Mudanças nas condições socioeconômicas e de saúde dos brasileiros durante a pandemia de COVID-19

Impact of financial toxicity on adults with cancer during the COVID-19 pandemic: an integrative review

OBJECTIVES

to identify the repercussions of financial toxicity on the lives of adult cancer patients during the COVID-19 pandemic.

METHODS

an integrative review was conducted using the PubMed, Web of Science, Scopus, and Embase databases, as well as the Virtual Health Library portal, in March 2023.

RESULTS

out of 62 studies found, 13 were included for analysis. The primary repercussions of financial toxicity included difficulties in covering basic expenses such as food, housing, medication, transportation, and internet access; increased anxiety and concerns related to health and financial situations; reduction or absence of income; challenges in obtaining treatment or accessing healthcare services; rising expenses; and telemedicine as a less burdensome alternative.

CONCLUSIONS

the pandemic has exacerbated financial toxicity; therefore, healthcare teams must recognize it as an adverse event of oncological treatment and understand its potential to affect various aspects of patients' lives.

Accessing Dementia Care in Brazil: An Analysis of Case Vignettes

BACKGROUND AND OBJECTIVES

Despite the rapid increase in the number of people living with dementia in Brazil, dementia care is limited. This study describes how people living with dementia and their carers access care, treatment, and support, and identifies what characteristics are likely to enable or prevent access.

RESEARCH DESIGN AND METHODS

We created 10 vignettes to illustrate fictitious but realistic scenarios involving people living with dementia in Brazil. The vignettes explore a combination of socioeconomic and demographic variables. They were completed using an in-depth desk review of the dementia care landscape in Brazil; a Strengths, Opportunities, Weaknesses, and Threats (SWOT) analysis of the desk review; and expert knowledge. The analysis focused on identifying common sources of service provision, barriers of access to care and support, and specific issues experienced by some population groups.

FINDINGS

Access to a dementia diagnosis, care, and support for people living with dementia in Brazil is limited. Demographic and socio-economic circumstances play a role in determining the type of services to which a person might have access. Poor knowledge about dementia, lack of capacity in the health system, and lack of formal long-term care support are among the identified barriers to accessing timely diagnosis, care, and support in the country.

DISCUSSION AND IMPLICATIONS

Understanding the barriers and facilitators of access to diagnosis, treatment, and support for people with dementia and families with different demographic and socioeconomic characteristics is crucial for designing dementia policies that are context-specific and responsive to the care needs of different socioeconomic groups in Brazil.

Sociodemographic and economic characteristics of families and health and education conditions of children in the BRISA cohort during the COVID-19 pandemic

OBJECTIVE

To describe changes in sociodemographic, economic and variables related to the characterization of family, health and education during the COVID-19 pandemic in a birth cohort evaluated at 10-11 years of age.

METHODS

Cross-sectional study involving 1,033 children from a cohort of children born in 2010/2011, in the city of Ribeirão Preto, SP, Brazil. Data were collected from July to October 2021 by telephone or video interview held with the person responsible for the child. The questionnaires discussed family organization, child behavior and health, school attendance, socioeconomic assessment and occurrence of COVID-19 during the period of social isolation due to the pandemic. Descriptive statistics were used to describe the data. The chi-square test was used to verify group differences by minimum wages (MW).

RESULTS

Of the respondents, 47.6% reported worsening of their financial situation during the pandemic, which was more frequent in the group with a household income <3 MW compared to the group with >6 MW (59.1 vs. 15.7%; p<0.001). According to the respondents, 62% of the children exhibited behavioral changes during the period and anxiety was the most frequently reported condition. In addition, 61.4% of the children had learning difficulties and these problems were more prevalent among children from households with lower incomes compared to those with higher incomes (74.7 vs. 45.1%; p<0.001).

CONCLUSION

The COVID-19 pandemic has changed different economic aspects of families, as well as educational, health and behavioral indicators of children. Lower-income families were the most affected both economically and in terms of other indicators.

Implications of the COVID-19 pandemic in monitoring health and cardiovascular diseases: survey study

OBJECTIVE

To analyze the implications of COVID-19 in the monitoring of health and cardiovascular diseases in health services.

METHOD

This is a descriptive, cross-sectional, survey-type study with 798 adults, selected by snowball on social networks, between June and July 2020. Data were collected in an electronic form validated for this study.

RESULTS

There was a negative impact on monitoring health and cardiovascular diseases with missed appointments and elective exams. Symptoms such as chest pain and hypertensive crisis were neglected due to fear of contagion, lack of knowledge or structural lack of services, in addition to impaired monitoring of chronic conditions.

