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Telles L, Gerk A, Carroll M, Faleiro MD, Barbosa de Oliveira T, Naus A, Ferreira R, Botelho F, Bustorff-Silva J, Mooney DP, Ferreira J. Frequency of splenectomy for pediatric splenic injury in Brazil: a retrospective analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 36:100844. [PMID: 39170858 PMCID: PMC11338162 DOI: 10.1016/j.lana.2024.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/28/2024] [Accepted: 07/09/2024] [Indexed: 08/23/2024]
Abstract
Background Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources. Methods Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed. Findings 4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate. Interpretation The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- Luiza Telles
- Instituto de Educação Médica (IDOMED/Estácio, Campus Vista Carioca), Rio de Janeiro, RJ, Brazil
| | - Ayla Gerk
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, MA, United States
- Department of Surgical and Interventional Sciences, McGill University, Quebec, Canada
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Quebec, Canada
| | - Madeleine Carroll
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, MA, United States
- Yale New Haven Hospital, New Haven, CT, United States
| | | | | | - Abbie Naus
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, MA, United States
| | - Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Quebec, Canada
| | - Joaquim Bustorff-Silva
- Division of Pediatric Surgery, State University of Campinas Medical School, Campinas, SP, Brazil
| | | | - Julia Ferreira
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Quebec, Canada
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Candido MA, Alonso N. Impact of COVID-19 Pandemic on Cleft Lip/Palate Surgery in Brazil: Assessing the Current Landscape. Cleft Palate Craniofac J 2024:10556656241265926. [PMID: 39043227 DOI: 10.1177/10556656241265926] [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: 07/25/2024] Open
Abstract
OBJECTIVE This study aims to evaluate the impact of COVID-19 and the current situation for cleft lip/palate treatment surgeries within Brazil's public health system. DESIGN Our retrospective study analyzed CL/P corrective surgeries in Brazil's health system using DATASUS TabNet data from March 2020 to December 2022, with historical data from January 2016 to February 2020. We employed ARIMA analysis to estimate pandemic-related surgery cancellations. RESULTS In 2020, 1992 (CI 95%: 989-2995) CL/P surgeries were not conducted due to pandemics, a 44.1% (CI 95%: 28.1-54.2%) decrease compared to expectations for march to December 2020. Between the onset of the pandemic in Brazil and the end of 2022, 10,643 surgeries were performed in the country, representing a 33.8% shortfall compared to the expected number for the period (16,076; 95% CI: 9697-22,456). CONCLUSION The study highlights COVID-19's impact on CL/P surgeries in Brazil. Post-pandemic, surgeries increased but regional disparities remain, urging collaborative efforts to improve services and support affected patients.
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Affiliation(s)
- Marcelo A Candido
- Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Nivaldo Alonso
- Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
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Shoib S, Saeed F, Philip S, Chandradasa M, Das S, de Filippis R, Yousaf Z, Ojeahere M, Gad HK, Yadivel R, Legris Z, Jatchavala C, Paul R, Gupta AK, Handuleh JIM, Gürcan A, da Costa MP, Dannatt L, Ahmad AR, Jaguga F, Saleem SM, Sawitri B, Arif N, Islam MS, Haque MA, Őri D, Chumakov E, Swed S, Roza TH, Islam SMS. Parity of esteem: A global COVID-19 vaccination approach for people with mental illnesses, based on facts from 34 countries; recommendations and solutions. Ind Psychiatry J 2024; 33:30-40. [PMID: 38853796 PMCID: PMC11155657 DOI: 10.4103/ipj.ipj_54_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/14/2022] [Indexed: 06/11/2024] Open
Abstract
