1
|
Müller MR, Ortega F. Mental Health Collaborative Care in Brazil and the Economy of Attention: Disclosing Barriers and Therapeutic Negotiations. Cult Med Psychiatry 2024; 48:507-525. [PMID: 38652342 PMCID: PMC11362260 DOI: 10.1007/s11013-024-09852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/25/2024]
Abstract
The introduction of mental health collaborative care (MHCC) is one of the strategies to scale up access to mental health care in primary health care in Brazil. This article investigates an experience of mental health collaborative care in the city of Rio de Janeiro, Brazil. It is a qualitative study involving interviews with physicians and mental health professionals working in primary health care units located in the northern part of the city of Rio de Janeiro, Brazil. The aim is to examine the various strategies and negotiations that primary health care professionals deploy to identify mental distress and plan health care interventions. We discuss the results within the economy of attention framework. We argue that divergences in diagnostic design and therapeutic planning carried out by professionals and users or observed in MHCC meetings illustrate the health-disease-care seeking phenomenon as a negotiated process, entangled in complex interactions. Our results evince that those interactions are not always evident and configure 'what is at stake' in mental suffering. The incorporation of cultural and structural determinants in collaborative care may enable the expansion of mental health initiatives sensitive to local needs and realities.
Collapse
Affiliation(s)
- Manuela Rodrigues Müller
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro, Brazil
| | - Francisco Ortega
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Av. Catalunya 35, 43002, Tarragona, Spain.
| |
Collapse
|
2
|
Chiwaridzo OT. Austerity Measures and the Resilience of Zimbabwe's Healthcare System: Challenges and Solutions. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241269118. [PMID: 39119742 DOI: 10.1177/27551938241269118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Austerity measures have become a contentious topic, shaping the landscape of health care systems around the world. As governments grapple with economic challenges, the impact of austerity on health care has emerged as a critical concern. This study focuses on the consequences of austerity actions adopted by the Zimbabwean government under the Transitional Stabilization Program (TSP) from August 2018 to December 2025. This research examines the impact of austerity measures on Zimbabwe's health care sector, exploring its connections with health infrastructure and resources, accessibility and affordability of health care, health funding, health care inequalities, and the health care workforce. Using a quantitative approach and data from 970 participants, including the general populace, health care providers, and government officials, significant positive correlations between austerity measures and these health care variables were identified. The findings indicated a noteworthy positive correlation between the independent variable "austerity measures" and five dependent variables: health care accessibility and affordability, health care inequalities, infrastructure and resources, health care funding, and health care workforce. The t-statistics values exceeded the threshold of 1.96, with values of 5.085, 3.120, 6.459, 8.517, and 3.830, respectively. These findings highlight the importance of considering the effects of austerity on health care access, health funding, health care inequalities, health workforce, health infrastructure and resources development. Policymakers should prioritize equitable resource allocation and targeted investments to strengthen the resilience of the health care system during economic challenges. Understanding these associations is crucial for evidence-based policy decisions and fostering a more equitable and resilient health care system in Zimbabwe.
Collapse
|
3
|
Buss PM, Estephanio JM, Kavanami V, Burger P. Unmatched opportunity: Brazil must use its G20 presidency to focus on transformative global pacts. BMJ 2024; 386:q1571. [PMID: 39043413 DOI: 10.1136/bmj.q1571] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- Paulo M Buss
- WHO-PAHO Collaborative Center for Global Health Diplomacy and South-South Cooperation, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
- National Academy of Medicine, Brazil
- Latin-American Alliance for Global Health
| | | | - Vitoria Kavanami
- Fiocruz Center for Global Health and Health Diplomacy, Rio de Janeiro, Brazil
| | - Pedro Burger
- Fiocruz Center for Global Health and Health Diplomacy, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Ventura D, Martins J, Leme AS, Pereira P, Trivellato PR, Viegas L. Brazil should use its G20 leadership to support public health systems and promote decolonisation of global health. BMJ 2024; 386:e080209. [PMID: 39043401 PMCID: PMC11261785 DOI: 10.1136/bmj-2024-080209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- Deisy Ventura
- Global Health and Sustainability Program, School of Public Health, University of São Paulo São Paulo, Brazil
- Institute of International Relations, University of São Paulo, São Paulo, Brazil
| | - Jameson Martins
- Global Health and Sustainability Program, School of Public Health, University of São Paulo São Paulo, Brazil
| | - Adriana Salay Leme
- Laboratory for Historical Studies of Drugs and Food, University of São Paulo, São Paulo, Brazil
| | - Pamella Pereira
- Global Health and Sustainability Program, School of Public Health, University of São Paulo São Paulo, Brazil
| | - Paulo Roberto Trivellato
- Global Health and Sustainability Program, School of Public Health, University of São Paulo São Paulo, Brazil
| | - Leandro Viegas
- Institute of International Relations, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
5
|
Souza MLP, Orellana JDY, Jesus FO, Horta BL. The rise in mortality due to intentional self-poisoning by medicines in Brazil between 2003 and 2022: relationship with regional and global crises. Front Public Health 2024; 12:1428674. [PMID: 39056078 PMCID: PMC11269127 DOI: 10.3389/fpubh.2024.1428674] [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: 05/06/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
In recent years, suicide rates in Brazil have increased, but little is known about the temporal behavior and characteristics of suicides due to intentional self-poisoning by medicines. The aim of the present study was to provide an overview of sociodemographic characteristics and place of death related to suicide due to intentional self-poisoning by medicines, to evaluate the trend of mortality rates in Brazil between 2003 and 2022, and its relationship with regional and global crises. Ecological time series study with data from the Mortality Information System of the Brazilian Ministry of Health, related to individuals aged 10 years and over, who committed suicides due to intentional drug overdose, in the period from 2003 to 2022. The analyses were performed in the R environment in RStudio. Between 2003 and 2022, there was a predominance of deaths in women (55.5%), individuals aged 30-49 years (47.2%), of White race/color (53.2%), occurring in health facilities (67.0%), using drugs or unspecified substances (40.4%); a higher concentration in the southern region (22.8%) and a positive trend in mortality rates due to intentional drug overdose, especially from 2016 onwards. A rise of 264% was observed in the comparison of 2022 and 2003. A peculiar sociodemographic profile was observed in the victims of intentional self-poisoning by medicines and a positive temporal trend in mortality rates, especially in a period marked by regional and global crises.
Collapse
Affiliation(s)
| | | | | | - Bernardo Lessa Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| |
Collapse
|
6
|
Kharenine Serbim A, Ayre J, Manganelli Girardi Paskulin L, Nutbeam D, Muscat D. Qualitative Evaluation of a Health Literacy Program for Older Adults Who Live in a Community Dwelling in Brazil. Health Lit Res Pract 2024; 8:e140-e150. [PMID: 39136215 PMCID: PMC11360679 DOI: 10.3928/24748307-20240722-01] [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: 12/20/2023] [Accepted: 06/20/2024] [Indexed: 09/01/2024] Open
Abstract
To address current gaps in health literacy research and practice in low-resource settings, the 'Alfa-Health Program' was designed to improve health literacy in older adults who live in a community dwelling in a socioeconomically disadvantaged community in North-East Brazil. In this longitudinal qualitative study, participants were interviewed before and after participating in the group-based program that was delivered November 2017 to December 2017 in the Primary Care Health Unit. Semi-structured interviews were guided by a previously validated health literacy instrument, translated and adapted for use in Brazil. Data was analyzed using Framework analysis. Of the 21 participants, the majority were age 60 to 69 years with a median of 4-years of school education. Our analysis identified self-reported improvements in health knowledge, behaviors, and skills that matched program content and indicated that participants were supported to manage their health conditions more autonomously. Other themes reflect the distributed nature of health literacy and the potential for group-based health literacy programs to facilitate feelings of social support and cohesion through co-learning. However, age-related deficits in memory and external and structural factors remained important barriers to program participation. This study provides insight into developing health literacy in low-resource settings with older adults, where health literacy is compounded by social determinants and cognitive and sensory changes that contribute to health disparities. Although the targeted Alfa Health Program addresses calls to ensure that priority is proportionate to need by reaching and engaging population groups who are disproportionately affected by low health literacy, further work is needed to adapt the program for people who are unable to read or write. [HLRP: Health Literacy Research and Practice. 2024;8(3):e140-e150.].
Collapse
Affiliation(s)
- Andreivna Kharenine Serbim
- Address correspondence to Andreivna Kharenine Serbim, BscN, MN, PhD, Federal University of Alagoas (UFAL), Arapiraca Campus, Manoel Severino Barbosa Avenue, Bom Sucesso, 57309-005, Alagoas, Brazil;
| | | | | | | | | |
Collapse
|
7
|
Ferreira DP, Bolognani CV, Santana LA, Fernandes SES, de Moraes MSF, Fernandes LAS, de Oliveira DQ, de Santana RB, Gottems LBD, Amorim FF. Impact of the COVID-19 Pandemic on Elective and Emergency Surgeries, and Postoperative Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study. Risk Manag Healthc Policy 2024; 17:1701-1712. [PMID: 38946840 PMCID: PMC11214554 DOI: 10.2147/rmhp.s459307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/13/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in surgical services. The primary objective of the study was to assess the impact of COVID-19 on elective and emergency surgeries in a Brazilian metropolitan area. The secondary objective was to compare the postoperative hospital mortality before and during the pandemic. Patients and Methods Time-series cohort study including data of all patients admitted for elective or emergency surgery at the hospitals in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. A causal impact analysis was used to evaluate the impact of COVID-19 on elective and emergency surgeries and hospital mortality. Results There were 174,473 surgeries during the study period. There was a reduction in overall (absolute effect per week: -227.5; 95% CI: -307.0 to -149.0), elective (absolute effect per week: -170.9; 95% CI: -232.8 to -112.0), and emergency (absolute effect per week: -57.7; 95% CI: -87.5 to -27.7) surgeries during the COVID-19 period. Comparing the surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs 68.8%, P < 0.001) and no significant hospital length of stay (P = 0.112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: -0.01 to 4.2). Conclusion Our study showed a reduction in elective and emergency surgeries during the COVID-19 pandemic, possibly due to disruptions in surgical services. These findings highlight that it is crucial to implement effective strategies to prevent the accumulation of surgical waiting lists in times of crisis and improve outcomes for surgical patients.