CONCLUSION

The severity of results is noted considering the COVID-19 progression and the risk of complications. It is necessary to organize flows and structures compatible with each care profile, in health services, to guarantee care and promote diagnosis and control of chronic conditions in the set of actions to contain pandemics. It is crucial to prioritize primary care in health follow-ups during pandemic periods, as this has a direct impact on the progression of critical conditions at other levels of care.

Physical, psychological, and behavioral problems among children and adolescents in countries with different economic statuses during the COVID-19 pandemic: a systematic review and meta-analysis

Introduction

The COVID-19 pandemic has impacted children and adolescents' physical activity (PA), sleeping patterns, and psychological and behavioral health. Yet, little is known about the differences between those in countries with various economic statuses.

Methods

Articles published from database inception through 16 March 2022 were retrieved using CINAHL Complete, Cochrane Library, EMBASE, Medline, PubMed, and PsycINFO. High-quality studies that reported the number of participants with parameters associated with PA, sleeping patterns, and psychological and behavioral problems in young people aged under 18 years during the pandemic were included. We referenced the Canadian 24-Hour Movement Guidelines for PA and sleep duration to provide the event rate for young people who were not compliant with the guidelines. The event rate of young people who had decreased sleep quality and experienced psychological and behavioral problems were also investigated. A subgroup analysis was conducted to identify the differences in those in countries with diverse economic statuses. Funnel plot analysis and Egger's test were also conducted to identify any risk of publication bias.

Result

A total of 66 studies with 1,371,168 participants aged between 0 and 18 years, involving 27 countries, were included. During the pandemic, we identified that 41% (95% CI: 39%, 43%; I2 = 96.62) and 43% (95% CI: 34%, 52%; I2 = 99.42) of young people did not meet the PA and sleep duration recommendation guidelines. In addition, 31% (95% CI: 28%, 35%; I2 = 99.66) of young people had decreased their sleep quality. Yet, no significant difference was found across countries with different economic statuses. However, the event rates of participants with psychological and behavioral problems were 32% (95% CI: 28%, 36%; I2 = 99.85) and 19% (95% CI: 14%, 25%; I2 = 99.72), respectively. In addition, the rate of psychological problems was more severe in those who live in lower middle-income countries (p < 0.001), while the rate of behavioral problems was more severe in those who live in high-income countries (p = 0.001).

Discussion

During the pandemic, the discouragement of PA, poor sleep quality, and high risk of psychological and behavioral problems are concerning. A large number of young people did not comply with the recommendation guidelines. Timely implementation of recovery plans is critical to address the adverse effects on young people.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309209, identifier CRD42022309209.

COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management

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.

The Increased Alcohol and Marijuana Use Associated with the Quality of Life and Psychosocial Aspects: a Study During the Covid-19 Pandemic in a Brazilian University Community

The primary practice adopted to reduce Covid-19 contamination is social distancing (SD). SD had significant consequences on alcohol/drug use, quality of life, and psychosocial aspects. In the university community specifically, SD produces a collective traumatic event with changes in the work routine by the suspension of presence. This study aims to identify and analyze the associations of increased alcohol and marijuana consumption on the quality of life and psychosocial aspects of the university community (students, professors, and technical and administrative staff) at a Brazilian public university during SD due to Covid-19 pandemic. This descriptive and cross-sectional study used an online questionnaire to obtain information from 2790 university community participants. Data were analyzed using IBM SPSS Statistics version 22. The analysis included descriptive associations performed using Spearman's correlation coefficient and p < 0.05 was taken as statistically significant. The participants' majority was 62% female, 95.4% students, 73% were 17-25 years old, 33.4% had income between 1 and 3 minimum wage, and 48% of the university community "totally adhered to SD." The increased alcohol consumption during SD was associated with a worsening in quality of life (p = 0.001), health satisfaction (p = 0.015), the meaning of life (p = 0.040), ability to concentrate (p = 0.001), satisfaction with yourself (p = 0.029), and frequency of negative feelings (p = 0.001); in contrast, increased alcohol use improved satisfaction with peer support (p = 0.042), as well as increased marijuana use improved satisfaction with sex life (p < 0.001). The increased alcohol use was higher in women (30.5%) than in men (26.7%) and was negatively associated with more quality of life and psychosocial aspects among women than men. Students were the segment that presented the highest frequency of associations with increased alcohol and/or marijuana use in the three domains analyzed. This study innovated by associating increased alcohol and/or marijuana use with worsening quality of life and psychosocial aspects rather than evaluating them apart. Future studies must identify whether this association between increased alcohol use, mainly, and the worsening quality of life and psychosocial aspects during the SD period is maintained or improved with the return to face-to-face activities at the university, with particular attention to women and students. Psychologists and other mental health professionals should be called upon to develop interventions to meet emerging mental health needs.