Background The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has detrimental effects on physical and mental health. Patients with severe mental illness are at higher risk of contracting the virus due to social determinants of health. Vulnerable populations include the elderly, people with pre-existing conditions, and those exposed to SARS-CoV-2. Unfortunately, only a few countries have updated vaccination strategies to prioritize patients with mental illnesses. Therefore, we aimed to explore whether individuals with mental disorders are prioritized in vaccine allocation strategies in different world regions. They are often neglected in policymaking but are highly vulnerable to the threatening complications of COVID-19. Methods A questionnaire was developed to record details regarding COVID-19 vaccination and prioritizations for groups of persons with non-communicable diseases (NCDs), mental disorders, and substance use disorders (SUDs). NCDs were defined according to the WHO as chronic diseases that are the result of a combination of genetic, physiological, environmental, and behavioral factors such as cardiovascular diseases, cancer, respiratory diseases, and diabetes. Results Most countries surveyed (80%) reported healthcare delivery via a nationalized health service. It was found that 82% of the countries had set up advisory groups, but only 26% included a mental health professional. Most frequently, malignancy (68%) was prioritized followed by diabetes type 2 (62%) and type 1 (59%). Only nine countries (26%) prioritized mental health conditions. Conclusion The spread of the coronavirus has exposed both the strengths and flaws of our healthcare systems. The most vulnerable groups suffered the most and were hit first and faced most challenges. These findings raise awareness that patients with mental illnesses have been overlooked in immunization campaigns. The range of their mortality, morbidity, and quality of life could have widened due to this delay.
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Affiliation(s)
- Sheikh Shoib
- Department of Health Services, Srinagar, India
- Sharda University, Greater Noida, Uttar Pradesh, India
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fahimeh Saeed
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sharad Philip
- Department of Psychiatry, Clinical Neuro Sciences and Addiction Medicine, All India Institute of Medical Sciences, Guwahati, Silbharal, Changsari, Kamrup -Rural Guwahati, Assam, India
| | | | - Soumitra Das
- Consultant Psychiatrist, Emergency Mental Health, Sunshine Hospital, Melbourne, Australia
| | - Renato de Filippis
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Zohaib Yousaf
- Department of Internal Medicine, Reading Hospital, Tower Health, West Reading, PA, US
| | - Margaret Ojeahere
- Department of Psychiatry, Jos University Teaching Hospital, Jos, Plateau, Nigeria
| | | | | | - Zahra Legris
- College of Psychiatrists of Ireland, Republic of Ireland
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ravi Paul
- Department of Psychiatry, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Anoop K. Gupta
- Department of Psychiatry, National Medical College, Birgunj, Nepal
| | - Jibril I. M. Handuleh
- Department of Psychiatry, St Paul’s Hospital Millennium Medical College, Swaziland Street, Addis Ababa, Ethiopia
| | - Ahmet Gürcan
- Department of Psychiatry, Başkent University Medical Faculty, Ankara, Turkey
| | | | - Lisa Dannatt
- University of Cape Town, Cape Town, South Africa
| | - Araz R. Ahmad
- Director of Media and Lecturer, University of Raparin, Ranya, Iraq
| | | | | | | | - Nigar Arif
- Department of Mental Health, Azerbaijan Republican Psychiatric Hospital, Baku, Azerbaijan
| | - Md. Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Dhaka, Bangladesh
| | - Md Ariful Haque
- Yan an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China
| | - Dorottya Őri
- Institute of Behavioural Sciences, Semmelweis University, Hungry
- Department of Mental Health, Heim Pal National Pediatric Institute, Budapest, Hungry
| | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Thiago H. Roza
