101
|
Furtado MAS, Sousa Junior RR, Soares LA, Soares BA, Mendonça KT, Rosenbaum P, Oliveira VC, Camargos ACR, Leite HR. Analysis of Informative Content on Cerebral Palsy Presented in Brazilian-Portuguese YouTube Videos. Phys Occup Ther Pediatr 2022; 42:369-383. [PMID: 35253603 DOI: 10.1080/01942638.2022.2046677] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aims: To describe the characteristics of the most accessed YouTube videos in Brazilian-Portuguese on cerebral palsy (CP), and to analyze content of informational videos about this topic.Methods: This was a cross-sectional study. Searching on YouTube website was conducted by two independent examiners between November and December 2019, using the keywords "Paralisia Cerebral" sorted by videos' number of views. Videos that did not present content related to CP or duplicate videos were excluded. The interaction parameters and content characteristics of the included videos were extracted. To access the trustworthiness and quality of informational videos, the modified Discern checklist and the Global Quality Score was used.Results: Following the eligibility criteria 90 videos were included. Fifty-three (53) were classified as experiential videos and 37 as informational videos. Informational videos presented multi-topics about different aspects of CP. This group of videos presented moderate trustworthiness due to the lack of scientific evidence content. Informational videos had good quality and generally good flow.Conclusion: YouTube presented a large number of videos about CP in Brazilian-Portuguese. Informational videos are useful for patients and healthcare providers; however, it is necessary to included information about scientific evidence, as a strategy to facilitate and promote knowledge translation.
Collapse
Affiliation(s)
- Michelle A S Furtado
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ricardo R Sousa Junior
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Luana A Soares
- Graduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Bruno A Soares
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Karoline T Mendonça
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Peter Rosenbaum
- McMaster University, CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada
| | - Vinícius C Oliveira
- Graduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.,Graduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Ana C R Camargos
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Hércules R Leite
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| |
Collapse
|
102
|
Malta DC, Gomes CS, Prates EJS, Santos FPD, Almeida WDSD, Stopa SR, Pereira CA, Szwarcwald CL. Analysis of demand and access to services in the last two weeks previous to the National Health Survey 2013 and 2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210002. [PMID: 34910056 DOI: 10.1590/1980-549720210002.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Compare the demand and use of health services between 2013 and 2019, and analyze the associated sociodemographic and health variables in 2019. METHODS Cross-sectional study with data from the National Health Survey (PNS) 2013 and 2019. The prevalence and 95% confidence intervals (95% CI) for the demand and use of health services were estimated. In 2019, the differences in the indicators were analyzed according to sociodemographic variables and the crude and adjusted by sex and age prevalence ratios (RP) were estimated. RESULTS There was an increase of 22% in the demand for health care in the last two weeks, going from 15.3% (95%CI 15.0-15.7) in 2013 to 18.6% (95%CI 18.3-19.0) in 2019. There was a reduction in use in the last two weeks, from 97% (95%CI 96.6-97.4) in 2013 to 86.1% (95%CI 85.4-86.8) in 2019, which was observed for most Federation Units. In 2019, the demand for care was greater among women, the elderly, those with high schooling, individuals with health insurance and poor self-rated health. They obtained greater access to health services in the fifteen days prior to the survey: men, children or adolescents up to 17 years of age, people with health insurance and poor health self-assessment. CONCLUSION The demand for health services has grown and reduced access in the last 15 days between 2013 and 2019. These differences may have been exacerbated by the austerity measures implemented in the country.
Collapse
Affiliation(s)
- Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Crizian Saar Gomes
- Postgraduate Program in Public Health, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | | | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Sheila Rizzato Stopa
- Department of Health Analysis and Surveillance of Chronic Non-communicable Diseases, Secretariat of Health Surveillance, Ministry of Health - Brasília (DF), Brazil
| | - Cimar Azeredo Pereira
- Directorate of Research, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brazil
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| |
Collapse
|
103
|
Gomes CS, Gonçalves RPF, Silva AGD, Sá ACMGND, Alves FTA, Ribeiro ALP, Malta DC. Factors associated with cardiovascular disease in the Brazilian adult population: National Health Survey, 2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210013. [PMID: 34910067 DOI: 10.1590/1980-549720210013.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/13/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to estimate the prevalence and investigate the sociodemographic, health, and lifestyle factors associated with the self-reported diagnosis of Cardiovascular Disease (CVD) in the adult Brazilian population. METHODS Data from the National Health Survey (PNS 2019) were analyzed. The presence of CVD was self-reported through the question: "Has any doctor ever given you a diagnosis of heart disease?". Sociodemographic factors, health conditions, and lifestyle were evaluated. For data analysis, Poisson Regression with robust variance was used. RESULTS 5.3% (95%CI 5.04-5.57) of Brazilian adults reported CVD, of which, 29.08% (95%CI 27.04-31.21) underwent coronary artery bypass surgery or angioplasty and 8.26% (95%CI 7.09-9.6) reported severe limitation in usual activities due to CVD. The factors associated with CVD were advanced age; being male; white race/color; complete middle school and incomplete high school education; have health insurance; self-assessing health as regular or bad/very bad; self-reported hypertension, high cholesterol, and diabetes; being a former smoker; consuming fruits and vegetables as recommended; not consuming alcohol in excess; and not practicing leisure-time physical activity. CONCLUSIONS CVD is associated with sociodemographic, health, and lifestyle factors. It is important to support public policies, programs, and goals for the reduction of cardiovascular diseases in Brazil, especially in the most vulnerable groups.
Collapse
Affiliation(s)
- Crizian Saar Gomes
- Postgraduate Program in Public Health, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Renata Patrícia Fonseca Gonçalves
- Postgraduate Program in Health Education, Department of Nursing, Universidade Federal dos Vales do Jequitinhonha e Mucuri - Diamantina (MG), Brazil
| | - Alanna Gomes da Silva
- Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | | | - Antonio Luiz Pinho Ribeiro
- Hospital das Clínicas, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Deborah Carvalho Malta
- Postgraduate Program in Public Health, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.,Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.,Maternal and Child Department, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| |
Collapse
|
104
|
Lemonica R, Patricio KP. Impact of the National Policy on Integrative and Complementary Practices on Brazilian Public Homeopathy Services. HOMEOPATHY 2021; 111:235-239. [PMID: 34891177 DOI: 10.1055/s-0041-1736333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Homeopathy has been experiencing a period of expansion in Brazil due to its practical relevance in the face of new global and national health demands, culminating in the launch in 2006 of the National Policy for Integrative and Complementary Practices (NPICP) by the Ministry of Health of Brazil, which standardized and regularized the position of homeopathy within the Brazilian Unified Health System (SUS). AIMS To understand the impact of the guidelines proposed by the NPICP on homeopathy services in the SUS, specifically in the south-east region of Brazil, according to the perceptions of their managers. METHODS This is a descriptive, exploratory research study with a qualitative approach, conducted in homeopathy services in the south-east region of Brazil, through semi-structured interviews and with data processed using content analysis. RESULTS The data show the importance of the NPICP in regulating and offering homeopathy in the services studied. However, the NPICP's objective of promoting and fully developing integrative and complementary practices has not been achieved because it has failed to translate strategies into actions. CONCLUSIONS Though important to the development of homeopathy services in any given location, policies stated in the NPICP were revealed to have limited impact on the implementation and development of new services. Without further legislation, training programs and appropriate budget allocation, new services will be unable to thrive and their users unable to benefit from a more comprehensive approach to healthcare.
Collapse
Affiliation(s)
- Renata Lemonica
- Universidade Estadual Paulista 'Julio de Mesquita Filho', Faculdade de Medicina, Câmpus de Botucatu, Botucatu, São Paulo, Brazil
| | | |
Collapse
|
105
|
Knaul FM, Touchton M, Arreola-Ornelas H, Atun R, Anyosa RJCC, Frenk J, Martínez-Valle A, McDonald T, Porteny T, Sánchez-Talanquer M, Victora C. Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico. LANCET REGIONAL HEALTH. AMERICAS 2021; 4:100086. [PMID: 34664040 PMCID: PMC8514423 DOI: 10.1016/j.lana.2021.100086] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 12/25/2022]
Abstract
We present a new concept, Punt Politics, and apply it to the COVID-19 non-pharmaceutical interventions (NPI) in two epicenters of the pandemic: Mexico and Brazil. Punt Politics refers to national leaders in federal systems deferring or deflecting responsibility for health systems decision-making to sub-national entities without evidence or coordination. The fragmentation of authority and overlapping functions in federal, decentralized political systems make them more susceptible to coordination problems than centralized, unitary systems. We apply the concept to pandemics, which require national health system stewardship, using sub-national NPI data that we developed and curated through the Observatory for the Containment of COVID-19 in the Americas to illustrate Punt Politics in Mexico and Brazil. Both countries suffer from protracted, high levels of COVID-19 mortality and inadequate pandemic responses, including little testing and disregard for scientific evidence. We illustrate how populist leadership drove Punt Politics and how partisan politics contributed to disabling an evidence-based response in Mexico and Brazil. These cases illustrate the combination of decentralization and populist leadership that is most conducive to punting responsibility. We discuss how Punt Politics reduces health system functionality, providing lessons for other countries and future pandemic responses, including vaccine rollout.
Collapse
Affiliation(s)
- Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Fundación Mexicana para la Salud, Mexico City, Mexico,Tómatelo a Pecho, Mexico City, Mexico
| | - Michael Touchton
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Department of Political Science, Institute for Advanced Studies of the Americas, University of Miami, Coral Gables, FL, USA,Corresponding author: Michael Touchton, University of Miami, Coral Gables, FL, USA
| | - Héctor Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Fundación Mexicana para la Salud, Mexico City, Mexico,Tómatelo a Pecho, Mexico City, Mexico
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Renzo JC Calderon Anyosa
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | | | - Adolfo Martínez-Valle
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Tim McDonald
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,RAND Corporation, Santa Monica, CA, USA
| | - Thalia Porteny
- Departments of Community Health and Occupational Therapy, Tufts University, Medford, MA, USA
| | | | | |
Collapse
|
106
|
Booij L, Nicolosi M. Early childhood care, support and research: how early screening and longitudinal studies can help children thrive. J Pediatr (Rio J) 2021; 97:579-581. [PMID: 34019848 PMCID: PMC9432234 DOI: 10.1016/j.jped.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Linda Booij
- Concordia University, Department of Psychology, Montreal, Canada; Sainte-Justine University Hospital Research Center, Montreal, Canada.
| | - Melissa Nicolosi
- Concordia University, Department of Psychology, Montreal, Canada; Sainte-Justine University Hospital Research Center, Montreal, Canada
| |
Collapse
|
107
|
The Regionalization Process for Universal Health Coverage in Brazil (2008-2015). Healthcare (Basel) 2021; 9:healthcare9101380. [PMID: 34683060 PMCID: PMC8544391 DOI: 10.3390/healthcare9101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
The objective of this article is to analyze the development of the public and private offer for the universalization of health services, specifically, for the progression of the public network. The time period examined is from 2008 to 2015, when there was considerable economic growth and expansion of private health insurance and an unprecedented historical period with economic growth and reduction of social inequality. Across 5570 municipalities, the multivariate analysis model was used to estimate the level of concentration and the imbalance (heterogeneity) of installed health capacity of the network of health care services. Public spending on investment and human resources showed positive variation in all regions and in almost all population strata. The offer by the Unified Health System (public) of primary health care increased by 8000 new establishments in all regions, especially in previously uncovered cities and cities that had shortages of public health services. Public universalization almost reached its maximum, with about 70% of municipalities. The only setback was the significant reduction of 50% in the number of private establishments in primary health care services. The data suggest a positive movement toward the universalization of health services in Brazil, with the concentration of high-complexity care and the heterogeneity of the installed capacity being points for improvement.