Discontinuation of Health Interventions Among Brazilian Older Adults During the Covid-19 Pandemic: REMOBILIZE Study

The objective of this study was to analyze changes in access to health interventions during the pandemic among Brazilian older adults and to investigate the factors associated with social and health inequalities. We conducted an online survey with Brazilian adults aged 60  +  years between May and June 2020. A multidimensional questionnaire was used to investigate access to health interventions during the pandemic and associated factors. Of 1482 participants, 56.5% reported health care before the pandemic, and 36.4% discontinued it during the pandemic. The discontinuation rate was 64.4% (95% CI 61.1-67.6). Participants with higher educational level (nine or more years of education: OR 0.34; 95% CI 0.17-0.70) and higher income (eight or more times the minimum wage: OR 0.54; 95% CI 0.36-0.81) were associated with less probability of discontinuation. Presenting multimorbidity (OR: 1.42; 95% CI 1.06-1.90) and polypharmacy (OR: 0.61; 95% CI 0.46-0.81) were associated with discontinuity in health interventions. Our study showed that structural health inequities in access to health care shaped the rates of discontinuation in health care interventions during the COVID-19 pandemic. Strategic actions should be set up to actively monitor socially vulnerable older adults and strengthen community-based services to mitigate the discontinuation of health care interventions.

Willingness and uptake of the COVID-19 testing and vaccination in urban China during the low-risk period: a cross-sectional study

BACKGROUND

Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Evidence on the willingness and uptake of the COVID-19 testing is scarce, and the willingness and uptake of vaccination may change as the pandemic evolves. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China.

METHODS

A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents' willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate factors associated with the willingness and uptake of the two measures.

RESULTS

In early 2021, about half (52.45%) of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) of the respondents were willing to receive testing. About two-thirds (63.28%) of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants, having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated.

CONCLUSIONS

By early 2021, Chinese adults expressed almost universal willingness of COVID-19 testing and over half of adults have been tested, while the willingness and uptake of COVID-19 vaccination were relatively low at the low-risk period of the COVID-19 pandemic. Maintaining willingness of COVID-19 vaccination is critical and necessary, especially when the pandemic evolved into a low-risk period.

Consumo de álcool em professores da rede pública estadual durante a pandemia da COVID-19

RESUMO Objetivo: Avaliar o consumo de álcool entre os professores da rede pública estadual do ensino básico antes e durante a pandemia da COVID-19 e os fatores associados aos que aumentaram o consumo de bebidas alcoólicas durante a pandemia. Métodos: Inquérito epidemiológico do tipo websurvey , realizado com professores da educação básica das escolas da rede pública estadual de Minas Gerais. A coleta ocorreu de agosto a setembro/2020 via formulário digital e contou com o apoio da Secretaria de Estado de Educação. A variável dependente adotada foi o aumento no consumo de bebidas alcoólicas pelos professores durante a pandemia. Foi utilizada a regressão de Poisson, adotando nível de significância de 5%. Resultados: Participaram do estudo 15.641 professores de 795 municípios mineiros. Em relação ao consumo de bebidas alcoólicas, antes da pandemia, 46,9% dos professores consumiam pelo menos uma vez por semana e durante a pandemia 7,1% relataram que estavam bebendo mais do que costumavam. Observou-se maior consumo de bebida alcoólica durante a pandemia entre os homens, com menor faixa etária, com maior renda familiar, os que tiveram muita dificuldade em realizar as atividades escolares, os insatisfeitos com o trabalho, os que começaram a ter problemas de sono e naqueles com algum familiar/amigo que desenvolveu sintomas graves da COVID-19. Conclusões: Os resultados evidenciaram que a maioria dos participantes manteve o seu consumo ou o diminuiu durante a pandemia, com 7,1% aumentando o uso de álcool. Esse aumento foi associado a fatores sociodemográficos e econômicos, condições de trabalho durante a pandemia, comportamentos/hábitos de vida e condições de saúde.