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Degani Costa LH, Yepes Pereira B, Queiros Castro I, Werneck H, Mizubuti GB, Falcão LFDR. Impact of COVID-19 pandemic on surgical activity in the Brazilian private healthcare system. PLoS One 2023; 18:e0289032. [PMID: 38096262 PMCID: PMC10720996 DOI: 10.1371/journal.pone.0289032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/07/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Surgical volume was drastically reduced in many countries due to challenges imposed by the COVID-19 pandemic. OBJECTIVES We sought to estimate the number of cancelled surgical and diagnostic procedures within the Brazilian private healthcare system between 2020 and 2021 over the course of the COVID-19 pandemic, and to project the procedural backlog generated for specific elective and time-sensitive surgeries, and diagnostic procedures. METHODS Data were systematically extracted from the Brazilian national regulatory agency for the private healthcare system and included (i) quarterly and annual surgical and diagnostic volume, and (ii) the number of private health insurance beneficiaries between January 2016 and June 2021. Based on pre-pandemic data we estimated the expected number of surgical and diagnostic procedures that failed to be performed between 2020 and 2021. RESULTS The average quarterly surgical and diagnostic procedures declined by 29.5% in 2020 and by 21.5% in 2021 compared to 2019. In 2020, such reduction reflected a lower number of diagnostic procedures under anesthesia (-35.1%), as well as elective (-14.7%), time-sensitive (-18.8%), and urgent (-4.6%) surgeries. In the first half of 2021, though the surgical and diagnostic procedures increased compared to 2020, they remained significantly below their historical average. The estimated backlogs were 134.385,64 for total surgical procedures, 2.634,64 for bariatric surgery and arthroplasty revision (elective surgeries), 2.845,61 for oncologic (time-sensitive) surgeries, and 304.193,99 for diagnostic procedures, requiring 1.7, 15.9, and 6.8 years, respectively, to make up for such backlogs. CONCLUSION There was a major decline on the number of surgical and diagnostic procedures due to the COVID-19 pandemic. Despite a slight recovery of elective surgeries throughout the pandemic, many time-sensitive surgeries and diagnostic procedures were cancelled, with potential medium- to long-term consequences to patients and the system as a whole.
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Affiliation(s)
- Luiza Helena Degani Costa
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Centro Universitário São Camilo, São Paulo, São Paulo, Brazil
| | - Barbara Yepes Pereira
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Heitor Werneck
- Agência Nacional de Saúde Suplementar, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Glenio B. Mizubuti
- Kingston Health Sciences Center, Queen’s University, Kingston, Ontario, Canada
| | - Luiz Fernando dos Reis Falcão
- Centro Universitário São Camilo, São Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo – Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, São Paulo, Brazil
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de Carvalho PVR, Bellas H, Viana J, de Castro Nunes P, Arcuri R, da Silva Fonseca V, Carneiro APM, Jatobá A. Transformative dimensions of resilience and brittleness during health systems' collapse: a case study in Brazil using the Functional Resonance Analysis Method. BMC Health Serv Res 2023; 23:349. [PMID: 37032325 PMCID: PMC10084590 DOI: 10.1186/s12913-023-09301-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/17/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic. In January 2021, the Amazonas state's health system collapsed, especially in the city of Manaus, where acute Covid-19 patients died due to scarcity of medical supplies for respiratory therapy. METHODS This paper explores the case of the health system's collapse in Manaus to uncover the elements that prevented the system from performing resiliently to the pandemic, by carrying out a grounded-based systems analysis of the performance of health authorities in Brazil using the Functional Resonance Analysis Method. The major source of information for this study was the reports from the congressional investigation carried out to unveil the Brazilian response to the pandemic. RESULTS Poor cohesion between the different levels of government disrupted essential functions for managing the pandemic. Moreover, the political agenda interfered in the abilities of the system to monitor, respond, anticipate, and learn, essential aspects of resilient performance. CONCLUSIONS Through a systems analysis approach, this study describes the implicit strategy of "living with Covid-19", and an in-depth view of the measures that hampered the resilience of the Brazilian health system to the spread of Covid-19.