Collapse
|
108
|
Sikder SS, Ghoshal R, Bhate-Deosthali P, Jaishwal C, Roy N. Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015-2020). BMC WOMENS HEALTH 2021; 21:360. [PMID: 34629077 PMCID: PMC8504083 DOI: 10.1186/s12905-021-01499-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022]
Abstract
Background Violence against women (VAW) is a global challenge, and the health sector is a key entry point for survivors to receive care. The World Health Organization adopted an earlier framework for health systems response to survivors. However, documentation on the programmatic rollout of health system response to violence against women is lacking in low and middle-income countries. This paper studies the programmatic roll out of the health systems response across select five low- and middle-income countries (LMIC) and identifies key learnings. Methods We selected five LMIC settings with recent or active programming on national-level health system response to VAW from 2015 to 2020. We synthesized publicly available data and program reports according to the components of the WHO Health Systems Framework. The countries selected are Bangladesh, Brazil, Nepal, Rwanda, and Sri Lanka. Results One-stop centers were found to be the dominant model of care located in hospitals in four countries. Each setting has implemented in-service training as key to addressing provider knowledge, attitudes and practice; however, significant gaps remain in addressing frequent staff turnover, provision of training at scale, and documentation of the impact of training. The health system protocols for VAW address sexual violence but do not uniformly include clinical and health policy responses for emotional or economic violence. Providing privacy to survivors within health facilities was a universal challenge. Conclusion Significant efforts have been made to address provider attitudes towards provision of care and to protocolize delivery of care to survivors, primarily through one-stop centers. Further improvements can be made in data collection on training impact on provider attitudes and practices, in provider identification of VAW survivors, and in prioritization of VAW within health system budgeting, staffing, and political priorities. Primary health facilities need to provide first-line support for survivors to avoid delays in response to all forms of VAW as well as for secondary prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01499-8.
Collapse
Affiliation(s)
| | - Rakhi Ghoshal
- CARE India, No.14, Patliputra Colony, Patna, Bihar, 800013, India.,WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | | | - Chandni Jaishwal
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden. .,The George Institute for Global Health, New Delhi, India.
| |
Collapse
|
109
|
Gadenz SD, Basso J, de Oliviera PRBP, Sperling S, Zuanazzi MVD, Oliveira GG, da Silva IM, Motta RM, Gehres LG, de Brito Mallmann É, Rodrigues ÁS, Pachito DV, de Faria Leao B. Telehealth to support referral management in a universal health system: a before-and-after study. BMC Health Serv Res 2021; 21:1012. [PMID: 34563176 PMCID: PMC8467186 DOI: 10.1186/s12913-021-07028-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Management of patient flow within a healthcare network, allowing equitable and qualified access to healthcare, is a major challenge for universal health systems. Implementation of telehealth strategies to support referral management has been shown to increase primary care resolution and to promote coordination of care. The objective of this study was to assess the impact of telehealth strategies on waiting lists and waiting times for specialized care in Brazil. METHODS Before-and-after study with measures obtained between January 2019 and February 2020. Baseline measurements of waiting lists were obtained immediately before the implementation of a remotely operated referral management system. Post-interventional measurements were obtained monthly, up to six months after the beginning of operation. Data was extracted from the database of the project. General linear models were applied to assess interaction of locality and time over number of cases on waiting lists and waiting times. RESULTS At baseline, the median number of cases on waiting lists ranged from 2961 to 12,305 cases. Reductions of the number of cases on waiting lists after six months of operation were observed in all localities. The magnitude of the reduction ranged from 54.67 to 88.97 %. Interaction of time measurements was statistically significant from the second month onward. Median waiting times ranged from 159 to 241 days at baseline. After six months, there was a decrease of 100 and 114 waiting days in two localities, respectively, with reduction of waiting times only for high-risk cases in the third locality. CONCLUSIONS Adoption of telehealth strategies resulted in the reduction of number of cases on waiting lists. Results were consistent across localities, suggesting that telehealth interventions are viable in diverse settings.
Collapse
Affiliation(s)
- Sabrina Dalbosco Gadenz
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | - Josué Basso
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | | | - Stephan Sperling
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | | | | | - Ivonice Martins da Silva
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | - Raphael Mendes Motta
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| | - Luana Gonçalves Gehres
- Ministry of Health, Esplanada dos Ministérios, Bloco G, 3º Andar, 70058-900, Brasília, Distrito Federal, Brazil
| | - Érica de Brito Mallmann
- Ministry of Health, Esplanada dos Ministérios, Bloco G, 3º Andar, 70058-900, Brasília, Distrito Federal, Brazil
| | - Átila Szczecinski Rodrigues
- Ministry of Health, Esplanada dos Ministérios, Bloco G, 3º Andar, 70058-900, Brasília, Distrito Federal, Brazil
| | - Daniela V Pachito
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil.
| | - Beatriz de Faria Leao
- Regula Mais Brasil Hospital Sírio-Libanês, Rua Barata Ribeiro,142, 01308-000, São Paulo, SP, Brazil
| |
Collapse
|
110
|
Harris J, Libardi Maia J. Universal healthcare does not look the same everywhere: Divergent experiences with the private sector in Brazil and Thailand. Glob Public Health 2021; 17:1809-1826. [PMID: 34555293 DOI: 10.1080/17441692.2021.1981973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
How does the private sector structure the trajectory of a country's universal healthcare programme? Social scientists have long pointed to the importance of path dependence in shaping health reform. Yet, rarely have middle-income countries' experience with the private sector under Universal Health Coverage (UHC) been examined from comparative perspective. In this paper, we explore the changing landscape of the health sector in Brazil and Thailand before UHC reform and after. We find path-dependent processes at work that have pushed two countries that both adopted UHC reforms in divergent directions. In Brazil, a comparatively large and entrenched private sector that existed before reform has grown over time, and a sizable private health insurance industry has exerted powerful influence on health policy, weakening the public sector. In Thailand, constraints on private health insurance growth and sustained investment in public health infrastructure and governance have helped check the growth of private sector influence, although battles over health policy still remain contentious. The experiences of these countries offer lessons for policymakers seeking to achieve and maintain robust UHC programmes in other contexts.
Collapse
Affiliation(s)
- Joseph Harris
- Department of Sociology, Boston University, Boston, MA, USA
| | - Juliana Libardi Maia
- Health Resources in Action, Health Equity Research Lab, Cambridge Health Alliance, Boston, MA, USA
| |
Collapse
|
111
|
Scanlon ML, Maldonado LY, Ikemeri JE, Jumah A, Anusu G, Chelagat S, Keter JC, Songok J, Ruhl LJ, Christoffersen-Deb A. 'It was hell in the community': a qualitative study of maternal and child health care during health care worker strikes in Kenya. Int J Equity Health 2021; 20:210. [PMID: 34556148 PMCID: PMC8461886 DOI: 10.1186/s12939-021-01549-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care workers in Kenya have launched major strikes in the public health sector in the past decade but the impact of strikes on health systems is under-explored. We conducted a qualitative study to investigate maternal and child health care and services during nationwide strikes by health care workers in 2017 from the perspective of pregnant women, community health volunteers (CHVs), and health facility managers. METHODS We conducted in-depth interviews and focus group discussions (FGDs) with three populations: women who were pregnant in 2017, CHVs, and health facility managers. Women who were pregnant in 2017 were part of a previous study. All participants were recruited using convenience sampling from a single County in western Kenya. Interviews and FGDs were conducted in English or Kiswahili using semi-structured guides that probed women's pregnancy experiences and maternal and child health services in 2017. Interviews and FGDs were audio-recorded, translated, and transcribed. Content analysis followed a thematic framework approach using deductive and inductive approaches. RESULTS Forty-three women and 22 CHVs participated in 4 FGDs and 3 FGDs, respectively, and 8 health facility managers participated in interviews. CHVs and health facility managers were majority female (80%). Participants reported that strikes by health care workers significantly impacted the availability and quality of maternal and child health services in 2017 and had indirect economic effects due to households paying for services in the private sector. Participants felt it was the poor, particularly poor women, who were most affected since they were more likely to rely on public services, while CHVs highlighted their own poor working conditions in response to strikes by physicians and nurses. Strikes strained relationships and trust between communities and the health system that were identified as essential to maternal and child health care. CONCLUSION We found that the impacts of strikes by health care workers in 2017 extended beyond negative health and economic effects and exacerbated fundamental inequities in the health system. While this study was conducted in one County, our findings suggest several potential avenues for strengthening maternal and child health care in Kenya that were highlighted by nationwide strikes in 2017.
Collapse
Affiliation(s)
- Michael L Scanlon
- Indiana University Center for Global Health, 702 Rotary Circle, Suite RO 101, Indianapolis, IN, USA. .,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - Lauren Y Maldonado
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Justus E Ikemeri
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Anjellah Jumah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Getrude Anusu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sheilah Chelagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Julia Songok
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Laura J Ruhl
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Astrid Christoffersen-Deb
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| |
Collapse
|
112
|
Ornell F, Borelli WV, Benzano D, Schuch JB, Moura HF, Sordi AO, Kessler FHP, Scherer JN, von Diemen L. The next pandemic: impact of COVID-19 in mental healthcare assistance in a nationwide epidemiological study. ACTA ACUST UNITED AC 2021; 4:100061. [PMID: 34518824 PMCID: PMC8427141 DOI: 10.1016/j.lana.2021.100061] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/30/2022]
Abstract
Background Studies have reported the worsening of psychiatric symptoms during the COVID-19 pandemic. However, few studies have evaluated the impact on the access to mental health services during COVID-19. Our aim was to analyze temporal trends and prediction of appointments held in Brazil's public health system, to compare the observed and expected number of mental healthcare appointments during the COVID-19 pandemics. Methods An ecological time-series study was performed, analyzing mental health appointments before and during the pandemic (from 2016 and 2020) from the Brazilian governmental database. The structural break in the data series was assessed using the Chow test, with the break considered in March 2020. Bayesian structural time-series models were used to estimate current average appointments and the predicted expectation if there was no pandemic. Findings Compared to the expected, between March and August 2020 about 28% less outpatient appointments in mental health were observed, totaling 471,448 individuals with suspended assistance. Group appointments and psychiatric hospitalizations were also severely impacted by the pandemic (decreased of 68% and 33%, respectively). On the other hand, mental health emergency consultations and home care increased during this period (36% and 52%, respectively). Interpretation Our findings demonstrate a dramatic change in mental health assistance during the COVID-19 pandemic, which corroborates a recent WHO survey. This phenomenon can aggravate the mental health crisis and generate a parallel pandemic that may last for a longer time than the COVID-19 pandemic. Funding This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.