Collapse
Affiliation(s)
| | - Claudia Vicari Bolognani
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| | - Levy Aniceto Santana
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| | - Sergio Eduardo Soares Fernandes
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| | | | | | | | | | - Leila Bernarda Donato Gottems
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| | - Fabio Ferreira Amorim
- Graduation Program in Health Sciences, University of Brasília (Unb), Brasília, Brazil
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| |
Collapse
|
8
|
Coelho Tavares da Silva S, Tavares da Silva PH, Antão de Medeiros R, Barbosa do Nascimento V. Litigation in access to universal health coverage for children and adolescents in Brazil. Front Public Health 2024; 12:1402648. [PMID: 38983258 PMCID: PMC11232527 DOI: 10.3389/fpubh.2024.1402648] [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: 03/29/2024] [Accepted: 06/05/2024] [Indexed: 07/11/2024] Open
Abstract
Background Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model. Methods The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams. Results The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018. Conclusion Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.
Collapse
Affiliation(s)
- Suely Coelho Tavares da Silva
- Centro Universitário FMABC (FMABC), Santo André, Brazil
- Centro Universitário de João Pessoa (UNIPÊ), João Pessoa, Brazil
| | | | | | | |
Collapse
|
9
|
Barberia LG, Masiero G, Alves de Lima I, Santana L, Moraes de Sousa TC. The influence of political disagreements and corruption on state health leader turnover during the COVID-19 pandemic in Brazil. Leadersh Health Serv (Bradf Engl) 2024; ahead-of-print. [PMID: 38884379 DOI: 10.1108/lhs-01-2024-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
PURPOSE Governments faced formidable challenges in coordinating public health responses to the COVID-19 pandemic. This study aims to enhance the understanding of effective organizational leadership during crises by investigating the factors influencing the turnover of health leaders during the COVID-19 pandemic in Brazil. DESIGN/METHODOLOGY/APPROACH Using primary data encompassing all appointments and dismissals of federal and state health secretaries, this paper conducted a quantitative analysis of the relational and reputational factors that contributed to leader turnover during the COVID-19 pandemic. This paper also examined whether leaders' management and public health experience increase the duration of tenure. FINDINGS States encountered significant challenges in retaining experienced and effective leadership during the health emergency, primarily due to political conflicts in policymaking and, to a lesser extent, allegations of corruption. Furthermore, leaders with expertise in public health were found to be less likely to be removed from office. However, managerial experience did not prolong the tenure of state health secretaries during the emergency. RESEARCH LIMITATIONS/IMPLICATIONS Since most health leaders have public health and management experience, the contributions of each factor to the duration of a secretary's tenure are difficult to separate and analyze separately. PRACTICAL IMPLICATIONS This study provides empirical insights into what factors drive health leader turnover during major health emergencies. SOCIAL IMPLICATIONS During major health emergencies, health leaders often strongly disagree with elected officials on the response. This paper test how crisis leadership theories help explain state health leaders' duration in one of the world's largest public health systems during the COVID-19 pandemic. This paper find that policy disagreements contributed to significant turnover. ORIGINALITY/VALUE To the best of the authors' knowledge, this paper is the first that are aware of that uses novel primary data on public health executive leader characteristics and turnover causes in the context of the COVID-19 pandemic. It provides empirical evidence contributing to the crisis leadership literature by examining health leader turnover in one of the world's largest public health systems.
Collapse
Affiliation(s)
| | - Gilmar Masiero
- Administração, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Luciana Santana
- Ciência Política, Universidade Federal de Alagoas, Maceio, Brazil
| | | |
Collapse
|
10
|
Caldas B, Portela M, Stelson E, Singer S, Amaral T, Amaral C, Escosteguy C, Martins M, de Andrade CLT, Soares L, Cornish F, Rosenthal M, Aveling EL. Promoting equity, diversity, and inclusion in surveys: insights from a patient-engaged study to assess long COVID health-care needs in Brazil. J Clin Epidemiol 2024; 173:111423. [PMID: 38880435 DOI: 10.1016/j.jclinepi.2024.111423] [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: 03/28/2024] [Revised: 06/01/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may persist for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socioeconomically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC health care and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in 3 guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of health-care access. RESULTS The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our 3 principles through survey content, instrument design, and administration. Six hundred fifty-one participants with diverse LC symptoms, demography, and socioeconomic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.
Collapse
Affiliation(s)
- Bárbara Caldas
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Margareth Portela
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Elisabeth Stelson
- Patient-Led Research Collaborative, Calabasas, CA, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sara Singer
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
| | - Thatiana Amaral
- Center for Health Sciences and Sports, Universidade Federal do Acre (UFAC), Rio Branco, Brazil
| | - Cledir Amaral
- Instituto Federal do Acre (IFAC), Rio Branco, Brazil
| | - Claudia Escosteguy
- Epidemiology Service, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Mônica Martins
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Flora Cornish
- Department of Methodology, London School of Economics and Political Science, London, UK
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Emma-Louise Aveling
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
11
|
Tempski P, Girotto LC, Brenelli S, Giamberardino DD, Martins MA. Accreditation of medical education in Brazil: an evaluation of seventy-six medical schools. BMC MEDICAL EDUCATION 2024; 24:656. [PMID: 38867222 PMCID: PMC11167757 DOI: 10.1186/s12909-024-05623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND We present the first results of the Accreditation System of Medical Schools (Sistema de Acreditação de Escolas Médicas - SAEME) in Brazil. METHODS We evaluated the results of the accreditation of medical schools from 2015 to 2023. The self-evaluation form of the SAEME is specific for medical education programs and has eighty domains, which results in final decisions that are sufficient or insufficient for each domain. We evaluated the results of the first seventy-six medical schools evaluated by the SAEME. RESULTS Fifty-five medical schools (72.4%) were accredited, and 21 (27.6%) were not. Seventy-two (94.7%) medical schools were considered sufficient in social accountability, 93.4% in integration with the family health program, 75.0% in faculty development programs and 78.9% in environmental sustainability. There was an emphasis on SAEME in student well-being, with seventeen domains in this area, and 71.7% of these domains were sufficient. The areas with the lowest levels of sufficiency were interprofessional education, mentoring programs, student assessment and weekly distribution of educational activities. CONCLUSION Medical schools in Brazil are strongly committed to social accountability, integration with the national health system, environmental sustainability and student well-being programs. SAEME is moving from episodic evaluations of medical schools to continuous quality improvement policies.
Collapse
Affiliation(s)
- Patricia Tempski
- Sistema de Acreditação de Escolas Médicas, Conselho Federal de Medicina, Brasilia, Brazil
- Centro de Desenvolvimento de Educação Médica da Faculdade de Medicina, da Universidade de São Paulo, Av. Dr. Arnaldo 455 sala 1210, Sao Paulo, 01246-903, Brazil
| | - Leticia C Girotto
- Sistema de Acreditação de Escolas Médicas, Conselho Federal de Medicina, Brasilia, Brazil
- Centro de Desenvolvimento de Educação Médica da Faculdade de Medicina, da Universidade de São Paulo, Av. Dr. Arnaldo 455 sala 1210, Sao Paulo, 01246-903, Brazil
| | - Sigisfredo Brenelli
- Sistema de Acreditação de Escolas Médicas, Conselho Federal de Medicina, Brasilia, Brazil
- Centro de Desenvolvimento de Educação Médica da Faculdade de Medicina, da Universidade de São Paulo, Av. Dr. Arnaldo 455 sala 1210, Sao Paulo, 01246-903, Brazil
| | - Donizeti D Giamberardino
- Sistema de Acreditação de Escolas Médicas, Conselho Federal de Medicina, Brasilia, Brazil
- Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Milton A Martins
- Sistema de Acreditação de Escolas Médicas, Conselho Federal de Medicina, Brasilia, Brazil.
- Centro de Desenvolvimento de Educação Médica da Faculdade de Medicina, da Universidade de São Paulo, Av. Dr. Arnaldo 455 sala 1210, Sao Paulo, 01246-903, Brazil.
| |
Collapse
|
12
|
Paredes LP, da Silva Brandao Rodrigues M, Santos-Oliveira R. Deciphering Trends in Cancer Mortality: A Comprehensive Analysis of Brazilian Data From 1979 to 2021 With Emphasis on Breast and Prostate Cancers. World J Oncol 2024; 15:463-471. [PMID: 38751694 PMCID: PMC11092415 DOI: 10.14740/wjon1831] [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: 01/30/2024] [Accepted: 03/30/2024] [Indexed: 05/18/2024] Open
Abstract
Background This study examined cancer mortality trends in Brazil from 1979 to 2021, emphasizing breast and prostate cancers. Methods Utilizing data from the Brazilian Mortality Information System and the Brazilian Institute of Geography and Statistics, it analyzed cancer deaths nationally and regionally, highlighting gender-specific and regional disparities. Results The research finds that cancer death rates have been growing at an average of 12% per year, contrasting with the population growth rate of 2.2%. This trend is more pronounced in the southern and southeastern regions of Brazil. A comparison of cancer mortality rates between Brazil, the USA, and China reveals that while the Brazilian and Chinese rates exhibit slower growth, the US rate shows a continuous decline since the 1990s. Conclusions The study adopts a novel approach by focusing on growth rates and employing polynomial interpolation, revealing a deceleration in cancer death growth over the last 15 years across all malignant neoplasms. The study also contextualizes these findings within Brazil's cancer control policies, tracing the evolution of preventive measures and treatment advancements. It highlights the significant role of the National Cancer Institute and the Unified Health System in implementing effective strategies. The decreasing trend in cancer mortality rates in Brazil, despite population growth, illustrates the effectiveness of comprehensive cancer control and prevention measures, underlining their importance in public health policy.