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Affiliation(s)
| | - Hugo Bellas
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jaqueline Viana
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula de Castro Nunes
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rodrigo Arcuri
- Programa de Pós-Graduação Em Engenharia de Produção (TPP), Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Valéria da Silva Fonseca
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Alessandro Jatobá
- Centro de Estudos, Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Oosterhoff M, Kouwenberg LHJA, Rotteveel AH, van Vliet ED, Stadhouders N, de Wit GA, van Giessen A. Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands. Soc Sci Med 2023; 320:115658. [PMID: 36689820 PMCID: PMC9810553 DOI: 10.1016/j.socscimed.2023.115658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/02/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic had a major impact on the continuity of healthcare provision. Appointments, treatments and surgeries for non-COVID patients were often delayed, with associated health losses for patients involved. OBJECTIVE To develop a method to quantify the health impact of delayed elective care for non-COVID patients. METHODS A model was developed that estimated the backlog of surgical procedures in 2020 and 2021 using hospital registry data. Quality-adjusted life years (QALYs) were obtained from the literature to estimate the non-generated QALYs related to the backlog. In sensitivity analyses QALY values were varied by type of patient prioritization. Scenario analyses for future increased surgical capacity were performed. RESULTS In 2020 and 2021 an estimated total of 305,374 elective surgeries were delayed. These delays corresponded with 319,483 non-generated QALYs. In sensitivity analyses where QALYs varied by type of patient prioritization, non-generated QALYs amounted to 150,973 and 488,195 QALYs respectively. In scenario analyses for future increased surgical capacity in 2022-2026, the non-generated QALYs decreased to 311,220 (2% future capacity increase per year) and 300,710 (5% future capacity increase per year). Large differences exist in the extent to which different treatments contributed to the total health losses. CONCLUSIONS The method sheds light on the indirect harm related to the COVID-19 pandemic. The results can be used for policy evaluations of COVID-19 responses, in preparations for future waves or other pandemics and in prioritizing the allocation of resources for capacity increases.
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Affiliation(s)
- Marije Oosterhoff
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Lisanne H J A Kouwenberg
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; Amsterdam UMC location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Adriënne H Rotteveel
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Ella D van Vliet
- Centre for Health Protection, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Niek Stadhouders
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101m 6500 HB, Nijmegen, the Netherlands.
| | - G Ardine de Wit
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; Vrije Universiteit Amsterdam, Faculty of Science, Department of Health Sciences & Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands.
| | - Anoukh van Giessen
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
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Faleiro MD, Fernandez MG, Santos JM, Menezes CEG, Lima JVS, Haddad JOD, Viana SW, Alonso N. Geographical Inequalities in Access to Bellwether Procedures in Brazil. World J Surg 2023; 47:593-599. [PMID: 36456731 PMCID: PMC9714764 DOI: 10.1007/s00268-022-06855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Brazil is a middle-income country that aims to provide universal health coverage, but its surgical system's efficiency has rarely been analyzed. In an effort to strengthen surgical national systems, the Lancet Commission on Global Surgery proposed bellwether procedures as quality indicators of surgical workforces. This study aims to evaluate regional inequalities in access to bellwether procedures and their associated mortality across the five Brazilian geographical regions. METHODS Using DATASUS, Brazil's national healthcare database, data were collected on the total amount of performed bellwether procedures-cesarean section, laparotomy, and open fracture management-and their associated mortality, by geographical region. We evaluated the years 2018-2020, both in emergent and elective conditions. Statistical analysis was performed by one-way ANOVA test and Tukey's multiple comparisons test. RESULTS During this period, DATASUS registered 2,687,179 cesarean sections, 1,036,841 laparotomies, and 648,961 open fracture treatments. The access and associated mortality related to these procedures were homogeneous between the regions in elective care. There were significant geographical inequalities in access and associated mortality in emergency care (p < 0.05, 95% CI) for all bellwether procedures. The Southeast, the most economically developed region of the country, was the region with the lowest amount of bellwether procedures per 100,000 inhabitants. CONCLUSION Brazil's public surgical system is competent at promoting elective surgical care, but more effort is needed to fortify emergency care services. Public policies should encourage equity in the geographic allocation of the surgical workforce.
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Affiliation(s)
- Matheus Daniel Faleiro
- Federal University of Minas Gerais, Belo Horizonte, Brazil.