Collapse
Affiliation(s)
- Felipe Ornell
- Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil
| | - Wyllians Vendramini Borelli
- Hospital de Clínicas de Porto Alegre, Neurology Service, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil
| | - Daniela Benzano
- Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil
| | - Jaqueline Bohrer Schuch
- Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil
| | - Helena Ferreira Moura
- Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil.,Universidade de Brasilia, Faculty of Medicine, Department of Psychiatry, Brasilia DF, Brazil
| | - Anne Orgler Sordi
- Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil
| | - Juliana Nichterwitz Scherer
- Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Ramiro Barcelos Street, 2350, Santa Cecilia, Porto Alegre, RS, Brazil
| |
Collapse
|
113
|
Marta GN, Moraes FY, Feher O, Vellutini EDAS, Pahl FH, Gomes MDQT, Cardoso ACC, Neville IS, Hanna SA, Palhares DMF, Teixeira MJ, Maldaun MVC, Pereira AAL. Social determinants of health and survival on Brazilian patients with glioblastoma: a retrospective analysis of a large populational database. LANCET REGIONAL HEALTH. AMERICAS 2021; 4:100066. [PMID: 36776713 PMCID: PMC9903794 DOI: 10.1016/j.lana.2021.100066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Abstract
Background The majority of patients diagnosed with glioblastoma develop recurrent disease resulting in poor prognoses. The current study aimed to determine the survival rates of patients diagnosed with glioblastoma in Brazil accounting for the influence of age, treatment modalities, public and private practices, and educational level using a population-based national database. Methods Patients diagnosed with glioblastoma from 1999-2020 were identified from The Fundação Oncocentro de São Paulo database to create a retrospective cohort. Patients were described according to age, education level treatment modalities and medical practice. In a Cox proportional hazards model, controlled for confounding factors for overall survival, the hazard ratio and 95% CI of overall survival in adults was evaluated. Findings A total of 4,511 patients were included. The median lengths of survival for patients treated in the public and private settings were 8 and 17 months (p<0.001), respectively. Young patients had longer median overall survival (OS: 18 to 40 years, 41 to 60 years, 61 to 65 years, 66 to 70 years and over than 70 years was 22 months, 10 months, 6 months, 5 months, 4 months, respectively (p<0.001). In general, combined treatments were associated with higher median survival compared to monotherapy. The higher educational level, the higher median survival was observed (4 months for illiterate versus 14 months for university degree). In the multivariable analyses, the significant independent predictors for overall survival were practice setting, educational level, age and treatment modalities. Interpretation Public practice, older patients, less intensive treatment, and lower educational level were associated with worse survival outcomes in Brazilian glioblastoma patients.
Collapse
Affiliation(s)
- Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil.,Latin America Cooperative Oncology Group (LACOG), Brazil.,Corresponding author
| | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group (LACOG), Brazil.,Department of Oncology, Division of Radiation Oncology, Queen's University - Kingston Health Science Centre, Kingston, ON, Canada
| | - Olavo Feher
- Department of Clinical Oncology, Hospital Sírio-Libanês, Brazil
| | | | | | | | | | - Iuri Santana Neville
- Neurosurgery Group, Hospital Sírio-Libanês, Brazil,Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil,Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | | | | | - Manoel Jacobsen Teixeira
- Neurosurgery Group, Hospital Sírio-Libanês, Brazil,Division of Neurosurgery Department of Neurology Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | | | | |
Collapse
|
114
|
Klumb EM, Scheinberg M, de Souza VA, Xavier RM, Azevedo VF, McElwee E, Restrepo MR, Monticielo OA. The landscape of systemic lupus erythematosus in Brazil: An expert panel review and recommendations. Lupus 2021; 30:1684-1695. [PMID: 34255586 PMCID: PMC8489682 DOI: 10.1177/09612033211030008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The objective of this review is to address the barriers limiting access to diagnosis and treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in Brazil, specifically for patients in the public healthcare system, arguably those with the least access to innovation. DESIGN A selected panel of Brazilian experts in SLE/LN were provided with a series of relevant questions to address in a multi-day conference. During the conference, responses were discussed and edited by the entire group through numerous drafts and rounds of discussion until a consensus was achieved. RESULTS The authors propose specific and realistic recommendations for implementing access to innovative diagnostic tools and treatment alternatives for SLE/LN in Brazil. Moreover, in creating these recommendations, the authors strived to address barriers and impediments for technology adoption. The multidisciplinary care required for SLE/LN necessitates the collective participation of all involved stakeholders. CONCLUSION A great need exists to expand the adoption of innovative diagnostic tools and treatments for SLE/LN not only in Brazil but also in most countries, as access issues remain an urgent demand. The recommendations presented in this article can serve as a strategy for new technology adoption in other countries in a similar situation.
Collapse
Affiliation(s)
- Evandro Mendes Klumb
- Rheumatology Department, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
115
|
Araújo LF, Pilecco FB, Correia FGS, Ferreira MJM. Challenges for breaking down the old colonial order in global health research: the role of research funding. LANCET GLOBAL HEALTH 2021; 9:e1057. [PMID: 34297954 DOI: 10.1016/s2214-109x(21)00196-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Larissa Fortunato Araújo
- Postgraduate Program in Public Health, Federal University of Ceará, Fortaleza, Ceará 60430-140, Brazil.
| | - Flávia B Pilecco
- Department of Preventive and Social Medicine and Postgraduate Program in Public Health, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | |
Collapse
|
116
|
Income inequality and non-communicable disease mortality and morbidity in Brazil States: a longitudinal analysis 2002-2017. LANCET REGIONAL HEALTH. AMERICAS 2021; 2:100042. [PMID: 36779037 PMCID: PMC9904117 DOI: 10.1016/j.lana.2021.100042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022]
Abstract
Background Income inequality can negatively affect population health by increasing social stress and conflict, and reducing trust, public goods and healthcare access. However there is limited evidence from low and middle-income countries (LMICs) with high levels of inequality. This study investigates the association between income inequality, morbimortality and risk factors of non-communicable diseases (NCDs) in 26 Brazilian states from 2002 to 2017. Methods Data was acquired for men and women from the Global Health Data Exchange, the Brazilian Institute of Geography and Statistics, and the Brazilian Ministry of Health, totalling 416 state-year observations. Disability-adjusted life years (DALYs) and risk factors of NCDs were the dependent variables. Gini Index was the main independent variable. Multivariate linear panel regressions were performed, controlling for state and time fixed effects, gross domestic product per capita, population ageing, poverty and access to healthcare. Findings A 1% increase in the Gini Index was associated with increases in alcohol abuse (of 923•4 DALYs per 100,000 people, 95%CI 217•6 to 1629•0) and diabetes mellitus morbidity (of 893•3 DALYs per 100,000 people, 95%CI 127•7 to 1659•0), and decreases in morbidity from attention disorder (of -4•0 DALYs per 100,000 people, 95%CI -7•4 to -0•5) and autism spectrum (of -2•4 DALYs per 100,000 people, 95%CI -4•3 to -0•5). These associations were greater for men, further supported by associations with alcohol use as a risk factor. Interpretation This study provides evidence from a highly unequal LMIC, Brazil, of negative associations between income inequality and NCDs, and the importance of addressing wider social determinants of health. Funding This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001 as a Brazilian CAPES scholarship to AZD and by the São Paulo Research Foundation (FAPESP), grant 2020/15944-8 to RSG.
Collapse
|
117
|
The COVID-19 Vaccination Strategy in Brazil-A Case Study. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2021; 2:338-359. [PMID: 36417230 PMCID: PMC9620893 DOI: 10.3390/epidemiologia2030026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 12/14/2022]
Abstract
Brazil is among the countries which have faced two devastating infection waves of COVID-19 in the past year. Despite the fact the country has one of the world's leading immunization programs, Brazil only slowly established a national COVID-19 vaccination strategy and campaign. This case study is based on an integrative review of primary and secondary literature sources. Different search strategies on Medline and Google Scholar were performed for the case presentation, for the management and outcome of the COVID-19 outbreak and for the state of the COVID-19 vaccination program. Official documents from the Brazilian Ministry of Health, the website of the World Health Organization and pharmaceutical companies were also reviewed. Searches were limited to English, French, German, Portuguese and Spanish. This article describes the Brazilian COVID-19 vaccination campaign and the drivers and barriers to its implementation; and evaluates further investigations needed to have a conclusive overview over the constantly evolving situation. Healthcare inequalities, which were widened during the pandemic, a lack of coordination at the federal level, the absence of federal government support for scientific research and the lack of endorsement and commitment to the mitigation of the COVID-19 pandemic set the country's COVID-19 vaccination campaign off to a challenging start. However, Brazil had a well-developed primary care system and national vaccination program prior to the pandemic, which are both important facilitators. At the time of writing, six vaccines are currently available in the country, and the program is advancing. The scientific community needs to continue to investigate the country's vaccination strategy and its implementation to make sure that maximum effort is undertaken for the health of the Brazilian population.
Collapse
|
118
|
Russo LX, Powell-Jackson T, Maia Barreto JO, Borghi J, Kovacs R, Gurgel Junior GD, Gomes LB, Sampaio J, Shimizu HE, de Sousa ANA, Bezerra AFB, Stein AT, Silva EN. Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009-2018. BMJ Glob Health 2021; 6:bmjgh-2021-005429. [PMID: 34244203 PMCID: PMC8273460 DOI: 10.1136/bmjgh-2021-005429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/18/2021] [Indexed: 01/13/2023] Open
Abstract
Background Evidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities. Methods We conducted a fixed effect panel data analysis over the period of 2009–2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs. Results The results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0–64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (−0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected. Conclusion We find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.
Collapse
Affiliation(s)
- Letícia Xander Russo
- Department of Economics, Federal University of Grande Dourados, Dourados, Brazil
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Roxanne Kovacs
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Juliana Sampaio
- Department of Health Promotion, Federal University of Paraiba, Joao Pessoa, Brazil
| | - Helena Eri Shimizu
- Department of Collective Health, University of Brasilia, Brasilia, Brazil
| | | | | | - Airton Tetelbom Stein
- Department of Public Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | |
Collapse
|
119
|
Azevedo DRM, Prates MO, Assunção RM. Estimating hidden populations by transferring knowledge from geographically misaligned levels. Stat Methods Med Res 2021; 30:62-74. [PMID: 33595400 DOI: 10.1177/0962280220930560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The estimation of hidden sub-populations is a hard task that appears in many fields. For example, public health planning in Brazil depends crucially of the number of people who holds a private health insurance plan and hence rarely uses the public services. Different sources of information about these sub-populations may be available at different geographical levels. The available information can be transferred between these different geographic levels to improve the estimation of the hidden population size. In this study, we propose a model that use individual level information to learn about the dependence between the response variable and explanatory variables by proposing a family of link functions with asymptotes that are flexible enough to represent the real aspects of the data and robust to departures from the model. We use the fitted model to estimate the size of the sub-population at any desired level. We illustrate our methodology estimating the sub-population that uses the public health system in each neighborhood of large cities in Brazil.
