
| | - Natan Feter
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Ricardo N C Pinto
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Felipe Mendes Delpino
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Júlia Cassuriaga
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Carine N da Silva
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Jayne S Leite
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jeferson S Jerônimo
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Sophia D P da Silva
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Felipe F Reichert
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Airton J Rombaldi
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Marcelo C da Silva
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
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Vieira YP, Rocha JQS, Dutra RP, Nunes LDS, Duro SMS, Saes MDO. Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil. BMC Health Serv Res 2023; 23:542. [PMID: 37231427 DOI: 10.1186/s12913-023-09476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Evidence on inequalities in the health services use is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the specialized health use services according to health insurance and income, following COVID-19 in individuals residing in Southern Brazil. METHODS This was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package. RESULTS 2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with specialist doctors after diagnosis of COVID-19. Individuals with health insurance were more likely to use specialized services. The probability of using specialized services was up to three times higher among the richest compared to the poorest. CONCLUSIONS There are socioeconomic inequalities in the specialized services use by individuals following COVID-19 in the far south of Brazil. It is necessary to reduce the difficulty in accessing and using specialized services and to extrapolate the logic that purchasing power transposes health needs. The strengthening of the public health system is essential to guarantee the population's right to health.
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Affiliation(s)
- Yohana Pereira Vieira
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil.
| | - Juliana Quadros Santos Rocha
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Rinelly Pazinato Dutra
- Postgraduate Programme in Public Health, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | | | | | - Mirelle de Oliveira Saes
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
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Luciani S, Caixeta R, Chavez C, Ondarsuhu D, Hennis A. What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region. BMJ Open 2023; 13:e070085. [PMID: 36863746 PMCID: PMC9990165 DOI: 10.1136/bmjopen-2022-070085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE This article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic. SETTING Information on public sector primary care services for NCDs, and related technical inputs from 35 countries in the Americas region are provided. PARTICIPANTS All Ministry of Health officials managing a national NCD programme, from a WHO Member State in the Americas region, were included throughout this study. Government health officials from countries that are not WHO Member States were excluded. OUTCOME MEASURES The availability of evidence-based NCD guidelines, essential NCD medicines and basic technologies in primary care, cardiovascular disease risk stratification, cancer screening and palliative care services were measured in 2019, 2020 and 2021. NCD service interruptions, reassignments of NCD staff during the COVID-19 pandemic and mitigation strategies to reduce disruptions for NCD services were measured in 2020 and 2021. RESULTS More than 50% of countries reported a lack of comprehensive package of NCD guidelines, essential medicines and related service inputs. Extensive disruptions in NCD services resulted from the pandemic, with only 12/35 countries (34%), reporting that outpatient NCD services were functioning normally. Ministry of Health staff were largely redirected to work on the COVID-19 response, either full time or partially, reducing the human resources available for NCD services. Six of 24 countries (25%) reported stock out of essential NCD medicines and/or diagnostics at health facilities which affected service continuity. Mitigation strategies to ensure continuity of care for people with NCDs were deployed in many countries and included triaging patients, telemedicine and teleconsultations, and electronic prescriptions and other novel prescribing practices. CONCLUSIONS The findings from this regional survey suggest significant and sustained disruptions, affecting all countries regardless of the country's level of investments in healthcare or NCD burden.
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Affiliation(s)
- Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Roberta Caixeta
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Carolina Chavez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Dolores Ondarsuhu
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
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Szwarcwald CL, Boccolini CS, da Silva de Almeida W, Soares Filho AM, Malta DC. COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management. Arch Public Health 2022; 80:255. [PMID: 36536434 PMCID: PMC9762984 DOI: 10.1186/s13690-022-01012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities in facing the emergency. In this article, we analyze data on COVID-19-related deaths in 2020-21 to show the epidemic consequences in Brazil. METHODS The Mortality Information System and the Live Birth Information System were the primary information sources. We used population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age, sex, and educational level. Considering the total number of COVID-19 deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily number of deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate (IMR); maternal mortality ratio (MMR); number and rate of orphans due to mother's COVID-19 death; the average number of years lost. RESULTS The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. The rate among illiterate people was 38.8/10,000, three times higher than a college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the age group of 40-59 years. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 live births (LB), representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 lost their mothers during the epidemic, with an orphans' rate of 7.5/10,000 children aged 0-17 years. The IMR was 11.7 per 1000 LB, with 0.2 caused by COVID-19. The peak of COVID-19 deaths occurred in March 2021, reaching almost 4000 COVID-19 deaths per day, higher than the average number of deaths per day from all causes in 2019. CONCLUSIONS The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths.