Collapse
Affiliation(s)
- Leonardo Pires Paredes
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Rio de Janeiro 21941906, Brazil
| | | | - Ralph Santos-Oliveira
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Rio de Janeiro 21941906, Brazil
| |
Collapse
|
13
|
Portela FSO, Rossetti CA, de Souza TF, Magnani AS, da Silva MFA, Portugal MFC, Teivelis MP, Wolosker N, Mendes CDA. Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil. EINSTEIN-SAO PAULO 2024; 22:eAO0676. [PMID: 38808797 PMCID: PMC11155721 DOI: 10.31744/einstein_journal/2024ao0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications. METHODS In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure. RESULTS Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments. CONCLUSION The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment.
Collapse
Affiliation(s)
| | - Carlos Augusto Rossetti
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Thulio Fernandes de Souza
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Arthur Souza Magnani
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Cynthia de Almeida Mendes
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| |
Collapse
|
14
|
Al Asfoor D, Tabche C, Al-Zadjali M, Mataria A, Saikat S, Rawaf S. Concept analysis of health system resilience. Health Res Policy Syst 2024; 22:43. [PMID: 38576011 PMCID: PMC10996206 DOI: 10.1186/s12961-024-01114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 01/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here, we review the concept of resilience, identifying its definitions, attributes, antecedents and consequences, and present the findings of a concept analysis of health system resilience. METHODS We follow Schwarz-Barcott and Kim's hybrid model, which consists of three phases: theoretical, fieldwork and final analysis. We identified the concept definitions, attributes, antecedents and consequences of health system resilience and constructed an evidence-informed framework on the basis of the findings of this review. We searched PubMed, PsycINFO, CINAHL Complete, EBSCOhost-Academic Search and Premier databases and downloaded identified titles and abstracts on Covidence. We screened 3357 titles and removed duplicate and ineligible records; two reviewers then screened each title, and disagreements were resolved by discussion with the third reviewer. From the 130 eligible manuscripts, we identified the definitions, attributes, antecedents and consequences using a pre-defined data extraction form. RESULTS Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking and finally, diversification of staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health and maintenance of health services that support universal health coverage (UHC) throughout crises. CONCLUSION A resilient health system maintains quality healthcare through times of crisis. During the coronavirus disease 2019 (COVID-19) epidemic, several seemingly robust health systems were strained under the increased demand, and services were disrupted. As such, elements of resilience should be integrated into the functions of a health system to ensure standardized and consistent service quality and delivery. We offer a systematic, evidence-informed method for identifying the attributes of health system resilience, intending to eventually be used to develop a measuring tool to evaluate a country's health system resilience performance.
Collapse
Affiliation(s)
| | - Celine Tabche
- WHOCC Imperial College London, London, United Kingdom
| | | | | | | | - Salman Rawaf
- WHOCC Imperial College London, London, United Kingdom
| |
Collapse
|
15
|
Malta DC, Gomes CS, Felisbino-Mendes MS, Veloso GA, Machado IE, Cardoso LDO, Azeredo RT, Jaime PC, Vasconcelos LLCD, Naghavi M, Ribeiro ALP. Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, analysis of the Global Burden of Disease, 1990 to 2019. Public Health 2024; 229:176-184. [PMID: 38452562 DOI: 10.1016/j.puhe.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The objective of this study was to analyse the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019. STUDY DESIGN This is an epidemiological time-series study. METHODS This study analysed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardised mortality rate, and disability-adjusted life years (DALYs). This study also analysed the correlation between the percentage variation of mortality rates and SDI. RESULTS A decrease in the number of deaths (-75 %), mortality rate (-75.1 %), and DALYS (-72 %) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6 %); however, the mortality rate (-9.7) and DALYs (-6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI. CONCLUSION Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality.
Collapse
Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno-Infatil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - C S Gomes
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - M S Felisbino-Mendes
- Departamento de Enfermagem Materno-Infatil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - G A Veloso
- Universidade Federal Fluminense, Instituto de Matemática e Estatística, Departamento de Estatística, Brazil.
| | - I E Machado
- Programa de Pós-graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.
| | - L de O Cardoso
- Secretaria de vigilância em saúde e ambiente, Ministério da Saúde, Brasilia/DF, Brazil.
| | - R T Azeredo
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - P C Jaime
- Departamento de Nutrição, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | - M Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, United States
| | - A L P Ribeiro
- Departamento de Clinica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| |
Collapse
|
16
|
Qin A, Qin W, Hu F, Wang M, Yang H, Li L, Chen C, Bao B, Xin T, Xu L. Does unequal economic development contribute to the inequitable distribution of healthcare resources? Evidence from China spanning 2001-2020. Global Health 2024; 20:20. [PMID: 38443966 PMCID: PMC10913684 DOI: 10.1186/s12992-024-01025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND There is a dearth of research combining geographical big data on medical resource allocation and growth with various statistical data. Given the recent achievements of China in economic development and healthcare, this study takes China as an example to investigate the dynamic geographical distribution patterns of medical resources, utilizing data on healthcare resources from 290 cities in China, as well as economic and population-related data. The study aims to examine the correlation between economic growth and spatial distribution of medical resources, with the ultimate goal of providing evidence for promoting global health equity. METHODS The data used in this study was sourced from the China City Statistical Yearbook from 2001 to 2020. Two indicators were employed to measure medical resources: the number of doctors per million population and the number of hospital and clinic beds per million population. We employed dynamic convergence model and fixed-effects model to examine the correlation between economic growth and the spatial distribution of medical resources. Ordinary least squares (OLS) were used to estimate the β values of the samples. RESULTS The average GDP for all city samples across all years was 36,019.31 ± 32,029.36, with an average of 2016.31 ± 1104.16 doctors per million people, and an average of 5986.2 ± 6801.67 hospital beds per million people. In the eastern cities, the average GDP for all city samples was 47,672.71 ± 37,850.77, with an average of 2264.58 ± 1288.89 doctors per million people, and an average of 3998.92 ± 1896.49 hospital beds per million people. Cities with initially low medical resources experienced faster growth (all β < 0, P < 0.001). The long-term convergence rate of the geographic distribution of medical resources in China was higher than the short-term convergence rate (|βi + 1| > |βi|, i = 1, 2, 3, …, 9, all β < 0, P < 0.001), and the convergence speed of doctor density exceeded that of bed density (bed: |βi| >doc: |βi|, i = 3, 4, 5, …, 10, P < 0.001). Economic growth significantly affected the convergence speed of medical resources, and this effect was nonlinear (doc: βi < 0, i = 1, 2, 3, …, 9, P < 0.05; bed: βi < 0, i = 1, 2, 3, …, 10, P < 0.01). The heterogeneity between provinces had a notable impact on the convergence of medical resources. CONCLUSIONS The experiences of China have provided significant insights for nations worldwide. Governments and institutions in all countries worldwide, should actively undertake measures to actively reduce health inequalities. This includes enhancing healthcare standards in impoverished regions, addressing issues of unequal distribution, and emphasizing the examination of social determinants of health within the domain of public health research.
Collapse
Affiliation(s)
- Afei Qin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Wenzhe Qin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Fangfang Hu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Meiqi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
| | - Haifeng Yang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Lei Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Chiqi Chen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Binghong Bao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Tianjiao Xin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Lingzhong Xu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China.
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan, 250012, Shandong, China.
| |
Collapse
|
17
|
Fana TE, Goudge J. Managing under austerity: a qualitative study of management-union relations during attempts to cut labour costs in three South African public hospitals. J Health Organ Manag 2024; 38:89-105. [PMID: 38448233 PMCID: PMC10993010 DOI: 10.1108/jhom-11-2022-0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/28/2023] [Accepted: 10/13/2023] [Indexed: 03/08/2024]
Abstract
PURPOSE In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity. DESIGN/METHODOLOGY/APPROACH A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used. FINDINGS Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union-management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies. ORIGINALITY/VALUE Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.
Collapse
Affiliation(s)
- Thanduxolo Elford Fana
- Faculty of Health Sciences,
Centre for Health Policy, School of
Public Health, University of the
Witwatersrand, Johannesburg, South
Africa
| | - Jane Goudge
- Faculty of Health Sciences,
Centre for Health Policy, School of
Public Health, University of the
Witwatersrand, Johannesburg, South
Africa
| |
Collapse
|
18
|
Folayan A, Cheong MWL, Fatt QK, Su TT. Health insurance status, lifestyle choices and the presence of non-communicable diseases: a systematic review. J Public Health (Oxf) 2024; 46:e91-e105. [PMID: 38084086 PMCID: PMC10901270 DOI: 10.1093/pubmed/fdad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/05/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Although health insurance (HI) has effectively mitigated healthcare financial burdens, its contribution to healthy lifestyle choices and the presence of non-communicable diseases (NCDs) is not well established. We aimed to systematically review the existing evidence on the effect of HI on healthy lifestyle choices and NCDs. METHODS A systematic review was conducted across PubMed, Medline, Embase, Cochrane Library and CINAHLComplet@EBSCOhost from inception until 30 September 2022, capturing studies that reported the effect of HI on healthy lifestyle and NCDs. A narrative synthesis of the studies was done. The review concluded both longitudinal and cross-sectional studies. A critical appraisal checklist for survey-based studies and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies were used for the quality assessment. RESULT Twenty-four studies met the inclusion criteria. HI was associated with the propensity to engage in physical activities (6/11 studies), consume healthy diets (4/7 studies), not to smoke (5/11 studies) or take alcohol (5/10 studies). Six (of nine) studies showed that HI coverage was associated with a lowered prevalence of NCDs. CONCLUSION This evidence suggests that HI is beneficial. More reports showed that it propitiated a healthy lifestyle and was associated with a reduced prevalence of NCDs.