Collapse
Affiliation(s)
- Douglas R M Azevedo
- Departamento de Estatística, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Marcos O Prates
- Departamento de Estatística, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Renato M Assunção
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| |
Collapse
|
120
|
A seroprevalence survey of anti-SARS-CoV-2 antibodies among individuals 18 years of age or older living in a vulnerable region of the city of São Paulo, Brazil. PLoS One 2021; 16:e0255412. [PMID: 34324603 PMCID: PMC8320930 DOI: 10.1371/journal.pone.0255412] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022] Open
Abstract
A second wave of COVID-19 has demonstrated how challenging it will be to achieve sustained control of the disease, even with vaccination underway in many countries. Therefore, it remains relevant to keep improving our understanding of the distribution of COVID-19, especially of asymptomatic individuals, among different populations, and particularly in vulnerable regions. Hence, this population-based serosurvey had the objective of estimating the prevalence of individuals 18 years of age or older infected by SARS-CoV-2, and the proportion of asymptomatic individuals, among a vulnerable population living in an urban setting. This was a cross-sectional single-stage cluster sampling serosurvey conducted between September and December of 2019, in a vulnerable region of the city of São Paulo, Brazil. Families covered by three public primary healthcare units represented the selected clusters. After study inclusion, participants were asked about signs and symptoms related to COVID-19, and had collected 10 mL of blood for serology testing. A total of 272 individuals from 185 families were included in the study, out of the 400 eligible individuals for inclusion, resulting in a non-response rate of 32%. The post stratified prevalence of individuals infected by SARS-CoV-2 was 45.2% (95% CI: 39.4–51.0%), with a proportion of asymptomatic cases of 30.2% (95% CI: 23.3–38.0%). This population-based serosurvey identified a greater prevalence of infected individuals by SARS-CoV-2 compared to data from the beginning of the pandemic, and from a recent citywide serosurvey, with a similar proportion of asymptomatic individuals. It demonstrated the value of primary healthcare services for disease surveillance activities, and the importance of more focused serosurveys, especially in vulnerable locations, and the need to evaluate new surveillance strategies to take into account asymptomatic cases.
Collapse
|
121
|
Sanine PR, Silva LIF. [Mental health and organizational quality of primary healthcare services in Brazil]. CAD SAUDE PUBLICA 2021; 37:e00267720. [PMID: 34346984 DOI: 10.1590/0102-311x00267720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022] Open
Abstract
The study aimed to assess the quality of care for persons with mental health distress in primary healthcare services in Brazil and the association with organizational structure variables. This evaluative study used data from the Brazilian National Program to Improve Acess and Quality in Primary Care (PMAQ-AB), collected in 2018. The study excluded teams that reported not performing this type of care. The sum of the 13 selected mental health indicators produced a score that was classified in three groups of quality: G1 (0 to 5 points - lower quality), G2 (6 to 9 points - medium quality), and G3 (10 to 13 points - higher quality), and the results were associated with nine organizational context variables favoring the teams' permanence in the respective quality groups. The study evaluated 36,384 teams, located in 5,026 municipalities (counties). The score ranged from 1 to 13 points (G1 = 9.7%; G2 = 25.1%; G3 = 65.2%). Having an environment favorable to dispensing medicines and privacy during patient consultations; existence of a medical specialist, psychologist, and pharmacist; inter-consultation with the Expanded Family Health Care Centers (NASF) and Centers for Psychosocial Care (CAPS); and weekly or biweekly team meetings, were more frequent in the teams with higher quality (p < 0.001). In conclusion, structural conditions related to infrastructure and availability of healthcare workers, as well as inter-consultation and spaces for reflection to discuss the (re)organization of work processes in care for patients with mental health distress are factors that influence the quality of care, requiring attention, especially given recent political setbacks.
Collapse
|
122
|
Botelho CH, Estevez-Diz MDP, Campolina AG. Cost-effectiveness analysis of trastuzumab for early breast cancer in Brazil. Expert Rev Pharmacoecon Outcomes Res 2021; 22:63-72. [PMID: 34319216 DOI: 10.1080/14737167.2021.1909478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Adjuvant chemotherapy with trastuzumab for HER2 positive breast cancers has brought considerable benefits to disease-free survival and overall survival.Objective: To conduct a cost-effectiveness analysis of the treatment of patients with early and locally advanced HER2 positive breast cancer, within the scope of the Brazilian public health system, comparing adjuvant chemotherapy with and without trastuzumab, for 1 year of treatment.Methods: A 4-state Markov model was developed to estimate strategy costs and outcomes.Results: Based on the proposed model, we verified an incremental benefit of trastuzumab therapy compared to treatment without trastuzumab with 0.84 quality-adjusted life years (QALY) and 1.16 life years gained (LYG). The use of adjuvant chemotherapy with trastuzumab has an ICER of US$19,599.26 for each quality-adjusted life year and US$14,180.68 for each life year gained in relation to chemotherapy without trastuzumab.Conclusion: In Brazil, adjuvant chemotherapy with trastuzumab may be considered cost-effective only if a cost-effectiveness threshold is stipulated with the value starting at three times the Brazilian GDP per capita for QALY or two times the Brazilian GDP per capita for LYG, from health system perspective.
Collapse
Affiliation(s)
- Carlos Henrique Botelho
- Department of Radiology and Oncology, Cancer Institute of the State of Sao Paulo/Faculty of Medicine at the University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Del Pilar Estevez-Diz
- Department of Radiology and Oncology, Cancer Institute of the State of Sao Paulo/Faculty of Medicine at the University of Sao Paulo, Sao Paulo, Brazil
| | - Alessandro Gonçalves Campolina
- Center for Translational Research in Oncology, Cancer Institute of the State of Sao Paulo/Faculty of Medicine of the University of Sao Paulo, São Paulo, Brazil
| |
Collapse
|
123
|
Zimmermann IR, Sanchez MN, Frio GS, Alves LC, Pereira CCDA, Lima RTDS, Machado C, Santos LMP, da Silva EN. Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020. PLoS One 2021; 16:e0254633. [PMID: 34270568 PMCID: PMC8284655 DOI: 10.1371/journal.pone.0254633] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/30/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. METHODS A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10-40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. RESULTS With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40-50% in people who needed an ICU admission. CONCLUSIONS The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.
Collapse
Affiliation(s)
- Ivan Ricardo Zimmermann
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Mauro Niskier Sanchez
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Gustavo Saraiva Frio
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Layana Costa Alves
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
- Institute of Collective Health (ISC) at the Federal University of Bahia, Salvador, Brazil
| | | | | | - Carla Machado
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Everton Nunes da Silva
- Department of Collective Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
- Collective Health Course, Faculty of Ceilândia, University of Brasilia, Brasilia, Brazil
| |
Collapse
|
124
|
Caldas BDN, Portela MC, Singer SJ, Aveling EL. How Can Implementation of a Large-Scale Patient Safety Program Strengthen Hospital Safety Culture? Lessons From a Qualitative Study of National Patient Safety Program Implementation in Two Public Hospitals in Brazil. Med Care Res Rev 2021; 79:562-575. [PMID: 34253081 DOI: 10.1177/10775587211028068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Large-scale (e.g., national) programs could strengthen safety culture, which is foundational to patient safety, yet we know little about how to optimize this potential. In 2013, Brazil's Ministry of Health launched the National Patient Safety Program, involving hospital-level safety teams and targeted safety protocols. We conducted in-depth qualitative case studies of National Patient Safety Program implementation in two hospitals, with different readiness, to understand how program implementation affected enabling, enacting, and elaborating processes that produce and sustain safety culture. For both hospitals, external mandates were insufficient for enabling hospital-level action. Internal enabling failures (e.g., little safety-relevant senior leadership) hindered enactment (e.g., safety teams unable to institute plans). Limited enactment and weak elaboration processes (e.g., bureaucratic monitoring) failed to institutionalize protocol use and undermined safety culture. Optimizing the safety culture impact of large-scale programs requires effective multi-level enabling and capitalizing on the productive potential of interacting national- and local-level influences.
Collapse
Affiliation(s)
- Bárbara do Nascimento Caldas
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.,National Institute of Cardiology, Rio de Janeiro, RJ, Brazil
| | | | | | | |
Collapse
|
125
|
Sampaio ML, Bispo Júnior JP. Towards comprehensive mental health care: experiences and challenges of psychosocial care in Brazil. BMC Public Health 2021; 21:1352. [PMID: 34238266 PMCID: PMC8268580 DOI: 10.1186/s12889-021-11397-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Recommendations are in place for mental health (MH) care to be developed into a comprehensive, people-centred perspective and organised primarily through community services. In recent decades, Brazil has promoted psychiatric reform aimed at transforming the hospital-centred model into a psychosocial model of MH. However, current political and economic changes threaten this reform. This article analyses the comprehensive MH care offered by a Psychosocial Care Network (Rede de Atenção Psicossocial – RAPS) in Brazil. Methods The study involved semi-structured in-depth interviews with 33 stakeholders (policymakers, health professionals, and MH service users) and direct observation of MH services members of the RAPS. Data were analysed using framework analysis with the following dimensions: mental health services access, long-term mental health care, comprehensive mental health care, and crisis patient care. Results Results indicated progression towards comprehensive MH care provision. We identified MH care provided primarily by community services, featuring an ‘open door’ policy, development of localised actions and a search for autonomy. Deinstitutionalisation principles and the psychosocial model support a comprehensive view of MH by policy makers, MH professionals, and users. However, difficulties in providing comprehensive care remain, with the main challenges being insufficient services offered and difficulties in user access at all levels of care, fragile integration between services, lack of clear definitions of the responsibilities of each service, discontinuity of care, limitations in family support, and fragility in crisis patient care. Conclusion We highlight the need to increase funding and services of RAPS, qualification of staff professional, family support, and development of strategies for integrating services. Support and expansion of MH care depend on strengthening the Brazilian health system, which is in danger of being dismantled. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11397-1.
Collapse
Affiliation(s)
- Mariá Lanzotti Sampaio
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - José Patrício Bispo Júnior
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil.
| |
Collapse
|
126
|
Cabral IE, Pestana-Santos M, Ciuffo LL, Nunes YDR, Lomba MDLLDF. Child health vulnerabilities during the COVID-19 pandemic in Brazil and Portugal. Rev Lat Am Enfermagem 2021; 29:e3422. [PMID: 34231787 PMCID: PMC8253372 DOI: 10.1590/1518-8345.4805.3422] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Objective: to analyze the vulnerabilities of children in the access to primary health
care during the COVID-19 pandemic in Brazil and Portugal. Method: documentary study based on Brazilian and Portuguese governmental guidelines
issued between March and August 2020 regarding access of children to primary
health care. Thematic analysis was based on the precepts of health
vulnerability. Results: 13 documents were issued in both countries addressing access to vaccination
and childcare. Due to the SARS-CoV-2, restrictions were imposed on the
circulation of people in social environments, health services, and social
protection, decreasing the demand for health services. Both countries
continued programs to promote the health of breastfeeding infants. In-person
childcare consultations were suspended for low-risk children in both
countries. Portugal maintained routine vaccination while Brazil interrupted
vaccination in the first 15 days of the pandemic. The countries adopted
remote care strategies - telemonitoring, teleconsultation, and mobile
applications - to maintain the bond between children and health
services. Conclusion: longitudinality was affected due to restricted access of children to health
promotion actions, determining greater programmatic vulnerability.
Individual vulnerabilities are related to exposure to preventable and
primary health care-sensitive diseases.