- International Student Surgical Network Brazil, Belo Horizonte, Brazil.
| | - Miguel Godeiro Fernandez
- International Student Surgical Network Brazil, Belo Horizonte, Brazil
- Bahiana School of Medicine and Public Health (EBMSP), Salvador, Brazil
| | - Jéssica Moreira Santos
- International Student Surgical Network Brazil, Belo Horizonte, Brazil
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Catarina Ester Gomes Menezes
- International Student Surgical Network Brazil, Belo Horizonte, Brazil
- State University of Bahia, Salvador, Brazil
| | - João Vitor Sabadine Lima
- Federal University of Minas Gerais, Belo Horizonte, Brazil
- International Student Surgical Network Brazil, Belo Horizonte, Brazil
| | | | - Sofia Wagemaker Viana
- International Student Surgical Network Brazil, Belo Horizonte, Brazil
- Kursk State Medical University, Kursk, Russia
| | - Nivaldo Alonso
- Division of Plastic Surgery, University of São Paulo, São Paulo, Brazil
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van Alphen AMIA, van Hof KS, Gravesteijn BY, Krijkamp EM, Bakx PAGM, Langenbach P, Busschbach JJ, Lingsma HF, Baatenburg de Jong RJ. Minimising population health loss in times of scarce surgical capacity: a modelling study for surgical procedures performed in nonacademic hospitals. BMC Health Serv Res 2022; 22:1456. [PMID: 36451147 PMCID: PMC9713162 DOI: 10.1186/s12913-022-08854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The burden of the COVID-19 pandemic resulted in a reduction of available health care capacity for regular care. To guide prioritisation of semielective surgery in times of scarcity, we previously developed a decision model to quantify the expected health loss due to delay of surgery, in an academic hospital setting. The aim of this study is to validate our decision model in a nonacademic setting and include additional elective surgical procedures. METHODS In this study, we used the previously published three-state cohort state-transition model, to evaluate the health effects of surgery postponement for 28 surgical procedures commonly performed in nonacademic hospitals. Scientific literature and national registries yielded nearly all input parameters, except for the quality of life (QoL) estimates which were obtained from experts using the Delphi method. Two expert panels, one from a single nonacademic hospital and one from different nonacademic hospitals in the Netherlands, were invited to estimate QoL weights. We compared estimated model results (disability adjusted life years (DALY)/month of surgical delay) based on the QoL estimates from the two panels by calculating the mean difference and the correlation between the ranks of the different surgical procedures. The eventual model was based on the combined QoL estimates from both panels. RESULTS Pacemaker implantation was associated with the most DALY/month of surgical delay (0.054 DALY/month, 95% CI: 0.025-0.103) and hemithyreoidectomy with the least DALY/month (0.006 DALY/month, 95% CI: 0.002-0.009). The overall mean difference of QoL estimates between the two panels was 0.005 (95% CI -0.014-0.004). The correlation between ranks was 0.983 (p < 0.001). CONCLUSIONS Our study provides an overview of incurred health loss due to surgical delay for surgeries frequently performed in nonacademic hospitals. The quality of life estimates currently used in our model are robust and validate towards a different group of experts. These results enrich our earlier published results on academic surgeries and contribute to prioritising a more complete set of surgeries.