Collapse
Affiliation(s)
- Adeola Folayan
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Malaysia
| | | | - Quek Kia Fatt
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Malaysia
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Malaysia
| |
Collapse
|
19
|
da Silva EP, Saturno-Hernández PJ, de Freitas MR, da Silva Gama ZA. Motivational drivers for health professionals in a large quality improvement collaborative project in Brazil: a qualitative study. BMC Health Serv Res 2024; 24:183. [PMID: 38336769 PMCID: PMC10854114 DOI: 10.1186/s12913-024-10678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The success of collaborative quality improvement (QI) projects in healthcare depends on the context and engagement of health teams; however, the factors that modulate teams' motivation to participate in these projects are still unclear. The objective of the current study was to explore the barriers to and facilitators of motivation; the perspective was health professionals in a large project aiming to implement evidence-based infection prevention practices in intensive care units of Brazilian hospitals. METHODS This qualitative study was based on content analysis of semistructured in-depth interviews held with health professionals who participated in a collaborative QI project named "Improving patient safety on a large scale in Brazil". In accordance with the principle of saturation, we selected a final sample of 12 hospitals located throughout the five regions of Brazil that have implemented QI; then, we conducted videoconference interviews with 28 health professionals from those hospitals. We encoded the interview data with NVivo software, and the interrelations among the data were assessed with the COM-B model. RESULTS The key barriers identified were belief that improvement increases workload, lack of knowledge about quality improvement, resistance to change, minimal involvement of physicians, lack of supplies, lack support from senior managers and work overload. The primary driver of motivation was tangible outcomes, as evidenced by a decrease in infections. Additionally, factors such as the active participation of senior managers, teamwork, learning in practice and understanding the reason for changes played significant roles in fostering motivation. CONCLUSION The motivation of health professionals to participate in collaborative QI projects is driven by a variety of barriers and facilitators. The interactions between the senior manager, quality improvement teams, and healthcare professionals generate attitudes that modulate motivation. Thus, these aspects should be considered during the implementation of such projects. Future research could explore the cost-effectiveness of motivational approaches.
Collapse
Affiliation(s)
- Eliane Pereira da Silva
- Department of Clinical Medicine, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
- Graduate Program of Collective Health, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | | | - Marise Reis de Freitas
- Department of Infectious Diseases, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Zenewton André da Silva Gama
- Graduate Program of Collective Health, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| |
Collapse
|
20
|
Monteiro dos Santos D, Libonati R, Garcia BN, Geirinhas JL, Salvi BB, Lima e Silva E, Rodrigues JA, Peres LF, Russo A, Gracie R, Gurgel H, Trigo RM. Twenty-first-century demographic and social inequalities of heat-related deaths in Brazilian urban areas. PLoS One 2024; 19:e0295766. [PMID: 38265975 PMCID: PMC10807764 DOI: 10.1371/journal.pone.0295766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024] Open
Abstract
Population exposure to heat waves (HWs) is increasing worldwide due to climate change, significantly affecting society, including public health. Despite its significant vulnerabilities and limited adaptation resources to rising temperatures, South America, particularly Brazil, lacks research on the health impacts of temperature extremes, especially on the role played by socioeconomic factors in the risk of heat-related illness. Here, we present a comprehensive analysis of the effects of HWs on mortality rates in the 14 most populous urban areas, comprising approximately 35% of the country's population. Excess mortality during HWs was estimated through the observed-to-expected ratio (O/E) for total deaths during the events identified. Moreover, the interplay of intersectionality and vulnerability to heat considering demographics and socioeconomic heterogeneities, using gender, age, race, and educational level as proxies, as well as the leading causes of heat-related excess death, were assessed. A significant increase in the frequency was observed from the 1970s (0-3 HWs year-1) to the 2010s (3-11 HWs year-1), with higher tendencies in the northern, northeastern, and central-western regions. Over the 2000-2018 period, 48,075 (40,448-55,279) excessive deaths were attributed to the growing number of HWs (>20 times the number of landslides-related deaths for the same period). Nevertheless, our event-based surveillance analysis did not detect the HW-mortality nexus, reinforcing that extreme heat events are a neglected disaster in Brazil. Among the leading causes of death, diseases of the circulatory and respiratory systems and neoplasms were the most frequent. Critical regional differences were observed, which can be linked to the sharp North-South inequalities in terms of socioeconomic and health indicators, such as life expectancy. Higher heat-related excess mortality was observed for low-educational level people, blacks and browns, older adults, and females. Such findings highlight that the strengthening of primary health care combined with reducing socioeconomic, racial, and gender inequalities represents a crucial step to reducing heat-related deaths.
Collapse
Affiliation(s)
| | - Renata Libonati
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade de Lisboa, Faculdade de Ciências, Instituto Dom Luiz, Lisbon, Portugal
- Forest Research Centre, School of Agriculture, University of Lisbon, Lisbon, Portugal
| | - Beatriz N. Garcia
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - João L. Geirinhas
- Universidade de Lisboa, Faculdade de Ciências, Instituto Dom Luiz, Lisbon, Portugal
| | - Barbara Bresani Salvi
- Escola Nacional de Saúde Pública Sergio Arouca - ENSP/ Fiocruz - Programa de Pós Graduação em Saúde Pública e Meio Ambiente
| | - Eliane Lima e Silva
- Departamento de Geografia, Universidade de Brasilia, Distrito Federal, Brazil
- LMI Sentinela, International Joint Laboratory “Sentinela” (Fiocruz, UnB, IRD), Distrito Federal, Brazil
| | - Julia A. Rodrigues
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo F. Peres
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Russo
- Universidade de Lisboa, Faculdade de Ciências, Instituto Dom Luiz, Lisbon, Portugal
| | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde - ICICT/Fiocruz Rio de Janeiro, Rio de Janeiro, Brazil
| | - Helen Gurgel
- Departamento de Geografia, Universidade de Brasilia, Distrito Federal, Brazil
- LMI Sentinela, International Joint Laboratory “Sentinela” (Fiocruz, UnB, IRD), Distrito Federal, Brazil
| | - Ricardo M. Trigo
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade de Lisboa, Faculdade de Ciências, Instituto Dom Luiz, Lisbon, Portugal
| |
Collapse
|
21
|
Alberto IRI, Alberto NRI, Altinel Y, Blacker S, Binotti WW, Celi LA, Chua T, Fiske A, Griffin M, Karaca G, Mokolo N, Naawu DKN, Patscheider J, Petushkov A, Quion JM, Senteio C, Taisbak S, Tırnova İ, Tokashiki H, Velasquez A, Yaghy A, Yap K. A scientometric analysis of fairness in health AI literature. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002513. [PMID: 38241250 PMCID: PMC10798451 DOI: 10.1371/journal.pgph.0002513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/07/2023] [Indexed: 01/21/2024]
Abstract
Artificial intelligence (AI) and machine learning are central components of today's medical environment. The fairness of AI, i.e. the ability of AI to be free from bias, has repeatedly come into question. This study investigates the diversity of members of academia whose scholarship poses questions about the fairness of AI. The articles that combine the topics of fairness, artificial intelligence, and medicine were selected from Pubmed, Google Scholar, and Embase using keywords. Eligibility and data extraction from the articles were done manually and cross-checked by another author for accuracy. Articles were selected for further analysis, cleaned, and organized in Microsoft Excel; spatial diagrams were generated using Public Tableau. Additional graphs were generated using Matplotlib and Seaborn. Linear and logistic regressions were conducted using Python to measure the relationship between funding status, number of citations, and the gender demographics of the authorship team. We identified 375 eligible publications, including research and review articles concerning AI and fairness in healthcare. Analysis of the bibliographic data revealed that there is an overrepresentation of authors that are white, male, and are from high-income countries, especially in the roles of first and last author. Additionally, analysis showed that papers whose authors are based in higher-income countries were more likely to be cited more often and published in higher impact journals. These findings highlight the lack of diversity among the authors in the AI fairness community whose work gains the largest readership, potentially compromising the very impartiality that the AI fairness community is working towards.