Effects of the pandemic on caregivers of individuals with neuropsychomotor disorders

Abstract Introduction Since social isolation during the COVID-19 pandemic can influence a patient’s and informal caregiver’s health, the present study was carried out to understand and improve the latter’s quality of life. Objective To analyze the physical, mental and quality of life effects on caregivers of patients with neurological sequelae and developmental delay during the COVID-19 pandemic. Methods: Thirty informal caregivers divided into two groups (G1: Psychomotor disorders and syndromes; G2: Neurological sequelae) were evaluated using questionnaires on general data, burden and quality of life. Chi-square tests with Bonferroni post-hoc correction were performed to compare the response rate between the dependent variables and the level of burden. The student’s t-test was applied to determine the correlation between groups and quality of life, obtaining significant findings (p ≤ 0.05). Results No or minimal burden was found in 33.3% of the caregivers, and mild to moderate in 66.7% of each group, with no significant effect between them. In terms of quality of life, a decline was found in all domains, with a significant intergroup difference in social aspects and G1 exhibiting the highest declines (G1: 70.00 ± 23.99%; G2: 86.66 ± 20.84%). Conclusion There was a mild-to-moderate impact on physical burden, with a change in the quality of life of caregivers evaluated during the COVID-19 pandemic. Caregivers of children with psychomotor disorders and syndromes were the most affected in the social aspect domain.

Efeitos da pandemia em cuidadores de indivíduos com alterações neuropsicomotoras

Resumo Introdução O isolamento social durante a pandemia de COVID-19 pode influenciar a saúde do paciente e do cuidador informal. No intuito de compreender e orientar a melhora da qualidade de vida destes cuidadores, este estudo foi realizado. Objetivo Analisar os efeitos físicos, mentais e a qualidade de vida de cuidadores de pacientes com sequelas neurológicas e atraso do desenvolvimento durante a pandemia de COVID-19. Métodos Trinta cuidadores informais divididos em dois grupos (G1: distúrbios psicomotores e síndromes; G2: sequelas neurológicas) foram avaliados com questionários sobre dados gerais, sobrecarga e qualidade de vida. Foram realizados os testes qui-quadrado com pós-teste de Bonferroni para comparar a taxa de resposta entre as variáveis dependentes e o nível de sobrecarga. Para a correlação entre os grupos e a qualidade de vida, utilizou-se o teste t de Student não pareado, sendo significativo os achados com p ≤ 0,05. Resultados Encontrou-se ausência de sobrecarga ou sobrecarga mínima em 33,3% e sobrecarga leve a moderada em 66,7% dos cuidadores em cada grupo, sem efeito significativo entre estes. Na qualidade de vida foi encontrado déficit em todos os domínios, com diferença significativa entre os grupos no domínio de aspectos sociais, tendo o G1 apresentado maiores déficits (G1: 70,00 ± 23,99%; G2: 86,66 ± 20,84%). Conclusão Conclui-se que houve impacto de leve a moderado na sobrecarga física, com alteração na qualidade de vida dos cuidadores avaliados durante a pandemia de COVID-19, sendo os cuidadores de crianças com distúrbios psicomotores e síndromes os mais acometidos no aspecto social.

Excess deaths from all causes and by COVID-19 in Brazil in 2020

OBJECTIVE

To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil.

METHODS

Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model.

RESULTS

Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups.

CONCLUSION

There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.

Psychometric properties of the Coronavirus Anxiety Scale (CAS) in Brazil

We aimed to adapt the Coronavirus Anxiety Scale (CAS) in Brazil, using a range of statistical techniques (e.g., factor analysis, item response theory). Two studies were conducted (N_total = 512). The unidimensional structure presented a good model fit and reliability, significant convergent validity, and all items presenting very high discrimination levels, adequately assessing medium and high anxiety levels. We also gathered evidence on cutoff points for detecting anxiety symptoms, reinforcing the diagnostic feasibility (for screening) of the CAS. Our findings emphasize the CAS as useful for rapid assessment and research involving COVID-19 and mental health markers.

Associations of Sociodemographic Factors and Health Behaviors with the Emotional Well-Being of Adolescents during the COVID-19 Pandemic in Brazil

This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12–17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. We used the “virtual snowball” sampling method, and students from private and public schools were included. A total of 9470 adolescents were analyzed. A hierarchical logistic regression model was used to find the factors associated with reporting at least two of three self-reported problems—sadness, irritability, and sleep problems. The main proximal factor was loneliness (AdjOR = 8.12 p < 0.001). Problems related to school closures also played an important role. Regular intake of fruits and vegetables, as well as physical activity, demonstrated a positive influence on emotional well-being, while excessive screen time (AdjOR = 2.05, p < 0.001) and alcohol consumption negatively affected outcomes (AdjOR = 1.73, p < 0.001). As for distal variables, less affluent adolescents were the most affected, and males reported fewer emotional problems than females. Uncertainty regarding the disease in a context of socioeconomic vulnerability, together with rises in unhealthy behaviors and isolation from their immediate social circles, have negatively affected adolescents’ emotional status throughout the COVID-19 pandemic.