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Affiliation(s)
- Anouk M I A van Alphen
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Kira S van Hof
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Benjamin Y Gravesteijn
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eline M Krijkamp
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Currently Employed By the Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Pieter A G M Bakx
- Department of Orthopedic Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Peter Langenbach
- CEO and Chairman of Maasstad Hospital, Rotterdam, the Netherlands.,Currently Employed By Zilveren Kruis (Achmea) Health Insurance, Leiden, the Netherlands
| | - Jan J Busschbach
- Department of Medical Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Demarchi PKH, Maurer E, Pierini NI, Lammel BL, Sirqueira ACV, Maggi LS, Santos KL, Shama SDFMS. O Impacto da Pandemia da Covid-19 no Volume de Mamografias no Brasil: uma Análise de Previsão Baseada nos Números Históricos. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Introdução: A neoplasia mamaria constitui a primeira causa de óbito por câncer em mulheres brasileiras. Dados sobre o real impacto da pandemia na política de rastreamento e diagnostico do câncer de mama no Brasil ainda são desconhecidos. Objetivo: Avaliar o efeito da pandemia da covid-19 no número de mamografias realizadas no Sistema Único de Saúde (SUS). Método: Estudo epidemiológico, quantitativo e de delineamento transversal. Foram selecionadas mamografias mensais realizadas no SUS após consulta ao Departamento de Informática do SUS (DATASUS). Foi avaliado o volume histórico, de janeiro de 2017 a marco de 2020, mês seguinte ao primeiro caso de covid-19 diagnosticado no Brasil, para se construir um modelo de previsão das mamografias esperadas de marco de 2020 até dezembro de 2021. Resultado: No ano de 2020, 1.705.475 mamografias deixaram de ser realizadas no Brasil em relação ao ano anterior, segundo o DATASUS. O modelo de previsão, com base nos valores históricos, mostrou um déficit de 1.635.42 mamografias. Em maio de 2020, ocorreu a maior queda na realização dos exames, representando apenas 20,69% das mamografias realizadas no mesmo mês do ano anterior. Conclusão: A detecção precoce do câncer de mama foi uma das áreas medicas impactadas pela política de restrição e isolamento impostos no ano de 2020. Nesse sentido, esforços governamentais futuros serão necessários para oferecer tratamento a eventuais pacientes com diagnostico tardio de câncer de mama, além das mamografias que não puderam ser realizadas.
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Mehta A, Awuah WA, Ng JC, Kundu M, Yarlagadda R, Sen M, Nansubuga EP, Abdul-Rahman T, Hasan MM. Elective surgeries during and after the COVID-19 pandemic: Case burden and physician shortage concerns. Ann Med Surg (Lond) 2022; 81:104395. [PMID: 35999832 PMCID: PMC9388274 DOI: 10.1016/j.amsu.2022.104395] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic had a significant impact on several aspects of global healthcare systems, particularly surgical services. New guidelines, resource scarcity, and an ever-increasing demand for care have posed challenges to healthcare professionals, resulting in the cancellation of many surgeries, with short and long-term consequences for surgical care and patient outcomes. As the pandemic subsides and the healthcare system attempts to reestablish a sense of normalcy, surgical recommendations and advisories will shift. These changes, combined with a growing case backlog (postponed surgeries + regularly scheduled surgeries) and a physician shortage, can have serious consequences for physician health and, as a result, surgical care. Several initiatives are already being implemented by governments to ensure a smooth transition as surgeries resume. Newer and more efficient steps aimed at providing adequate surgical care while preventing physician burnout, on the other hand, necessitate a collaborative effort from governments, national medical boards, institutions, and healthcare professionals. This perspective aims to highlight alterations in surgical recommendations over the course of the pandemic and how these changes continue to influence surgical care and patient outcomes as the pandemic begins to soften its grip. The COVID-19 pandemic had a significant impact on several aspects of surgical care. New surgical recommendations amidst an ever-increasing demand for care pose, short and long-term consequences for surgical care and patient outcomes. As the pandemic subsides, these changes, combined with a growing case backlog and a physician shortage, can have serious consequences for physician health and, as a result, surgical care.