Collapse
Affiliation(s)
| | | | - Yuksel Altinel
- Bagcilar Research and Training Hospital, General Surgery Department, University of Health Sciences, Istanbul, Turkey
| | - Sarah Blacker
- Department of Social Science, York University, Toronto, Ontario, Canada
| | - William Warr Binotti
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Leo Anthony Celi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tiffany Chua
- University of San Francisco, San Francisco, California, United States of America
| | - Amelia Fiske
- Institute for History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Molly Griffin
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Gulce Karaca
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Nkiruka Mokolo
- Meharry Medical College School of Medicine, Nashville, Tennessee, United States of America
| | - David Kojo N Naawu
- Meharry Medical College School of Medicine, Nashville, Tennessee, United States of America
| | | | - Anton Petushkov
- University of Michigan, Ann Arbor, Michigan, United States of America
| | - Justin Michael Quion
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Charles Senteio
- Department of Library and Information Science, Rutgers University School of Communication and Information, New Brunswick, New Jersey, United States of America
| | | | - İsmail Tırnova
- Department of General Surgery, Baskent University School of Medicine, Istanbul, Turkey
| | - Harumi Tokashiki
- Department of Medicine, Carney Hospital, Boston, Massachusetts, United States of America
| | - Adrian Velasquez
- Department of Medicine, Carney Hospital, Boston, Massachusetts, United States of America
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, United States of America
| | - Antonio Yaghy
- New England Eye Center, Boston, Massachusetts, United States of America
| | - Keagan Yap
- Harvard College, Cambridge, Massachusetts, United States of America
| |
Collapse
|
22
|
Nunes PDC, Bellas H, Paulino ÉT, Ramos A, Jatobá A. Maintenance of medium- and high-complexity health services in the context of high patient transition: a time series ecological study of the state of Rio de Janeiro, Brazil. CIENCIA & SAUDE COLETIVA 2024; 29:e16542022. [PMID: 38198330 DOI: 10.1590/1413-81232024291.16542022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/03/2023] [Indexed: 01/12/2024] Open
Abstract
The study addresses the historical disparities in the distribution of the medium- and high-complexity health network and the limits to budget adjustments between the municipality of Rio de Janeiro and its neighboring municipalities of the Metropolitan region 1. An ecological study was conducted with data related to the municipality of Rio de Janeiro, chosen because it has a large assistance network, while located on the borders of vulnerable and underprivileged areas, characterizing a locus that is representative of the situations faced throughout the country. A decrease in the gross values of the programmed quotas in all municipalities of Rio de Janeiro was observed from 2016 onwards. The temporal trend of the programmed quotas remained stable for all municipalities in the Metropolitan Region 1, even with significant increases in the accomplished quotas for neighboring municipalities. The resulting overload in local expenditure prevents the increase of capacity to anticipate fluctuations in demand, both known and unexpected ones, compromising the responsiveness of the health system regarding its regular operation, as well as the ability to adjust to cope with extraordinary events, essential characteristics of resilience.
Collapse
Affiliation(s)
- Paula de Castro Nunes
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho, Fundação Oswaldo Cruz. Av. Brasil 4036/10º andar, Prédio da Expansão, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| | - Hugo Bellas
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho, Fundação Oswaldo Cruz. Av. Brasil 4036/10º andar, Prédio da Expansão, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| | - Érica Tex Paulino
- Programa de Pós-Graduação em Medicina Topical, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - André Ramos
- Secretaria Municipal de Saúde do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Alessandro Jatobá
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho, Fundação Oswaldo Cruz. Av. Brasil 4036/10º andar, Prédio da Expansão, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| |
Collapse
|
23
|
Sari N, Omar M, Pasinringi SA, Zulkifli A, Sidin AI. Developing hospital resilience domains in facing disruption era in Indonesia: a qualitative study. BMC Health Serv Res 2023; 23:1395. [PMID: 38087264 PMCID: PMC10714512 DOI: 10.1186/s12913-023-10416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The studies of hospital resilience have been of increasing importance during the last decade due to disasters and pandemics. However, studies in developing the domain and indicators of hospital resilience were limited mainly on disaster response. A few studies of hospital resilience focused on how to deal with disruptions such as environmental turbulence, rapid technological changes, and changes in patient preferences. This study aims to develop domains and indicators of hospital resilience in facing the disruption era. METHODS This qualitative study focused on exploring the domains and indicators to face disruptions that have been identified in the first exploratory phase of the studies. Key informants included hospital experts from the government, medical practitioners, and academics. A total of 20 key informants were involved in semi-structured interviews which were conducted face-to-face, via telephone and Zoom. Data was analyzed using a grounded theory approach to discover domains for a resilient hospital. RESULTS The study identified a number of domains that are fundamental for a hospital to become a resilient in the face of disruption. These include readiness to face digital transformation, effective leadership, and flexibility in managing resources among others. Situation awareness and resilience ethos, implementation of marketing management, networking, and disaster anticipation are found to be equally important. These domains focused on the hospital's ability to deal with specific shocks from different perspectives as the result of changes from disruptions which are inevitable within the organizational business environment. CONCLUSIONS The domains identified in the study are able to respond to the limitations of the concept of hospital resilience, which is currently more focused on hospital disaster resilience. They can be used to measure hospital resilience in the context of the volatility, uncertainty, complexity, and ambiguity (VUCA), which are relevant to the context of the Indonesia hospital industry.
Collapse
Affiliation(s)
- Nurmala Sari
- Hospital Management Department, Public Health Faculty, Hasanuddin University, Makassar, Indonesia.
| | - Maye Omar
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Syahrir A Pasinringi
- Magister of Hospital Administration Study Program, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
| | - Andi Zulkifli
- Magister of Hospital Administration Study Program, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
| | - Andi Indahwaty Sidin
- Magister of Hospital Administration Study Program, Public Health Faculty, Hasanuddin University, Makassar, Indonesia
| |
Collapse
|
24
|
Koester SW, Bertani R, Batista S, Bishay AE, Perret C, Dewan MC, Paiva W, Campos WK, Figueiredo EG. Current State of Brazilian Neurosurgery: Evaluation of Burden of Care and Case Volume. World Neurosurg 2023; 180:e309-e316. [PMID: 37769838 DOI: 10.1016/j.wneu.2023.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Low- and middle-income countries (LMICs) bear a heavier burden of neurosurgical diseases than high-income countries. Brazil, a growing middle-income country, holds promise as a health care market. However, there exists a lack of information to characterize the state of neurosurgical practice and access to care in Brazil. This study aimed to characterize neurosurgical practice in Brazil and identify barriers to care. METHODS A collaborative survey was developed with Brazilian neurosurgeons and distributed by the Brazilian Society of Neurosurgery. The survey gathered demographic information, practice characteristics, case volume, referral patterns, income sources, and assessed barriers using a Likert scale. Descriptive statistics were employed for data analysis. RESULTS One-hundred and forty-nine neurosurgeons participated (response rate: 17.5%), representing various states in Brazil. Neurosurgeons practiced in more than 4 different hospital systems on average, with most consultations and procedures occurring in public hospitals. Common procedures included tumor surgeries, general neurosurgery, spine surgeries, trauma surgeries, and hydrocephalus management. Equipment shortage and systemic issues were identified as major barriers to care. CONCLUSIONS Neurosurgical practice in Brazil exhibits diverse age distribution, widespread distribution across states, and involvement in both public and private hospitals. Survey insights shed light on neurosurgical workload and neurosurgical practice characterization. Lack of equipment and inadequate postoperative resources pose significant barriers to care. The findings highlight the need for investments in equipment, critical care facilities, and improved health care system coordination to enhance access to neurosurgical care in Brazil.
Collapse
Affiliation(s)
- Stefan W Koester
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Raphael Bertani
- Department of Neurosurgery, Hospital das Clinicas Universidade de São Paulo, São Paulo, Brazil
| | - Savio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Anthony E Bishay
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Caio Perret
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wellingson Paiva
- Department of Neurosurgery, Hospital das Clinicas Universidade de São Paulo, São Paulo, Brazil
| | | | - Eberval G Figueiredo
- Department of Neurosurgery, Hospital das Clinicas Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
25
|
Mattar A, Hegg R, Tayar DO, Rocha M, Terzian ALB, Oliveira RW, Julian GS, Gebrim LH. Prognostic Factors and Survival Outcomes of Patients With Early HER2+ Breast Cancer Treated With Trastuzumab in a Brazilian Public Reference Center: A Real-World Study. Clin Breast Cancer 2023; 23:864-875.e7. [PMID: 37802752 DOI: 10.1016/j.clbc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Trastuzumab was introduced into the Brazilian public health care service for early breast cancer (BC) in 2012. This study describes the survival outcomes and prognostic factors related to early HER2+ BC treatment in a Brazilian reference cancer center. PATIENTS AND METHODS This were a retrospective, single-center, observational study of early HER2+ BC patients treated with trastuzumab in the (neo)adjuvant setting between 2012 and 2018 at Hospital Pérola Byington. Demographic, clinical, disease-free survival (DFS) and overall survival (OS) data were evaluated. Multivariate analysis was performed to assess independent prognostic factors. RESULTS One hundred seventy-six and 353 patients treated in the neoadjuvant and adjuvant setting were included, respectively. The 3- and 5-year OS rates were 79% and 56% for the neoadjuvant group and 97% and 92% for the adjuvant group, respectively. Node positivity at diagnosis predicted poor OS for both groups. In the neoadjuvant group, stage III disease at diagnosis, delayed surgery, and lack of pathological complete response (pCR) predicted poor prognosis. The 3- and 5-year DFS rates were 67% and 46% in the neoadjuvant group and 91% and 86% in the adjuvant group, respectively. Histological grade 2, stage III disease at diagnosis, and lack of pCR predicted poor DFS for the neoadjuvant group. For the adjuvant group, node positivity at diagnosis predicted poor DFS. CONCLUSION Our results reveal multiple clinical parameters affecting survival outcomes according to the treatment setting. Patients treated with neoadjuvant therapy have a poor prognosis since they present with more advanced disease, indicating the importance of early diagnosis and optimized treatment.