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Affiliation(s)
- Célia Landmann Szwarcwald
- grid.418068.30000 0001 0723 0931Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cristiano Siqueira Boccolini
- grid.418068.30000 0001 0723 0931Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Wanessa da Silva de Almeida
- grid.418068.30000 0001 0723 0931Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Adauto Martins Soares Filho
- grid.8430.f0000 0001 2181 4888Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Deborah Carvalho Malta
- grid.8430.f0000 0001 2181 4888School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais Brazil
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Muzy J, Campos M, Emmerick I, Avelar FGD. Characterization of primary health care for patients with diabetes based on the PMAQ-AB. Ciênc saúde coletiva 2022. [DOI: 10.1590/1413-81232022279.17542021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This article aims to present a proposal for making the instruments used in the three cycles of the PMAQ-AB compatible and to analyze the information on access, coverage, structure, organization and provision of services in PHC related to care for DM in Brazil, according to regions, from the perspective of family health professionals and users. We performed an analysis of the degree of compatibility of the PMAQ-AB questions (2012, 2014 and 2017). To analyze the temporal evolution of the components, we performed a proportion difference test. We calculated the percentage difference between the perspective of professionals and users, per year analyzed, for Brazil. In general, there was an improvement in the quality of care and examinations, except for the diabetic foot. Worse results were found for the North region in relation to the other regions. Despite the structural improvement and the quality of care reported by professionals, there are significant gaps in the quality of care for patients with DM in the SUS. In the scenario of scarce investment added to the growing prevalence of DM, obstacles become progressively more challenging. Therefore, monitoring and evaluating the quality of services provided are essential tasks of the Brazilian Health System.
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Muzy J, Campos M, Emmerick I, Avelar FGD. Characterization of primary health care for patients with diabetes based on the PMAQ-AB. Cien Saude Colet 2022; 27:3583-3602. [PMID: 36000646 DOI: 10.1590/1413-81232022279.17542021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
This article aims to present a proposal for making the instruments used in the three cycles of the PMAQ-AB compatible and to analyze the information on access, coverage, structure, organization and provision of services in PHC related to care for DM in Brazil, according to regions, from the perspective of family health professionals and users. We performed an analysis of the degree of compatibility of the PMAQ-AB questions (2012, 2014 and 2017). To analyze the temporal evolution of the components, we performed a proportion difference test. We calculated the percentage difference between the perspective of professionals and users, per year analyzed, for Brazil. In general, there was an improvement in the quality of care and examinations, except for the diabetic foot. Worse results were found for the North region in relation to the other regions. Despite the structural improvement and the quality of care reported by professionals, there are significant gaps in the quality of care for patients with DM in the SUS. In the scenario of scarce investment added to the growing prevalence of DM, obstacles become progressively more challenging. Therefore, monitoring and evaluating the quality of services provided are essential tasks of the Brazilian Health System.
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Affiliation(s)
- Jéssica Muzy
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Mônica Campos
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
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Abstract
BACKGROUND The COVID-19 pandemic has already claimed more than six million direct deaths. Low-and middle-income countries, such Brazil, were severely hit, not only due to direct effects on mortality, but also for its indirect effects on other causes of deaths. AIMS The objective of this study was to estimate the excess suicides in Brazil and evaluate patterns within and between its regions during the COVID-19 pandemic in 2020. METHOD The observed suicides are gathered from the mortality information system of the Brazilian Ministry of Health. The estimates of expected suicides, according to sex, age group, bimonthly period and region, were reached through quasi-Poisson generalized additive models, with adjustment for overdispersion. The analyses were performed in R software, version 3.6.1 and RStudio, version 1.2.1335. RESULTS From March 2020 to December 2020, 10,409 suicides were observed in Brazil, resulting in an overall decrease of 13%, in comparison to the expected rate for the period. There were excess suicides of 26% in men from the Northern region in the 60 years and more age group, as well as in women from the Northern region in the 30 to 59 years age group in two consecutive bimonthly periods. Excess suicides of 40% was also observed in women in the 60 years and more age group from the Northeastern region. CONCLUSIONS Despite the overall decrease in suicides in Brazil over the period assessed, substantial excess suicides were observed in different age groups and sexes from the Northern and Northeastern regions of the country, which are regions that are historically more prone to health and socioeconomic inequalities.