Collapse
Affiliation(s)
- Ivone Evangelista Cabral
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil.,Universidade do Estado do Rio de Janeiro, Faculdade de Enfermagem. Rio de Janeiro, RJ. Brazil.,Fellowship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Márcia Pestana-Santos
- Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde-Enfermagem, Coimbra, Portugal.,Universidade do Porto, Porto, Portugal
| | - Lia Leão Ciuffo
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil
| | - Yan do Rosario Nunes
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil.,Scholarship holder at the Institutional Program of Scientific Initiation of the Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
127
|
Özçelik EA, Massuda A, Castro MC, Barış E. A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care? Health Syst Reform 2021; 7:e1939931. [PMID: 34402403 DOI: 10.1080/23288604.2021.1939931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Brazil and Turkey are among the few high-middle-income countries that explicitly chose to strengthen their primary health care (PHC) systems as the centerpiece of much broader health system reforms aiming to narrow inequities in access to care. This comparative case study reviews the organization of Brazil and Turkey's PHC systems to derive lessons that can apply to other countries that may consider reforming the organization of PHC systems as a way to address health inequities. The analysis uses the Flagship Framework to investigate how the organization of PHC delivery in Brazil and Turkey can lead to measurable improvements in access to care. It compares (1) the degree of decentralization in PHC service delivery responsibilities, (2) the use of multi-professional PHC teams, and (3) patient impanelment strategies. The comparative analysis offers three important lessons. First, changes in the organization of PHC systems can contribute to observable improvements in the level and distribution of health outcomes, but organizational strategies do not guarantee eliminating disparities in access. Second, PHC systems can operate in health systems with varying degrees of decentralization, but the level of decentralization may influence implementation. Third, relying on multi-professional PHC teams that serve geographically empaneled populations can improve equitable access to care, but course corrections may be needed to address evolving health demands.
Collapse
Affiliation(s)
- Ece A Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Adriano Massuda
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Enis Barış
- Health, Nutrition and Population, World Bank Group, Washington, DC, USA
| |
Collapse
|
128
|
Parro VC, Lafetá MLM, Pait F, Ipólito FB, Toporcov TN. Predicting COVID-19 in very large countries: The case of Brazil. PLoS One 2021; 16:e0253146. [PMID: 34197489 PMCID: PMC8248665 DOI: 10.1371/journal.pone.0253146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/29/2021] [Indexed: 11/19/2022] Open
Abstract
This work presents a practical proposal for estimating health system utilization for COVID-19 cases. The novel methodology developed is based on the dynamic model known as Susceptible, Infected, Removed and Dead (SIRD). The model was modified to focus on the healthcare system dynamics, rather than modeling all cases of the disease. It was tuned using data available for each Brazilian state and updated with daily figures. A figure of merit that assesses the quality of the model fit to the data was defined and used to optimize the free parameters. The parameters of an epidemiological model for the whole of Brazil, comprising a linear combination of the models for each state, were estimated considering the data available for the 26 Brazilian states. The model was validated, and strong adherence was demonstrated in most cases.
Collapse
Affiliation(s)
- V. C. Parro
- Instituto Mauá de Tecnologia, Electrical Engineering, São Caetano do Sul, Brazil
| | - M. L. M. Lafetá
- Instituto Mauá de Tecnologia, Electrical Engineering, São Caetano do Sul, Brazil
| | - F. Pait
- Escola Politécnica da Universidade de São Paulo, São Paulo, Brazil
| | - F. B. Ipólito
- Instituto Mauá de Tecnologia, Electrical Engineering, São Caetano do Sul, Brazil
| | - T. N. Toporcov
- Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
129
|
Hone T, Stokes J, Trajman A, Saraceni V, Coeli CM, Rasella D, Durovni B, Millett C. Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals. BMC Public Health 2021; 21:1287. [PMID: 34210313 PMCID: PMC8252284 DOI: 10.1186/s12889-021-11328-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence is limited on racial/ethnic group disparities in multimorbidity and associated health outcomes in low- and middle-income countries hampering effective policies and clinical interventions to address health inequalities. METHODS This study assessed race/ethnic and socioeconomic disparities in the prevalence of multimorbidity and associated healthcare utilisation, costs and death in Rio de Janeiro, Brazil. A cross-sectional analysis was carried out of 3,027,335 individuals registered with primary healthcare (PHC) services. Records included linked data to hospitalisation, mortality, and welfare-claimant (Bolsa Família) records between 1 Jan 2012 and 31 Dec 2016. Logistic and Poisson regression models were carried out to assess the likelihood of multimorbidity (two or more diagnoses out of 53 chronic conditions), PHC use, hospital admissions and mortality from any cause. Interactions were used to assess disparities. RESULTS In total 13,509,633 healthcare visits were analysed identifying 389,829 multimorbid individuals (13%). In adjusted regression models, multimorbidity was associated with lower education (Adjusted Odds Ratio (AOR): 1.26; 95%CI: 1.23,1.29; compared to higher education), Bolsa Família receipt (AOR: 1.14; 95%CI: 1.13,1.15; compared to non-recipients); and black race/ethnicity (AOR: 1.05; 95%CI: 1.03,1.06; compared to white). Multimorbidity was associated with more hospitalisations (Adjusted Rate Ratio (ARR): 2.75; 95%CI: 2.69,2.81), more PHC visits (ARR: 3.46; 95%CI: 3.44,3.47), and higher likelihood of death (AOR: 1.33; 95%CI: 1.29,1.36). These associations were greater for multimorbid individuals with lower educational attainment (five year probability of death 1.67% (95%CI: 1.61,1.74%) compared to 1.13% (95%CI: 1.02,1.23%) for higher education), individuals of black race/ethnicity (1.48% (95%CI: 1.41,1.55%) compared to 1.35% (95%CI: 1.31,1.40%) for white) and individuals in receipt of welfare (1.89% (95%CI: 1.77,2.00%) compared to 1.35% (95%CI: 1.31,1.38%) for non-recipients). CONCLUSIONS The prevalence of multimorbidity and associated hospital admissions and mortality are greater in individuals with black race/ethnicity and other deprived socioeconomic groups in Rio de Janeiro. Interventions to better prevent and manage multimorbidity and underlying disparities in low- and middle-income country settings are needed.
Collapse
Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8R, UK.
| | - Jonathan Stokes
- Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Anete Trajman
- Programa de Pós-graduação em Clínica Médica and Mestrado Profissional em Atenção Primária à Saúde, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia Medina Coeli
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Davide Rasella
- Public Health Policy Evaluation Unit, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8R, UK
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Betina Durovni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8R, UK
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil
| |
Collapse
|
130
|
Durski KN, Osterholm M, Majumdar SS, Nilles E, Bausch DG, Atun R. Shifting the paradigm: using disease outbreaks to build resilient health systems. BMJ Glob Health 2021; 5:bmjgh-2020-002499. [PMID: 32424013 PMCID: PMC7239499 DOI: 10.1136/bmjgh-2020-002499] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kara N Durski
- Harvard Humanitarian Initiative, Harvard T H Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA .,School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Osterholm
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Suman S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Eric Nilles
- Harvard Humanitarian Initiative, Harvard T H Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Daniel G Bausch
- UK Public Health Rapid Support Team, Public Health England/London School of Hygiene & Tropical Medicine, London, UK
| | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| |
Collapse
|
131
|
Fana T, Goudge J. Austerity, resilience and the management of actors in public hospitals: a qualitative study from South Africa. BMJ Glob Health 2021; 6:bmjgh-2020-004157. [PMID: 33622710 PMCID: PMC7907882 DOI: 10.1136/bmjgh-2020-004157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background Global economic recession coupled with internal inefficiencies and corruption has led to a period of austerity in the South African healthcare system. This paper examines the strategies used by management in response to austerity in the three public hospitals and their effect on organisational functioning. Methods We used a comparative qualitative case study approach, collecting data using a combination of in-depth interviews with managers, and focus group discussion and interviews with shop stewards and staff. Results Austerity, imposed by the introduction of a provincial cost containment committee, has led to a reduction in staff, benefits, shortages of equipment and delayed procurement and recruitment processes. Managers in the first hospital maintained training on labour relations for staff and managers, they jointly planned how to cope with reduced staff and initiated a new forum for HR and finance staff. These strategies improved the way actors engaged, enabling them to resolve problems. Good communication ensured that staff understood what was within the hospitals control and what was not. A second hospital relied on absorptive strategies, such as asking staff to do more with less. The result was resistance, and greater use of sick leave. Some staff gave their own money to help feed patients but were angry at management for putting them in this difficult position. Leadership in the third hospital did not manage actors well either; help from the Government’s Expanded Public Works Programme was rejected by the unions, managers did not attend meetings as they felt their contributions were not listened to. Poor communication meant that the managers and staff did not understand what was within the hospital’s control and what was not; a misunderstanding led to a physical fight between managers. Conclusion Organisational resilience in the face of austerity requires leaders to manage different stakeholders well. Hospital managers who promote democratic or participatory leadership and management, open communication, teamwork and trust among all stakeholders will lead better functioning organisations. A special focus should be placed on such practices to develop the resilience of health systems’ organisations.
Collapse
Affiliation(s)
- Thanduxolo Fana
- Faculty of Health Sciences, School of Public Health, Centre for Health Policy, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Jane Goudge
- Centre for Health Policy, University of the Witwatersrand School of Public Health, Johannesburg, Gauteng, South Africa
| |
Collapse
|
132
|
Rezende LFM, Ferrari G, Bahia LR, Rosa RDS, da Rosa MQM, de Souza RC, Lee DH, Giovannucci E, Eluf-Neto J. Economic burden of colorectal and breast cancers attributable to lack of physical activity in Brazil. BMC Public Health 2021; 21:1190. [PMID: 34158014 PMCID: PMC8220697 DOI: 10.1186/s12889-021-11221-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background The increasing number of cancer patients has an escalating economic impact to public health systems (approximately, International dollars- Int$ 60 billion annually in Brazil). Physical activity is widely recognized as one important modifiable risk factor for cancer. Herein, we estimated the economic costs of colon and post-menopausal breast cancers in the Brazilian Unified Health System (SUS) attributable to lack of physical activity. Methods Population attributable fractions were calculated using prevalence data from 57,962 adults who answered a physical activity questionnaire in the Brazilian National Health Survey, and relative risks of colon and breast cancer from a meta-analysis. Annual costs (1 Int$ = 2.1 reais) with hospitalization, chemotherapy and radiotherapy were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Two counterfactual scenarios were considered: theoretical minimum risk exposure level (≥8000 MET-min/week) and physical activity guidelines (≥600 MET-min/week). Results Annually, the Brazilian SUS expended Int$ 4.5 billion in direct costs related to cancer treatment, of which Int$ 553 million due to colon and breast cancers. Direct costs related to colon and breast cancers attributable to lack of physical activity were Int$ 23.4 million and Int$ 26.9 million, respectively. Achieving at least the physical activity guidelines would save Int$ 10.3 mi (colon, Int$ 6.4 mi; breast, Int$ 3.9 mi). Conclusions Lack of physical activity accounts for Int$ 50.3 million annually in direct costs related to colon and post-menopausal breast cancers. Population-wide interventions aiming to promote physical activity are needed to reduce the economic burden of cancer in Brazil.