Collapse
Affiliation(s)
- André Mattar
- Hospital Pérola Byington, São Paulo, SP, Brazil; Hospital da Mulher, São Paulo, SP, Brazil; Oncoclínicas São Paulo, São Paulo, SP, Brazil.
| | | | - Daiane O Tayar
- Roche Brazil, Rua Dr Rubens Gomes Bueno, São Paulo, SP, Brazil
| | - Mauricio Rocha
- Roche Brazil, Rua Dr Rubens Gomes Bueno, São Paulo, SP, Brazil
| | | | | | | | | |
Collapse
|
26
|
Ortega F, Pele A. Brazil's unified health system: 35 years and future challenges. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100631. [PMID: 38033357 PMCID: PMC10682286 DOI: 10.1016/j.lana.2023.100631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Francisco Ortega
- Catalan Institution for Research and Advanced Studies, Barcelona, Spain
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Antonio Pele
- Pontifical Catholic University of Rio de Janeiro, Law School, Rio de Janeiro, Brazil
- Marie Curie Researcher, École des Hautes Études en Sciences Sociales (EHESS) / Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux (IRIS), Paris, France
| |
Collapse
|
27
|
Copeland S, Hinrichs-Krapels S, Fecondo F, Santizo ER, Bal R, Comes T. A resilience view on health system resilience: a scoping review of empirical studies and reviews. BMC Health Serv Res 2023; 23:1297. [PMID: 38001460 PMCID: PMC10675888 DOI: 10.1186/s12913-023-10022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prompted by recent shocks and stresses to health systems globally, various studies have emerged on health system resilience. Our aim is to describe how health system resilience is operationalised within empirical studies and previous reviews. We compare these to the core conceptualisations and characteristics of resilience in a broader set of domains (specifically, engineering, socio-ecological, organisational and community resilience concepts), and trace the different schools, concepts and applications of resilience across the health literature. METHODS We searched the Pubmed database for concepts related to 'resilience' and 'health systems'. Two separate analyses were conducted for included studies: a total of n = 87 empirical studies on health system resilience were characterised according to part of health systems covered, type of threat, resilience phase, resilience paradigm, and approaches to building resilience; and a total of n = 30 reviews received full-text review and characterised according to type of review, resilience concepts identified in the review, and theoretical framework or underlying resilience conceptualisation. RESULTS The intersection of health and resilience clearly has gained importance in the academic discourse with most papers published since 2018 in a variety of journals and in response to external threats, or in reference to more frequent hospital crisis management. Most studies focus on either resilience of health systems generally (and thereby responding to an external shock or stress), or on resilience within hospitals (and thereby to regular shocks and operations). Less attention has been given to community-based and primary care, whether formal or informal. While most publications do not make the research paradigm explicit, 'resilience engineering' is the most prominent one, followed by 'community resilience' and 'organisational resilience'. The social-ecological systems roots of resilience find the least application, confirming our findings of the limited application of the concept of transformation in the health resilience literature. CONCLUSIONS Our review shows that the field is fragmented, especially in the use of resilience paradigms and approaches from non-health resilience domains, and the health system settings in which these are used. This fragmentation and siloed approach can be problematic given the connections within and between the complex and adaptive health systems, ranging from community actors to local, regional, or national public health organisations to secondary care. Without a comprehensive definition and framework that captures these interdependencies, operationalising, measuring and improving resilience remains challenging.
Collapse
Affiliation(s)
- Samantha Copeland
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Saba Hinrichs-Krapels
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands.
| | - Federica Fecondo
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Esteban Ralon Santizo
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burg. Oudlaan 50, Rotterdam, The Netherlands
| | - Tina Comes
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| |
Collapse
|
28
|
Portela MC, Martins M, Lima SML, de Andrade CLT, de Aguiar Pereira CC. COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data. Int J Equity Health 2023; 22:238. [PMID: 37978531 PMCID: PMC10655483 DOI: 10.1186/s12939-023-02037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS. METHODS This cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS' Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it. RESULTS About 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021. CONCLUSIONS COVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country.
Collapse
Affiliation(s)
- Margareth Crisóstomo Portela
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | - Mônica Martins
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sheyla Maria Lemos Lima
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Claudia Cristina de Aguiar Pereira
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
29
|
Cerqueira-Silva T, Marcilio I, de Araújo Oliveira V, Tavares Veras Florentino P, Penna GO, Pereira Ramos PI, Boaventura VS, Barral-Netto M. Early detection of respiratory disease outbreaks through primary healthcare data. J Glob Health 2023; 13:04124. [PMID: 37917874 PMCID: PMC10623377 DOI: 10.7189/jogh.13.04124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background The emergence of coronavirus disease 2019 (COVID-19) in 2020 highlighted the relevance of surveillance systems in detecting early signs of potential outbreaks, thus enabling public health authorities to act before the pathogen becomes widespread. Syndromic digital surveillance through web applications has played a crucial role in monitoring the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. However, this approach requires expensive infrastructure, which is not available in developing countries. Pre-existing sources of information, such as encounters in primary health care (PHC), can provide valuable data for a syndromic surveillance system. Here we evaluated the utility of PHC data to identify early warning signals of the first COVID-19 outbreak in Bahia-Brazil in 2020. Methods We compared the weekly counts of PHC encounters due to respiratory complaints and the number of COVID-19 cases in 2020 in Bahia State - Brazil. We used the data from December 2016 to December 2019 to predict the expected number of encounters in 2020. We analysed data aggregated by geographic regions (n = 34) and included those where historical PHC data was available for at least 70% of the population. Results Twenty-one out of 34 regions met the inclusion criteria. We observed that notification of COVID-19 cases was preceded by at least two weeks with an excess of encounters of respiratory complaints in 18/21 (86%) of the regions analysed and four weeks or more in 10/21 (48%) regions. Conclusions Digital syndromic surveillance systems based on already established PHC databases may add time to preparedness and response to emerging epidemics.
Collapse
Affiliation(s)
- Thiago Cerqueira-Silva
- Laboratório de Medicina e Saúde Pública de Precisão – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Izabel Marcilio
- Centro de Integração de Dados e Conhecimentos para Saúde – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | | | | | - Gerson O Penna
- Centro de Medicina Tropical – Universidade de Brasília, Escola Fiocruz de Governo, Brasília, Brazil
| | - Pablo I Pereira Ramos
- Centro de Integração de Dados e Conhecimentos para Saúde – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Viviane S Boaventura
- Laboratório de Medicina e Saúde Pública de Precisão – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Manoel Barral-Netto
- Laboratório de Medicina e Saúde Pública de Precisão – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| |
Collapse
|
30
|
Rent S, Rocha T, Silva L, Souza JVP, Guinsburg R, Filho AC, Staton C, Vissoci JRN. The Impact of Time, Region, and Income Level on Stillbirth and Neonatal Mortality in Brazil, 2000-2019. J Pediatr 2023; 262:113613. [PMID: 37459908 DOI: 10.1016/j.jpeds.2023.113613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To describe trends in perinatal loss across Brazil, a country that transitioned in 2006 from a lower-middle income to an upper-middle income country, from 2000 to 2019 and analyze the effect of municipal wealth status on perinatal outcomes. STUDY DESIGN We conducted an ecological cohort study, based on publicly available data from the Brazilian Ministry of Health's data repository on live births and deaths. The Atlas of Human Development in Brazil was used to associate each region with a World Bank income classification. RESULTS The national neonatal mortality rate (NMR) for infants born at ≥22 weeks of gestation decreased from 21.2 in 2000 to 12.4 in 2019. The stillbirth rate (SBR) decreased from 12.0 to 10.2 during this period. For infants born between 22 and 27 weeks of gestation, worsening perinatal outcomes were seen after 2012. In 2019, the median rates of neonatal mortality and stillbirth were both 4 points higher in lower- to middle-income municipalities compared with high-income municipalities (P < .01). CONCLUSION Brazil has made significant progress in neonatal mortality and stillbirth from 2000 to 2019, yet inequity in perinatal outcomes remains and is correlated with municipal economic status. Nationally, ongoing improvement is needed for infants <28 weeks of gestation, and closer exploration is needed into why there are increasing rates of negative perinatal outcomes among infants born at 22-27 weeks of gestation after 2012.
Collapse
Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Global Health Institute, Durham, NC.
| | - Thiago Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC; Global Emergency Medicine Innovation and Implementation Center, Duke University, Durham, NC
| | - Lincoln Silva
- Global Emergency Medicine Innovation and Implementation Center, Duke University, Durham, NC
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Catherine Staton
- Duke Global Health Institute, Durham, NC; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, NC; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
| |
Collapse
|
31
|
Freire NP, Cunha ICKO, Ximenes Neto FRG, Vargas FL, Santiago BKDA, Lourenção LG. Impacts of the infodemic on COVID-19 for Brazilian health professionals. CIENCIA & SAUDE COLETIVA 2023; 28:3045-3056. [PMID: 37878945 DOI: 10.1590/1413-812320232810.13902022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/17/2023] [Indexed: 10/27/2023] Open
Abstract
This article aims to analyze the effects of the COVID-19 infodemic from the perspective of Brazilian health workers regarding the patients, measure the impacts of fake news on health professionals, and verify the perception of health multidisciplinary teams regarding the authorities' stance. This cross-sectional study is nested in the research "Health Professionals' Working Conditions in the Brazilian Context of COVID-19". The nationwide non-probability sampling included 15,132 professionals who worked in the COVID-19 frontline in health institutions of 2,200 Brazilian municipalities. Approximately 91% of respondents believed that fake news is an obstacle in fighting the SARS-CoV-2 virus; 76.1% declared they had seen patients who expressed faith in fake news about COVID-19; 29.3% agreed that the health authorities' stance about COVID-19 was consistent and enlightening, and 62.6% disagreed about this. The respondents believe that the COVID-19 infodemic confused patients, impaired adherence to PHC measures, and stirred people's negative behavior vis-à-vis the pandemic. The lack of clarity of the authorities' stance influenced the COVID-19 infodemic process.