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11
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Frio GS, Russo LX, de Albuquerque CP, da Mota LMH, Barros-Areal AF, Oliveira APRA, Firmino-Machado J, da Silva EN. The disruption of elective procedures due to COVID-19 in Brazil in 2020. Sci Rep 2022; 12:10942. [PMID: 35768482 PMCID: PMC9243075 DOI: 10.1038/s41598-022-13746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Elective procedures were temporarily suspended several times over the course of the pandemic of COVID-19. Monthly data from the Unified Health System (SUS) were used for the period between January 2008 and December 2020 and the interrupted time series method was used to estimate the effect of the pandemic on the number of elective surgeries and elective procedures that were not performed. Considering a 9-month period, a reduction of 46% in the number of elective procedures carried out in the SUS could be attributed to COVID-19, corresponding to about 828,429 elective procedures cancelled, ranging from 549,921 to 1,106,936. To a full recovery of pre-pandemic performance, SUS would need to increase about 21,362 hospital beds, ranging from 12,370 to 36,392 hospital beds during a 6 month-period. This effort would represent an increase of 8.48% (ranging from 4.91 to 14.45%) in relation to the total number of SUS’s hospital beds in 2019. As a result, the pandemic will leave a large number of elective procedures to be carried out, which will require efforts by health agencies to meet this demand.
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Affiliation(s)
- Gustavo Saraiva Frio
- Graduate Program in Collective Health, Faculty of Health Science, University of Brasilia, Brasília, Brazil.,Catholic University of Pelotas, Pelotas, Brazil
| | - Letícia Xander Russo
- Department of Economics, Federal University of Grande Dourados, Dourados, Brazil.
| | - Cleandro Pires de Albuquerque
- Graduate Program in Medical Science, Faculty of Medicine, University Hospital of Brasília, University of Brasilia, Brasília, Brazil
| | | | - Adriana Ferreira Barros-Areal
- Graduate Program in Medical Science, Health Department of the Federal District (SES/DF), Faculty of Medicine, University of Brasilia, Brasília, Brazil
| | | | - João Firmino-Machado
- Faculty of Medicine, Institute of Public Health (ISPUP), University of Porto, Porto, Portugal
| | - Everton Nunes da Silva
- Graduate Program in Collective Health, Faculty of Health Science, Faculty of Ceilândia, University of Brasilia, Brasília, Brazil
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12
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Faria CGF, de Matos UMA, Llado-Medina L, Pereira-Sanchez V, Freire R, Nardi AE. Understanding and addressing COVID-19 vaccine hesitancy in low and middle income countries and in people with severe mental illness: Overview and recommendations for Latin America and the Caribbean. Front Psychiatry 2022; 13:910410. [PMID: 36177216 PMCID: PMC9513790 DOI: 10.3389/fpsyt.2022.910410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022] Open
Abstract
Despite the speedy development of vaccines for COVID-19, their rollout has posed a major public health challenge, as vaccine hesitancy (VH) and refusal are high. Addressing vaccine hesitancy is a multifactorial and context-dependent challenge. This perspective focuses on VH in the world region of Latin America and the Caribbean (LAC) and includes people suffering from severe mental illness, therefore covering populations and subpopulations often neglected in scientific literature. We present an overview of VH in LAC countries, discussing its global and historical context. Vaccine uptake has shown to widely vary across different subregions of LAC. Current data points to a possible correlation between societal polarization and vaccination, especially in countries going through political crises such as Brazil, Colombia, and Venezuela. Poor accessibility remains an additional important factor decreasing vaccination rollout in LAC countries and even further, in the whole Global South. Regarding patients with severe mental illness in LAC, and worldwide, it is paramount to include them in priority groups for immunization and monitor their vaccination coverage through public health indicators.
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Affiliation(s)
- Clara Gitahy Falcão Faria
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - Victor Pereira-Sanchez
- Department of Psychiatry, Columbia University, New York, NY, United States.,Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, NY, United States.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, Amoud University, Borama, Somalia
| | - Rafael Freire
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Department of Psychiatry and Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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13
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Candido Dos Reis FJ. Impact of COVID-19 Pandemic on Gynecologic Oncology Surgery in Brasil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:803-804. [PMID: 34872136 PMCID: PMC10183944 DOI: 10.1055/s-0041-1741121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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