Collapse
Affiliation(s)
- Leandro F M Rezende
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, Rua Botucatu, 740 -Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.
| | - Gerson Ferrari
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
| | - Luciana Ribeiro Bahia
- National Institute of Science and Technology for Health Technology Assessment (IATS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Roger Dos Santos Rosa
- National Institute of Science and Technology for Health Technology Assessment (IATS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS), Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Michelle Quarti Machado da Rosa
- National Institute of Science and Technology for Health Technology Assessment (IATS), Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Romulo Cristovão de Souza
- Departamento de Tecnologias da Informação e Educação em Saúde, Faculdade de Ciências Médicas - UERJ, Rio de Janeiro, Brazil
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edward Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - José Eluf-Neto
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| |
Collapse
|
133
|
Nicolelis MAL, Raimundo RLG, Peixoto PS, Andreazzi CS. The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil. Sci Rep 2021; 11:13001. [PMID: 34155241 PMCID: PMC8217556 DOI: 10.1038/s41598-021-92263-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
Although international airports served as main entry points for SARS-CoV-2, the factors driving the uneven geographic spread of COVID-19 cases and deaths in Brazil remain mostly unknown. Here we show that three major factors influenced the early macro-geographical dynamics of COVID-19 in Brazil. Mathematical modeling revealed that the "super-spreading city" of São Paulo initially accounted for more than 85% of the case spread in the entire country. By adding only 16 other spreading cities, we accounted for 98-99% of the cases reported during the first 3 months of the pandemic in Brazil. Moreover, 26 federal highways accounted for about 30% of SARS-CoV-2's case spread. As cases increased in the Brazilian interior, the distribution of COVID-19 deaths began to correlate with the allocation of the country's intensive care units (ICUs), which is heavily weighted towards state capitals. Thus, severely ill patients living in the countryside had to be transported to state capitals to access ICU beds, creating a "boomerang effect" that contributed to skew the distribution of COVID-19 deaths. Therefore, if (i) a lockdown had been imposed earlier on in spreader-capitals, (ii) mandatory road traffic restrictions had been enforced, and (iii) a more equitable geographic distribution of ICU beds existed, the impact of COVID-19 in Brazil would be significantly lower.
Collapse
Affiliation(s)
- Miguel A L Nicolelis
- Department of Neurobiology, Duke University Medical Center, Box 103905, Durham, NC, 27710, USA.
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Neurology, Duke University, Durham, NC, USA.
- Department of Neurosurgery, Duke University, Durham, NC, USA.
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
- Edmond and Lily Safra International Institute of Neurosciences, Natal, Brazil.
| | - Rafael L G Raimundo
- Department of Engineering and Environment and Postgraduate Program in Ecology and Environmental Monitoring (PPGEMA), Center for Applied Sciences and Education, Federal University of Paraíba-Campus IV, Rio Tinto, Paraíba, Brazil
| | - Pedro S Peixoto
- Department of Applied Mathematics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Cecilia S Andreazzi
- Laboratory of Biology and Parasitology of Wild Reservoir Mammals, IOC, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
134
|
Curado DDSP, Gomes DF, Silva TBC, Almeida PHRF, Tavares NUL, Areda CA, da Silva EN. Direct cost of systemic arterial hypertension and its complications in the circulatory system from the perspective of the Brazilian public health system in 2019. PLoS One 2021; 16:e0253063. [PMID: 34111216 PMCID: PMC8191920 DOI: 10.1371/journal.pone.0253063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Systemic arterial hypertension (SAH), a global public health problem and the primary risk factor for cardiovascular diseases, has a significant financial impact on health systems. In Brazil, the prevalence of SAH is 23.7%, which caused 203,000 deaths and 3.9 million DALYs in 2015. OBJECTIVE To estimate the cost of SAH and circulatory system diseases attributable to SAH from the perspective of the Brazilian public health system in 2019. METHODS A prevalence-based cost-of-illness was conducted using a top-down approach. The population attributable risk (PAR) was used to estimate the proportion of circulatory system diseases attributable to SAH. The direct medical costs were obtained from official Ministry of Health of Brazil records and literature parameters, including the three levels of care (primary, secondary, and tertiary). Deterministic univariate analyses were also conducted. RESULTS The total cost of SAH and the proportion of circulatory system diseases attributable to SAH was Int$ 581,135,374.73, varying between Int$ 501,553,022.21 and Int$ 776,183,338.06. In terms only of SAH costs at all healthcare levels (Int$ 493,776,445.89), 97.3% were incurred in primary care, especially for antihypertensive drugs provided free of charge by the Brazilian public health system (Int$ 363,888,540.14). Stroke accounted for the highest cost attributable to SAH and the third highest PAR, representing 47% of the total cost of circulatory diseases attributable to SAH. Prevalence was the parameter that most affected sensitivity analyses, accounting for 36% of all the cost variation. CONCLUSION Our results show that the main Brazilian strategy to combat SAH was implemented in primary care, namely access to free antihypertensive drugs and multiprofessional teams, acting jointly to promote care and prevent and control SAH.
Collapse
Affiliation(s)
| | - Dalila Fernandes Gomes
- Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
| | | | | | | | - Camila Alves Areda
- Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
| | - Everton Nunes da Silva
- Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
- Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
| |
Collapse
|
135
|
Lotta G, Nunes J. COVID-19 and health promotion in Brazil: community health workers between vulnerability and resistance. Glob Health Promot 2021; 29:14-22. [PMID: 34112004 DOI: 10.1177/17579759211012375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health promotion in Brazil relies on community health workers (CHWs), frontline providers linking the health system with vulnerable groups. Brazilian CHWs are overwhelmingly women from poor backgrounds, with precarious and sometimes hazardous working conditions, as well as fragmented and unsystematic training. This paper evaluates how the COVID-19 pandemic exacerbated pre-existing vulnerabilities of CHWs (pertaining to low salary, precarious and hazardous working conditions and inadequate training) and created new ones, with a profound impact on their ability to carry out health promotion activities. Drawing on testimonials of dozens of CHWs and online discussions promoted by their unions, the paper reveals that during the pandemic CHWs were asked to continue their work without adequate training and protective equipment, thus exposing themselves to the risk of infection. It further shows how the pandemic rendered dangerous the close interaction with patients that is at the heart of their health promotion role. Nonetheless, CHWs sought to adapt their work. In the absence of leadership and coordination on the part of the federal government, CHWs mobilized different forms of resistance at the national and individual levels. Despite this, COVID-19 contributed to a trajectory of erosion of health promotion in Brazil. Findings from this case signal the difficulties for health promotion in low- and middle-income countries relying on CHWs to bridge the health system and vulnerable users.
Collapse
Affiliation(s)
| | - João Nunes
- Department of Politics, University of York, York, North Yorkshire, UK
| |
Collapse
|
136
|
Menezes JA, Madureira AP, dos Santos RB, Duval IDB, Regoto P, Margonari C, Barata MMDL, Confalonieri U. Analyzing Spatial Patterns of Health Vulnerability to Drought in the Brazilian Semiarid Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126262. [PMID: 34207877 PMCID: PMC8296049 DOI: 10.3390/ijerph18126262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
Health determinants might play an important role in shaping the impacts related to long-term disasters such as droughts. Understanding their distribution in populated dry regions may help to map vulnerabilities and set coping strategies for current and future threats to human health. The aim of the study was to identify the most vulnerable municipalities of the Brazilian semiarid region when it comes to the relationship between drought, health, and their determinants using a multidimensional index. From a place-based framework, epidemiological, socio-economic, rural, and health infrastructure data were obtained for 1135 municipalities in the Brazilian semiarid region. An exploratory factor analysis was used to reduce 32 variables to four independent factors and compute a Health Vulnerability Index. The health vulnerability was modulated by social determinants, rural characteristics, and access to water in this semiarid region. There was a clear distinction between municipalities with the highest human welfare and economic development and those municipalities with the worst living conditions and health status. Spatial patterns showed a cluster of the most vulnerable municipalities in the western, eastern, and northeastern portions of the semiarid region. The spatial visualization of the associated vulnerabilities supports decision making on health promotion policies that should focus on reducing social inequality. In addition, policymakers are presented with a simple tool to identify populations or areas with the worst socioeconomic and health conditions, which can facilitate the targeting of actions and resources on a more equitable basis. Further, the results contribute to the understanding of social determinants that may be related to medium- and long-term health outcomes in the region.
Collapse
Affiliation(s)
- Júlia Alves Menezes
- Transdisciplinary Study Group on Health and Environment René Rachou Institute–Oswaldo Cruz Foundation, Avenida Augusto de Lima, 1715, Barro Preto, 30190-009 Belo Horizonte, MG, Brazil; (R.B.d.S.); (I.d.B.D.); (U.C.)
- Correspondence:
| | - Ana Paula Madureira
- Department of Biosystems Engineering, The Federal University of São João del-Rei, Praça Dom Helvécio, 74, Fábricas, 36301-160 São João del-Rei, MG, Brazil;
| | - Rhavena Barbosa dos Santos
- Transdisciplinary Study Group on Health and Environment René Rachou Institute–Oswaldo Cruz Foundation, Avenida Augusto de Lima, 1715, Barro Preto, 30190-009 Belo Horizonte, MG, Brazil; (R.B.d.S.); (I.d.B.D.); (U.C.)
| | - Isabela de Brito Duval
- Transdisciplinary Study Group on Health and Environment René Rachou Institute–Oswaldo Cruz Foundation, Avenida Augusto de Lima, 1715, Barro Preto, 30190-009 Belo Horizonte, MG, Brazil; (R.B.d.S.); (I.d.B.D.); (U.C.)
| | - Pedro Regoto
- Postgraduate Program of Meteorology, National Institute for Space Research, Rodovia Presidente Dutra Km 39, 12630-000 Cachoeira Paulista, SP, Brazil;
| | - Carina Margonari
- Leishmaniasis Study Group René Rachou Institute–Oswaldo Cruz Foundation, Avenida Augusto de Lima, 1715, Barro Preto, 30190-009 Belo Horizonte, MG, Brazil;
| | - Martha Macêdo de Lima Barata
- Postgraduate Program of Public Health and Environment, National School of Public Health–Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil;
| | - Ulisses Confalonieri
- Transdisciplinary Study Group on Health and Environment René Rachou Institute–Oswaldo Cruz Foundation, Avenida Augusto de Lima, 1715, Barro Preto, 30190-009 Belo Horizonte, MG, Brazil; (R.B.d.S.); (I.d.B.D.); (U.C.)
| |
Collapse
|
137
|
Prates CG, Caregnato RCA, Magalhães AMMD, Dal Pai D, Urbanetto JDS, Moura GMSSD. Evaluation of patient safety culture in a private general hospital: a case study in Brazil. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 34100568 DOI: 10.1108/ijhcqa-11-2020-0235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose is to assess the patient safety culture perceived by healthcare and administrative staff in a Brazilian hospital and examine whether education and experience are related to positive perceptions. DESIGN/METHODOLOGY/APPROACH A descriptive-analytical case study was carried out at Ernesto Dornelles Hospital, a private Brazilian institution. The Brazilian version of the Hospital Survey on Patient Safety Culture was used to assess the perceptions of 618 participants, of whom 315 worked in healthcare assistance and 303 in administrative services. The main outcome was the percentage of positive responses, and the independent variables included the type of work, schooling and length of experience. FINDINGS None of the twelve dimensions was strengthened. The percentage of positive responses was the highest for "Hospital management support for patient safety" (67.5%), and the lowest was for "Nonpunitive response to error" (29%). The healthcare staff had a slightly higher average than the administrative staff. The percentage of positive responses from professionals with undergraduate or graduate degrees was higher for the eight dimensions of safety culture. The length of hospital experience was not associated with any dimensions. ORIGINALITY/VALUE This study explored the influence of education and professional experience on the perception of patient safety in healthcare and administrative staff from a private institution. These approaches allow to know with greater depth and clarity factors that are related to the patient safety culture and, thus, have more consistent evidence to support interventions in specific needs.