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Santos LG, da Silva RV, Leal TC, Xavier JE, Figueiredo EVMDS, de Paiva JPS, da Silva LF, Rocha CADO, Nunes BEBR, Santana GBDA, Fernandes TRMDO, Costa FDA, Bezerra-Santos M, Feliciano do Carmo R, Armstrong ADC, de Souza CDF. Impact of the COVID-19 pandemic on hospital admissions and in-hospital lethality from cardiovascular diseases in Brazil: an ecological and time series study COVID-19 and cardiovascular diseases. Curr Probl Cardiol 2022:101216. [PMID: 35460687 PMCID: PMC9021219 DOI: 10.1016/j.cpcardiol.2022.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Since the onset of the coronavirus disease 2019 (COVID-19) pandemic in Brazil, several government policies have been taken. Herein, we aimed to assess the impact of the COVID-19 pandemic on hospital admissions and in-hospital lethality for cardiovascular diseases (CVD) in Brazil in 2020. METHODS An ecological and time-series study on hospitalizations and deaths from CVD in Brazil was conducted from January 2018 to December 2020. RESULTS The hospital admission rate for CVD reduced by 17.1%, with a significantly decreasing trend between January and May 2020 (Annual Percent Change: -8,7%; p-value <0.001). The in-hospital lethality rate increased from 8.2% in 2018 to 9.3% in 2020. During this period, Brazil totaled 21.8 million days of hospital stay. CONCLUSION Indicators of hospital admissions and lethality from CVD in Brazil were impacted by the emergence of the COVID-19 pandemic in different ways in the regions and depending on the nature of the indicator.
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Affiliation(s)
- Lucas Gomes Santos
- Department of Medicine, Federal University of Alagoas, Arapiraca, AL, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | - Rodrigo Feliciano do Carmo
- College of Pharmaceutical Sciences, Federal University of the São Francisco Valley (UNIVASF), Petrolina, Pernambuco, Brazil; Department of Medicine, Federal University of Alagoas, Arapiraca, AL, Brazil
| | - Anderson da Costa Armstrong
- College of Medicine, Federal University of the São Francisco Valley (UNIVASF), Petrolina, Pernambuco, Brazil
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Bispo Júnior JP, Santos DBD. [COVID-19 as a syndemic: a theoretical model and foundations for a comprehensive approach in health]. CAD SAUDE PUBLICA 2021; 37:e00119021. [PMID: 34644754 DOI: 10.1590/0102-311x00119021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/13/2021] [Indexed: 01/22/2023] Open
Abstract
This essay aims to present and discuss the theoretical framework for the COVID-19 syndemic. The first part presents the foundations and principles of syndemic theory. For the purposes of this essay, syndemic was defined as a process of synergic interaction between two or more diseases, in which the effects are mutually enhanced. We discussed the three principal typologies of syndemic interaction: mutually causal epidemics; epidemics interacting synergically; and serial causal epidemics. In the second part, COVID-19 is analyzed as a syndemic resulting from the interaction between various groups of diseases and the socioeconomic context. The theoretical model considered the interaction between COVID-19 and chronic noncommunicable diseases, infectious and parasitic diseases, and mental health problems. The essay addressed how social iniquities and conditions of vulnerability act at various levels to increase the effect of COVID-19 and other pandemics. The last section discusses the need for comprehensive, multisector, and integrated responses to COVID-19. A model for intervention was presented that involves the patient care and socioeconomic dimensions. In the sphere of patient care, the authors defend the structuring of strong and responsive health systems, accessible to the entire population. The economic and social dimension addressed the issue of reclaiming the ideals of solidarity, the health promotion strategy, and emphasis on social determinants of health. In conclusion, the lessons learned from the syndemic approach to COVID-19 call on government and society to develop policies that link clinical, sanitary, socioeconomic, and environmental interventions.
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