Collapse
Affiliation(s)
- Neyson Pinheiro Freire
- Grupo de Estudos e Pesquisa em Administração em Saúde e Gerenciamento de Enfermagem, Escola Paulista de Enfermagem, Universidade Federal de São Paulo. Rua Napoleão de Barros, 754 - Vila Clementino. 04024-002. São Paulo - SP Brasil.
| | - Isabel Cristina Kowal Olm Cunha
- Grupo de Estudos e Pesquisa em Administração em Saúde e Gerenciamento de Enfermagem, Escola Paulista de Enfermagem, Universidade Federal de São Paulo. Rua Napoleão de Barros, 754 - Vila Clementino. 04024-002. São Paulo - SP Brasil.
| | - Francisco Rosemiro Guimarães Ximenes Neto
- Grupo de Estudos e Pesquisa em Administração em Saúde e Gerenciamento de Enfermagem, Escola Paulista de Enfermagem, Universidade Federal de São Paulo. Rua Napoleão de Barros, 754 - Vila Clementino. 04024-002. São Paulo - SP Brasil.
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
- Universidade Estadual Vale do Acaraú. Sobral CE Brasil
| | - Filipe Leonel Vargas
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | | |
Collapse
|
32
|
Bacchus LJ, d'Oliveira AFPL, Pereira S, Schraiber LB, Aguiar JMD, Graglia CGV, Bonin RG, Feder G, Colombini M. An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation. BMC PRIMARY CARE 2023; 24:198. [PMID: 37749549 PMCID: PMC10519067 DOI: 10.1186/s12875-023-02150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 09/01/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Health systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA-Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil. METHODS The study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN). RESULTS HERA was feasible and acceptable to women and PHC providers, increased providers' readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women's disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Núcleo de Prevenção da Violência (Violence Prevention Nucleus-NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW. CONCLUSION Training should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal.
Collapse
Affiliation(s)
- Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Ana Flávia Pires Lucas d'Oliveira
- Preventive Medicine Department, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 Cerqueira César, 01246 903, São Paulo, Brasil.
| | - Stephanie Pereira
- Preventive Medicine Department, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 Cerqueira César, 01246 903, São Paulo, Brasil
| | - Lilia Blima Schraiber
- Preventive Medicine Department, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 Cerqueira César, 01246 903, São Paulo, Brasil
| | - Janaina Marques de Aguiar
- Preventive Medicine Department, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 Cerqueira César, 01246 903, São Paulo, Brasil
| | - Cecilia Guida Vieira Graglia
- Preventive Medicine Department, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 Cerqueira César, 01246 903, São Paulo, Brasil
| | - Renata Granusso Bonin
- Preventive Medicine Department, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 Cerqueira César, 01246 903, São Paulo, Brasil
| | - Gene Feder
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Manuela Colombini
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15-17 Tavistock Place, London, WC1H 9SH, UK
| |
Collapse
|
33
|
Soares BMD, Imoto AM, Ribeiro AJT, Simeoni LA, de Almeida KJQ, Bezerra LB, Braverman MS, Fernandes SES, Costa AM, Amorim FF. Evaluation of Functional and Joint Health and Associated Factors in Adults With Hemophilia From a Developing Country With Government-Backed Efforts to Improve Hemophilia Care. Perm J 2023; 27:68-78. [PMID: 37417806 PMCID: PMC10502392 DOI: 10.7812/tpp/23.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Introduction Hemophilic arthropathy affects people with hemophilia (PwH) and causes joint dysfunction and disability. Brazil has a unique situation and implemented policies to improve health care for PwH. The aim of this study was to evaluate the Functional Independence Score in Hemophilia (FISH), Hemophilia Joint Health Score (HJHS), and associated factors among adult PwH attending a Hemophilia Comprehensive Care Center in Brazil. Methods A post hoc analysis was conducted, including 31 patients who had submitted to a physical evaluation during a previously published cross-sectional study performed from June 2015 to May 2016 at the Brasília Blood Center Foundation, Brazil. Results The mean age was 30.8±9.4 years, and 80.6% had severe hemophilia. FISH was 27.0±3.8, and HJHS 18.0±10.8. The ankle was the most often affected joint (25/31, 80.6%). There were significant correlations between FISH and HJHS scores and the Hemophilia Quality of Life Questionnaire for Adults. Patients with severe hemophilia (P = 0.029) and PwH aged ≥ 30 years (P = 0.049) had lower FISH scores. Monthly household income > 2 Brazilian minimum wages was independently associated with improved HJHS (P = 0.033). The factors simultaneously associated with better HJHS and FISH were age < 30 years (P = 0.021) and monthly household income < 2 minimum wages (P = 0.013). Conclusion FISH and HJHS showed favorable scores despite being performed in a country with unfavorable socioeconomic conditions. In addition to hemophilia severity and age, monthly household income was independently associated with functional and articular state of PwH. The results highlight the importance of the free provision of coagulation factors in Brazil.
Collapse
Affiliation(s)
- Beatriz Mac Dowell Soares
- School of Medicine, Higher Education School of Health Sciences, Brasília, Federal District, Brazil
- Graduate Program in Health Sciences, University of Brasilia, Brasília, Federal District, Brazil
| | - Aline Mizusaki Imoto
- School of Medicine, Higher Education School of Health Sciences, Brasília, Federal District, Brazil
- Brasília Hemocentro Foundation, Federal District, Brazil
| | - Alexandre Jorge Teixeira Ribeiro
- School of Medicine, Higher Education School of Health Sciences, Brasília, Federal District, Brazil
- Brasília Hemocentro Foundation, Federal District, Brazil
| | - Luiz Alberto Simeoni
- Graduate Program in Health Sciences, University of Brasilia, Brasília, Federal District, Brazil
| | | | - Lucas Barbosa Bezerra
- School of Medicine, Higher Education School of Health Sciences, Brasília, Federal District, Brazil
| | | | | | - Ana Maria Costa
- School of Medicine, Higher Education School of Health Sciences, Brasília, Federal District, Brazil
| | - Fábio Ferreira Amorim
- School of Medicine, Higher Education School of Health Sciences, Brasília, Federal District, Brazil
- Graduate Program in Health Sciences, University of Brasilia, Brasília, Federal District, Brazil
| |
Collapse
|
34
|
Homauni A, Markazi-Moghaddam N, Mosadeghkhah A, Noori M, Abbasiyan K, Jame SZB. Budgeting in Healthcare Systems and Organizations: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1889-1901. [PMID: 38033850 PMCID: PMC10682572 DOI: 10.18502/ijph.v52i9.13571] [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: 12/24/2022] [Accepted: 03/16/2023] [Indexed: 12/02/2023]
Abstract
Background Budgeting is the process resource allocation to produce the best output according to the revenue levels involved. Among the constraints that healthcare organizations, including hospitals, both in the public and private sectors, grapple with is budgetary constraints. Therefore, cost control and resource management should be considered in healthcare organizations under such circumstances. Methods We aimed to identify methods of budgeting in healthcare systems and organizations as a systematic review. To extract and analyze the data, a form was designed by the researcher to define budgeting methods proposed in the literature and to identify their strengths, weaknesses, and dimensions. The search was conducted in Google Scholar, Web of science, Pub med and Scopus databases covering the period 1990-2022. Results Overall, 33 articles were included in the study for extraction and final analysis. The study results were reported in four main themes: healthcare system budgeting, capital budgeting, global budgeting, and performance-based budgeting. Conclusion Each budgeting approach has its own pros and cons and requires meeting certain requirements. These approaches are selected and implemented depending on each country's infrastructure and conditions as well as its organizations. These infrastructures need to be thoroughly examined before implementing any budgeting method, and then a budgeting method should be selected accordingly.
Collapse
Affiliation(s)
- Abbas Homauni
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Nader Markazi-Moghaddam
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Mosadeghkhah
- Department of Endocrinology, Aja University of Medical Science, Tehran, Iran
| | - Majid Noori
- Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Kourosh Abbasiyan
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| |
Collapse
|
35
|
Barufaldi LA, de Albuquerque RDCR, do Nascimento A, Martins LFL, Zimmermann IR, de Souza MC. Cost-Effectiveness Analysis of Monoclonal Antibodies Associated With Chemotherapy in First-Line Treatment of Metastatic Colorectal Cancer. Value Health Reg Issues 2023; 37:33-40. [PMID: 37207532 DOI: 10.1016/j.vhri.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of anti-epidermal growth factor receptor (cetuximab and panitumumab) or anti-vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy (CT) (fluorouracil and leucovorin with irinotecan) as a first-line treatment for unresectable metastatic colorectal cancer. METHODS A partitioned survival analysis model was adopted to simulate direct health costs and benefits comparing therapeutic options in a 10 years' time horizon. Model data were extracted from the literature and costs were obtained from Brazilian official government databases. The analysis considered the perspective of the Brazilian Public Health System; costs were measured in local currency (BRL) and benefits in quality-adjusted life-years (QALY). A 5% discount rate was applied to costs and benefits. Alternative willingness-to-pay scenarios, varying from 3 to 5 times the cost-effectiveness threshold established in Brazil, were estimated. The results were presented incremental cost-effectiveness ratio (ICER), and both deterministic and probabilistic sensitivity analyses were performed. RESULTS The most cost-effective choice would be the association of CT with panitumumab, with an ICER of $58 330.15/QALY compared with isolated CT. The second-best option was CT with bevacizumab and panitumumab, with an ICER of $71 195.40/QALY compared with panitumumab alone. Although having higher costs, the second-best option was the most effective. Both strategies were cost-effective in part of the Monte Carlo iterations, considering the 3× threshold. CONCLUSIONS The therapeutic option CT + panitumumab + bevacizumab represents the most significant effectiveness gain in our study. It is the second-lowest cost-effectiveness, and this option includes monoclonal antibodies association for patients with and without KRAS mutation.