Collapse
Affiliation(s)
| | | | | | - Daiane Dal Pai
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | |
Collapse
|
138
|
Thumé E, Kessler M, Machado KP, Nunes BP, Volz PM, Wachs LS, Soares MU, Saes MO, Duro SM, Dilélio AS, Facchini LA. Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology. BMC Public Health 2021; 21:1089. [PMID: 34098933 PMCID: PMC8182998 DOI: 10.1186/s12889-021-11078-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. METHODS/DESIGN The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). RESULTS Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.
Collapse
Affiliation(s)
- Elaine Thumé
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil.
| | - Marciane Kessler
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
- Institute of Health Equity, University College London, London, UK
| | - Karla P Machado
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Bruno P Nunes
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Pamela M Volz
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Louriele S Wachs
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Mariangela U Soares
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Mirelle O Saes
- Post-Graduate Programme in Health Science, Federal University of Rio Grande, Rio Grande, Brazil
| | - Suele M Duro
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | | | - Luiz A Facchini
- Post-Graduate Programme in Nursing, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| |
Collapse
|
139
|
Gill PJ, Ali SM, Elsobky Y, Okechukwu RC, Ribeiro TB, Soares Dos Santos Junior AC, Umpierre D, Richards GC. Building capacity in evidence-based medicine in low-income and middle-income countries: problems and potential solutions. BMJ Evid Based Med 2021; 26:82-84. [PMID: 31757839 DOI: 10.1136/bmjebm-2019-111272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Peter J Gill
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Yasmin Elsobky
- El-Galaa Military Medical Complex, Cairo, Egypt
- NAPHS Consultancy, Alexandria, Egypt
| | | | - Tatiane B Ribeiro
- Department of Preventive Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Daniel Umpierre
- Instituto de Avaliação de Tecnologia em Saúde (INCT IATS)/Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
140
|
Touchton M, Knaul FM, Arreola-Ornelas H, Porteny T, Sánchez M, Méndez O, Faganello M, Edelson V, Gygi B, Hummel C, Otero S, Insua J, Undurraga E, Rosado JA. A partisan pandemic: state government public health policies to combat COVID-19 in Brazil. BMJ Glob Health 2021; 6:e005223. [PMID: 34083242 PMCID: PMC8182751 DOI: 10.1136/bmjgh-2021-005223] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION To present an analysis of the Brazilian health system and subnational (state) variation in response to the COVID-19 pandemic, based on 10 non-pharmaceutical interventions (NPIs). MATERIALS AND METHODS We collected daily information on implementation of 10 NPI designed to inform the public of health risks and promote distancing and mask use at the national level for eight countries across the Americas. We then analyse the adoption of the 10 policies across Brazil's 27 states over time, individually and using a composite index. We draw on this index to assess the timeliness and rigour of NPI implementation across the country, from the date of the first case, 26 February 2020. We also compile Google data on population mobility by state to describe changes in mobility throughout the COVID-19 pandemic. RESULTS Brazil's national NPI response was the least stringent among countries analysed. In the absence of a unified federal response to the pandemic, Brazilian state policy implementation was neither homogenous nor synchronised. The median NPI was no stay-at-home order, a recommendation to wear masks in public space but not a requirement, a full school closure and partial restrictions on businesses, public transportation, intrastate travel, interstate travel and international travel. These restrictions were implemented 45 days after the first case in each state, on average. Rondônia implemented the earliest and most rigorous policies, with school closures, business closures, information campaigns and restrictions on movement 24 days after the first case; Mato Grosso do Sul had the fewest, least stringent restrictions on movement, business operations and no mask recommendation. CONCLUSIONS The study identifies wide variation in national-level NPI responses to the COVID-19 pandemic. Our focus on Brazil identifies subsequent variability in how and when states implemented NPI to contain COVID-19. States' NPIs and their scores on the composite policy index both align with the governors' political affiliations: opposition governors implemented earlier, more stringent sanitary measures than those supporting the Bolsonaro administration. A strong, unified national response to a pandemic is essential for keeping the population safe and disease-free, both at the outset of an outbreak and as communities begin to reopen. This national response should be aligned with state and municipal implementation of NPI, which we show is not the case in Brazil.
Collapse
Affiliation(s)
- Michael Touchton
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
| | - Felicia Marie Knaul
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Dept of Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Héctor Arreola-Ornelas
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Consejo Promotor de Universalidad y Competitividad en Salud, Fundacion Mexicana para la Salud AC, Mexico City, Mexico
| | - Thalia Porteny
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Mariano Sánchez
- Department of Politics, Colegio de Mexico, Mexico City, Mexico
| | - Oscar Méndez
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Consejo Promotor de Universalidad y Competitividad en Salud, Fundacion Mexicana para la Salud AC, Mexico City, Mexico
| | - Marco Faganello
- MAF dataScience, Universidade Estadual de Campinas, Campinas, Brazil
| | - Vaugh Edelson
- Dept of Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Benjamin Gygi
- Department of Political Science, University of Miami College of Arts and Sciences, Coral Gables, Florida, USA
| | - Calla Hummel
- Department of Political Science, University of Miami College of Arts and Sciences, Coral Gables, Florida, USA
| | - Silvia Otero
- Universidad del Rosario, Bogota, Cundinamarca, Colombia
| | - Jorge Insua
- Universidad del Rosario, Bogota, Cundinamarca, Colombia
| | - Eduardo Undurraga
- Department of Government, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Julio Antonio Rosado
- Department of Social Sciences and Politics (currently listed in Spanish), Universidad Iberoamericana, Mexico City, Mexico
| |
Collapse
|
141
|
Coêlho BM, Santana GL, Viana MC, Wang YP, Andrade LH. "I don't need any treatment" - barriers to mental health treatment in the general population of a megacity. ACTA ACUST UNITED AC 2021; 43:590-598. [PMID: 33950152 PMCID: PMC8639019 DOI: 10.1590/1516-4446-2020-1448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/04/2021] [Indexed: 12/28/2022]
Abstract
Objective: Most countries fail to treat individuals with psychopathologies. Investigating treatment barriers and reasons for dropout are key elements to overcoming this scenario. Methods: A representative sample of 2,942 urban-dwelling adults was interviewed face-to-face within a cross-sectional, stratified, multistage probability survey of the general population. Psychiatric diagnosis, severity level, use of services, reasons for not seeking treatment, and treatment dropout were investigated. Results: Only 23% of individuals with a psychopathology of any severity level in the last 12 months received treatment. Low perceived need for treatment (56%) was the most common reason for not seeking treatment. The most visited settings were psychiatric, other mental health care, and general medical care. Among those with a perceived need for treatment (44%), psychological barriers were the most common reason for not seeking it. Treatment dropout was more prevalent among those who visited a general medical care setting. Among individuals still in treatment, human services and psychiatric care were the most common types. Female sex was associated with structural barriers (OR = 2.1). Disorder severity was negatively associated with need barriers (OR = 0.4), and positively associated with structural barriers (OR = 2.5) and psychological barriers (OR = 2.5). Conclusion: Despite the need for treatment and better services, psychological barriers were the major reason for not seeking treatment. Apart from providing more specialists, investing in awareness, de-stigmatization, and information is the ultimate strategy for improving psychiatric care.
Collapse
Affiliation(s)
- Bruno M Coêlho
- Núcleo de Epidemiologia Psiquiátrica (LIM-23), Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Geilson L Santana
- Núcleo de Epidemiologia Psiquiátrica (LIM-23), Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria C Viana
- Programa de Pós-Graduação em Saúde Pública, Departamento de Medicina Social, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Yuan-Pang Wang
- Núcleo de Epidemiologia Psiquiátrica (LIM-23), Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Laura H Andrade
- Núcleo de Epidemiologia Psiquiátrica (LIM-23), Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
142
|
Castro MC, Kim S, Barberia L, Ribeiro AF, Gurzenda S, Ribeiro KB, Abbott E, Blossom J, Rache B, Singer BH. Spatiotemporal pattern of COVID-19 spread in Brazil. Science 2021; 372:821-826. [PMID: 33853971 DOI: 10.1126/science.abh1558] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/09/2021] [Indexed: 01/06/2023]
Abstract
Brazil has been severely hit by COVID-19, with rapid spatial spread of both cases and deaths. We used daily data on reported cases and deaths to understand, measure, and compare the spatiotemporal pattern of the spread across municipalities. Indicators of clustering, trajectories, speed, and intensity of the movement of COVID-19 to interior areas, combined with indices of policy measures, show that although no single narrative explains the diversity in the spread, an overall failure of implementing prompt, coordinated, and equitable responses in a context of stark local inequalities fueled disease spread. This resulted in high and unequal infection and mortality burdens. With a current surge in cases and deaths and several variants of concern in circulation, failure to mitigate the spread could further aggravate the burden.
Collapse
Affiliation(s)
- Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Sun Kim
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lorena Barberia
- Department of Political Science, University of São Paulo (USP), Sao Paulo, SP, Brazil
| | - Ana Freitas Ribeiro
- Universidade Nove de Julho, São Paulo, SP, Brazil.,Universidade Municipal de São Caetano do Sul, São Cetano do Sul, SP, Brazil
| | - Susie Gurzenda
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Karina Braga Ribeiro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of Collective Health, São Paulo, SP, Brazil
| | - Erin Abbott
- Center for Geographical Analysis, Harvard University, Cambridge, MA, USA
| | - Jeffrey Blossom
- Center for Geographical Analysis, Harvard University, Cambridge, MA, USA
| | - Beatriz Rache
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, SP, Brazil
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| |
Collapse
|
143
|
Pilevari N, Shiva MV. Country-Wide Resilience Model for the Health System: A Case Study on Iran, under Coronavirus Outbreak. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:806-815. [PMID: 34183931 PMCID: PMC8219615 DOI: 10.18502/ijph.v50i4.6007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The outbreak of the COVID-19 virus has had many destructive impacts on socio-economic and health systems. The health systems of countries could be supportive in crisis management, but they also are affected by the impact of the crisis, consequently, their operational level has declined. This study pursued resilience in an overall national health system under pandemic stress. Methods Based on WHO building blocks, by interviewing informants of the Ministry of Health and Medical Education, in Tehran-Iran, early 2021 a rich picture of the current situation depicted, the resilience model was extracted via a mixed method of Soft System Methodology (SSM) and total interpretive structural modeling (TISM). Dynamic capabilities were applied for the orchestration of the Iranian health system. Results Particular functional and structural suggestions applicable for designing a ubiquitous resilience model for the country-wide health system are presented in this study. The variables of crisis sensing, opportunity seizing, and reconfiguration are the cornerstones of health system resilience. Conclusion Well-suited health technology assessment (HTA) and health information system (HIS) play significant roles in the overall strengthening of the health system. All reforms for resilience will have a lasting result when the capabilities created by the resilience model are learned and reused in a dynamic cycle.
Collapse
Affiliation(s)
- Nazanin Pilevari
- Department of Industrial Management, West Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mahyar Valeh Shiva
- Department of Management and Economics, Sciences and Research Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
144
|
Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis. LANCET GLOBAL HEALTH 2021; 9:e782-e792. [PMID: 33857500 PMCID: PMC8041360 DOI: 10.1016/s2214-109x(21)00081-4] [Citation(s) in RCA: 175] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND COVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease). METHODS From several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities. FINDINGS The initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather than population age structure and prevalence of health risk factors. The states with a high (greater than median) SVI were able to expand hospital capacity, to enact stringent COVID-19-related legislation, and to increase physical distancing adherence in the population, although not sufficiently to prevent higher COVID-19 mortality during the initial phase of the epidemic compared with states with a low SVI. Death rates accelerated until June, 2020, particularly in municipalities with the highest socioeconomic vulnerability. Throughout the following months, however, differences in policy response converged in municipalities with lower and higher SVIs, while physical distancing remained relatively higher and death rates became relatively lower in the municipalities with the highest SVIs compared with those with lower SVIs. INTERPRETATION In Brazil, existing socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the epidemic, with a disproportionate adverse burden on states and municipalities with high socioeconomic vulnerability. Local government responses and population behaviour in the states and municipalities with higher socioeconomic vulnerability have helped to contain the effects of the epidemic. Targeted policies and actions are needed to protect those with the greatest socioeconomic vulnerability. This experience could be relevant in other low-income and middle-income countries where socioeconomic vulnerability varies greatly. FUNDING None. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
Collapse
|
145
|
Pinto M, Fernandes S, Barros L, Valongueiro S, Moreira MEL, Barreto de Araújo TV, Jofre-Bonet M, Entringer A, Lyra TM, Kuper H. Estimating the cost of congenital Zika syndrome to families and healthcare providers in Rio de Janeiro and Pernambuco, Brazil: results of a case-control study. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16623.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Children with congenital Zika syndrome (CZS) have a wide range of additional healthcare needs. This study aimed to estimate the direct costs of CZS from the health provider and family perspectives, and the indirect costs for families, in two Brazilian states: Rio de Janeiro and Pernambuco. Methods: A case-control study was undertaken between May 2017-January 2018 recruiting 174 cases with severe CZS, 41 with mild/moderate CZS and 269 children with no CZS, across the two sites, from existing studies. The primary caregiver was interviewed using a structured questionnaire to collect information on healthcare use and costs incurred during the previous 12 months. In Rio de Janeiro, health care utilization data was also extracted from electronic medical records. We estimated direct and indirect costs incurred as a result of CZS from the perspective of the health system and families. Results: Children with CZS accessed more healthcare facilities and reported longer travel and waiting times than children unaffected by CZS. Total costs from the health provider perspective of outpatient visits, were highest for children with severe CZS (U$1,411) followed by children with mild/moderate CZS (U$264) and children without CZS (U$107). This pattern was apparent for direct costs incurred by families, while median indirect costs were low. Families of children with CZS reported high levels of catastrophic expenditures; Expenses incurred by families to meet their child’s needs as a proportion of household income was 30% (IQR=14%-67%, p<0.01) for children with severe CZS, 11% (IQR=4%-33%, p<0.01) for mild/moderate CZS, and 1% (IQR=0%-8%) for controls. Costs incurred by families were generally higher in Rio de Janeiro than Pernambuco. Conclusions: Families of children affected by CZS in Brazil may need additional public health resources and social benefits to protect them from incurring catastrophic expenses while meeting the needs of their children.
Collapse
|
146
|
Campelo Barroso Carneiro VC, Ribeiro de Oliveira PDT, Rassy Carneiro S, Cardoso Maciel M, da Silva Pedroso J. Evidence of the effect of primary care expansion on hospitalizations: Panel analysis of 143 municipalities in the Brazilian Amazon. PLoS One 2021; 16:e0248823. [PMID: 33831030 PMCID: PMC8031449 DOI: 10.1371/journal.pone.0248823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/06/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The Family Health Strategy (FHS) became consolidated as a primary care model and gatekeeper for the Unified Health System (Sistema Único de Saúde, SUS) in the Brazil and it is considered one of the largest primary health care programmes in the world. Its rapid expansion allowed the SUS to meet the changing health care needs of the population remote localities of Brazilian municipalities. METHODS In the present study, exploratory data analysis was performed using modelling to provide a general overview of the study and to delineate possible structural characteristics of the cross-sectional time-series data. Panel regression methods were used to assess the association between FHS coverage and ambulatory care-sensitive hospitalizations (ACSH rates) in the municipalities of Pará, in the Brazilian Amazon, from 2008 to 2017. RESULTS The results showed strong evidence for the association between FHS coverage and ACSH rates, including reductions of 22% in preventable hospitalizations and 15% in hospital expenses that were directly linked to the 40% increase in FHS population coverage during the evaluated period. This expansion of primary care has mainly benefitted areas that are difficult to access and populations that were previously deprived of health care in the vast Amazon territory. CONCLUSIONS The findings of this study show that the increase of the expansion of primary care reduces the preventable hospitalization and the hospital expenses. This reinforces the need for public protection of the health of populations at risk and the positive impacts of primary care in the Brazilian Amazon.
Collapse
Affiliation(s)
| | | | - Saul Rassy Carneiro
- João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil
| | | | | |
Collapse
|
147
|
Sportello EF, Castilho V, Lima AFC. Coverage for the cost of outpatient nursing procedures by the Unified Health System: a percentage analysis. Rev Esc Enferm USP 2021; 55:e03692. [PMID: 33825786 DOI: 10.1590/s1980-220x2019026803692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/22/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To analyze the percentage of the coverage of transfers from the Brazilian Unified Health System regarding nursing procedures conducted in the Outpatient facility of a University Hospital. METHOD Quantitative, exploratory, descriptive case study. The sample for calculating the mean total direct costs was composed of non-participant observations of 656 procedures. The obtained costs were compared to transfers from the Unified Health System by multiplying the amount of procedures agreed upon by the unit cost in the Unified Table of Procedures in 2016 and 2017. RESULTS The Unified Health System transferred a percentage corresponding to 11.13% of the actual cost in 2016 and to 16.02% in 2017. In these two years, transfer values covered only a mean of 13.4%, resulting in a percentage difference in revenue significantly smaller than the actual cost. CONCLUSION The higher the productivity of the performed procedures, the higher was the hospital deficit and, consequently, the higher were the costs not covered by the Unified Health System.
Collapse
Affiliation(s)
- Elisabete Finzch Sportello
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Gerenciamento em Enfermagem, São Paulo, SP, Brazil
| | - Valéria Castilho
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Orientação Profissional, São Paulo, SP, Brazil
| | | |
Collapse
|
148
|
Jaeger BDB, Oliveira ML, Castilhos RM, Chaves MLF. Tertiary center referral delay of patients with dementia in Southern Brazil: associated factors and potential solutions. Dement Neuropsychol 2021; 15:210-215. [PMID: 34345362 PMCID: PMC8283886 DOI: 10.1590/1980-57642021dn15-020008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022] Open
Abstract
Early dementia diagnosis has many benefits and is a priority. In Brazil, most cases are diagnosed by a specialist.
Collapse
Affiliation(s)
- Brunna de Bem Jaeger
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre ‒ Porto Alegre, RS, Brazil.,Post-graduate Program in Medical Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul ‒ Porto Alegre, RS, Brazil
| | - Milena Lemos Oliveira
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul ‒ Porto Alegre, RS, Brazil
| | | | - Márcia Lorena Fagundes Chaves
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre ‒ Porto Alegre, RS, Brazil.,Post-graduate Program in Medical Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul ‒ Porto Alegre, RS, Brazil.,Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul ‒ Porto Alegre, RS, Brazil
| |
Collapse
|
149
|
Özçelik EA, Massuda A, McConnell M, Castro MC. Assessing the performance of beneficiary targeting in Brazil's More Doctors Programme. Health Policy Plan 2021; 36:149-161. [PMID: 33448298 PMCID: PMC7996646 DOI: 10.1093/heapol/czaa137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
Many countries employ strategies that rest on the use of an explicitly defined set of criteria to identify underserved communities. Yet, we know relatively little about the performance of community-level targeting in large-scale health programmes. To address this gap, we examine the performance of community targeting in the More Doctors Programme (MDP). Our analysis covers all 5570 municipalities in the period between 2013 and 2017 using publicly available data. We first calculate the rate at which vulnerable municipalities enrolled in the MDP. Next, we consider two types of mistargeting: (1) proportion of vulnerable municipalities that did not have any MDP physicians (i.e. under-coverage municipalities) and (2) proportion of MDP enrolees that did not fit the vulnerability criteria (i.e. non-target municipalities). We found that almost 70% of vulnerable municipalities received at least one MDP physician between 2013 and 2017; whereas non-target municipalities constituted 33% of beneficiaries. Targeting performance improved over time. Non-target municipalities had the highest levels of socioeconomic development and greater physician availability. The poverty rate among under-coverage municipalities was almost six times that in non-target municipalities. Under-coverage municipalities had the lowest primary care physician availability. They were also smaller and more sparsely populated. We also found small differences in the political party alignments of mayors and the President between under-coverage and non-target municipalities. Our results suggest that using community-level targeting approaches in large-scale health programmes is a complex process. Programmes using these approaches may face substantial challenges in beneficiary targeting. Our results highlight that policymakers who consider using these approaches should carefully study various municipal characteristics that may influence the implementation process, including the level of socioeconomic development, health supply factors, population characteristics and political party alignments.
Collapse
Affiliation(s)
- Ece A Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Adriano Massuda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Department of Administration, São Paulo School of Business Administration, Fundação Getulio Vargas, Avenue Nove de Julho, 2029, São Paulo 01313-902, Brazil
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| |
Collapse
|
150
|
Massuda A. Primary health care financing changes in the Brazilian Health System: advance ou setback? CIENCIA & SAUDE COLETIVA 2021; 25:1181-1188. [PMID: 32321001 DOI: 10.1590/1413-81232020254.01022020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
In 2019, the Brazilian government launched a new Primary Health Care (PHC) policy for the Unified Health System (SUS). Called "PrevineBrasil", the policy changed the PHC funding for municipalities. Instead of inhabitants and Family Health Strategy (ESF) teams, intergovernmental transfers are calculated from the number of people registered in PHC services and the results achieved in a selected group of indicators. The changes will have a set of impacts for the SUS and the health of the population, which must be observed and monitored. In this paper, possible effects of the new policy are discussed from a brief context analysis of global trends in health systems financing and health services' remuneration models, as well as on the advances, challenges, and threats to PHC and the SUS. Based on the analysis, the new policy seems to have a restrictive purpose, which should limit universality, increase distortions in financing and induce the focus of PHC actions on the SUS, contributing to the reversal of historic achievements in reducing health inequalities in Brazil.
Collapse
Affiliation(s)
- Adriano Massuda
- Fundação Getúlio Vargas, Escola de Administração do Estado de São Paulo, Av. 9 de Julho 2029/11º/FGVsaude, Bela Vista. 01313-902 São Paulo SP Brasil.
| |
Collapse
|