Collapse
Affiliation(s)
- Laura A Barufaldi
- Health Technology Assessment Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil.
| | - Rita de C R de Albuquerque
- Health Technology Assessment Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Aline do Nascimento
- Health Technology Assessment Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Luís Felipe L Martins
- Division of Surveillance and Situation Analysis, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Ivan R Zimmermann
- Faculty of Health Sciences, Department of Public Health, University of Brasilia, Brazil
| | - Mirian C de Souza
- Division of Populational Research, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
36
|
Wandark Filho I, Ferraz Segundo ZE, Cordeiro Fraga AF, Carnielli Tebet ML, Ribas Izidro Gomes E, Abrantes da Fonte EJ. The Level of Knowledge and Attitudes Toward Dementia Among Senior Medical Students in Recife, Brazil. Cureus 2023; 15:e45294. [PMID: 37846248 PMCID: PMC10576895 DOI: 10.7759/cureus.45294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Aging is no longer a phenomenon for society; it has become a reality in all countries, leading to a notable increase in the prevalence of dementia, a common condition among the elderly population. This situation highlights the importance of adequately preparing future healthcare professionals with the necessary knowledge and attitudes to effectively care for dementia patients. OBJECTIVE This study aims to describe the knowledge and attitudes toward dementia among fifth- and sixth-year medical students at a prestigious medical school in Recife, Brazil. MATERIALS AND METHODS A descriptive, analytical cross-sectional study was conducted in which participants answered questionnaires related to epidemiological and educational data of the involved students, the assessment of the sample's knowledge regarding dementia, and addressing attitude toward a patient with dementia. Data collection took place online, targeting fifth- and sixth-year medical students at the Faculdade Pernambucana de Saúde (FPS). RESULTS A total of 111 students participated in the study, with a majority of females (73.9%), most of them in the fifth year of medical school (79.3%). While the majority of the students received training during their undergraduate studies on cognitive changes related to dementia (58.6%), this knowledge was mostly theoretical (64%), and only a few students took extracurricular courses on the subject (7.2%). Regarding the questionnaire evaluating students' knowledge, the overall mean was 6.69 points (on a scale of 0-14). Notably, there was no significant difference in correct answers among the tested areas of epidemiology, diagnosis, and management, with percentages of correct answers of 49.8%, 45.27%, and 52.53%, respectively. As for their attitudes toward dementia, the majority of students responded in a manner consistent with current literature and best practices for managing patients with functional dependence and cognitive changes. CONCLUSION The results indicate that despite the notable rise in dementia cases across the world, the study revealed that the participants lacked essential knowledge about dementia. However, most of them demonstrated attitudes aligned with the best practices for managing dementia patients and their families. These data may suggest the need for greater attention in the teaching-learning process on the part of the medical school, as well as the promotion of extracurricular activities on this topic, in addition to enhancing the promotion of practical activities in geriatrics.
Collapse
Affiliation(s)
- Ivo Wandark Filho
- School of Medicine, Faculdade Pernambucana de Saúde (FPS), Recife, BRA
| | | | | | | | - Eduardo Ribas Izidro Gomes
- Department of Geriatrics, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, BRA
| | | |
Collapse
|
37
|
Gomes CLR, Cleto-Yamane TL, Ruzani F, Suassuna JHR. Socioeconomic Influences on the Outcomes of Dialysis-Requiring Acute Kidney Injury in Brazil. Kidney Int Rep 2023; 8:1772-1783. [PMID: 37705894 PMCID: PMC10496017 DOI: 10.1016/j.ekir.2023.06.003] [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: 12/16/2022] [Revised: 05/03/2023] [Accepted: 06/05/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction Although research suggests that socioeconomic deprivation is linked to a higher incidence of acute kidney injury (AKI) and worse outcomes in high-income countries, there is limited knowledge about these epidemiologic factors in developing countries. In addition, the impact of medical institution administration (private versus public) on AKI outcomes remains to be determined. Methods We studied 15,186 pediatric and adult patients with dialysis-requiring AKI (AKI-D) admitted to private and public hospitals in Rio de Janeiro, Brazil. According to Brazil's demographic census, socioeconomic indicators were derived from patient zip codes. Propensity score matching analysis and a mixed-effect Cox regression were used to assess the impact of socioeconomic indicators and hospital governance on patient survival. Results Crude mortality rates were higher in private hospitals than in public hospitals (71.8% vs. 59.5%, P < 0.001) and were associated with significant differences in age (75 years, interquartile range [IQR]: 61-83 vs. 53 years, IQR: 31-66), baseline renal function (prevalence of chronic kidney disease [CKD]: 33.2% vs. 23%, P < 0.001), comorbidities (Charlson score: 2.03 ± 0.87 vs. 1.72 ± 0.75, P < 0.001), and severity of presentation (mechanical ventilation: 76.5% vs. 58% and vasopressors: 72.8% vs. 50.5%, P < 0.001). After adjustments and propensity score matching, we found no effect of different hospital administrations or socioeconomic factors on mortality. Baseline characteristics and the severity of presentation primarily influenced AKI-D prognosis. Conclusions Despite significant racial and socioeconomic differences in hospital governance, these indicators had no independent influence on mortality. Future epidemiologic studies should investigate these relevant assumptions to allow healthcare systems to manage this severe syndrome promptly.
Collapse
Affiliation(s)
- Conrado Lysandro Rodrigues Gomes
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Kidney Assistance Ltd., Rio de Janeiro, Brazil
| | - Thais Lyra Cleto-Yamane
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Frederico Ruzani
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Kidney Assistance Ltd., Rio de Janeiro, Brazil
| | - José Hermógenes Rocco Suassuna
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Kidney Assistance Ltd., Rio de Janeiro, Brazil
| |
Collapse
|
38
|
Valentim JLRS, Dias-Trindade S, Oliveira ESG, Romão MH, Fernandes F, Caitano AR, Bonfim MAA, Dias AP, Gusmão CMG, Morais PSG, Melo RS, Fontoura de Souza G, Medeiros KC, Rêgo MCFD, Ceccim RB, Valentim RAM. Evaluation of massive education in prison health: a perspective of health care for the person deprived of freedom in Brazil. Front Public Health 2023; 11:1239769. [PMID: 37680276 PMCID: PMC10480506 DOI: 10.3389/fpubh.2023.1239769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
Education, with an emphasis on prison health, has acted as a policy inducing changes in work processes, which the Brazilian National Health System (SUS) has used, and which is present in permanent health education, which promotes health care for people deprived of liberty. This article aims to present an analysis of the impacts of the strategy of massive education on prison health in Brazil from the perspective of health professionals and other actors operating in the Brazilian prison system. The data used in the study come from a questionnaire consisting of 37 questions applied nationwide between March and June 2022. Responses were collected from students who completed the course "Health Care for People Deprived of Freedom" of the learning pathway "Prison System", available in the Virtual Learning Environment of the Brazilian Health System (AVASUS). This course was offered nationally, whose adhesion (enrollment) occurred spontaneously, i.e., the course was not a mandatory. The data collected allowed us to analyze the impacts of massive education on prison health. The study also shows that the search for the course is made by several areas of knowledge, with a higher incidence in the health area, but also in other areas, such as humanities, which also work directly with the guarantee of the rights of people deprived of liberty, which are professionals in the areas of social work, psychology, and education. The analysis based on the data suggests that the massive education mediated by technology through the courses of the learning pathway, besides disseminating knowledge-following the action plan of the 2030 Agenda of the United Nations Educational, Scientific and Cultural Organization (UNESCO)-, are an effective tool to promote resilience in response to prison health and care demands of people deprived of liberty.
Collapse
Affiliation(s)
- Janaína L. R. S. Valentim
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
- Centre for Interdisciplinary Studies, University of Coimbra, Coimbra, Portugal
| | - Sara Dias-Trindade
- Centre for Interdisciplinary Studies, University of Coimbra, Coimbra, Portugal
- Department of History, Political and International Studies (DHEPI), Faculty of Arts, University of Porto, Porto, Portugal
| | - Eloiza S. G. Oliveira
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
- Institute of Human Formation With Technologies, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Manoel H. Romão
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| | - Felipe Fernandes
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| | - Alexandre R. Caitano
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| | - Marilyn A. A. Bonfim
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Aline P. Dias
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| | - Cristine M. G. Gusmão
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
- Department of Biomedical Engineering, Federal University of Pernambuco, Recife, Brazil
- International Council for Open and Distance Education, Oslo, Norway
| | - Philippi S. G. Morais
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| | - Ronaldo S. Melo
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
- Institute of Human Formation With Technologies, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Gustavo Fontoura de Souza
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| | - Kelson C. Medeiros
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| | - Maria C. F. D. Rêgo
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
- Postgraduate Program in Education, Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| | - Ricardo B. Ceccim
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
- Postgraduate Program in Education, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Ricardo A. M. Valentim
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, State of Rio Grande do Norte, Brazil
| |
Collapse
|
39
|
Albuquerque G, Fernandes F, Barbalho IMP, Barros DMS, Morais PSG, Morais AHF, Santos MM, Galvão-Lima LJ, Sales-Moioli AIL, Santos JPQ, Gil P, Henriques J, Teixeira C, Lima TS, Coutinho KD, Pinto TKB, Valentim RAM. Computational methods applied to syphilis: where are we, and where are we going? Front Public Health 2023; 11:1201725. [PMID: 37680278 PMCID: PMC10481400 DOI: 10.3389/fpubh.2023.1201725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Syphilis is an infectious disease that can be diagnosed and treated cheaply. Despite being a curable condition, the syphilis rate is increasing worldwide. In this sense, computational methods can analyze data and assist managers in formulating new public policies for preventing and controlling sexually transmitted infections (STIs). Computational techniques can integrate knowledge from experiences and, through an inference mechanism, apply conditions to a database that seeks to explain data behavior. This systematic review analyzed studies that use computational methods to establish or improve syphilis-related aspects. Our review shows the usefulness of computational tools to promote the overall understanding of syphilis, a global problem, to guide public policy and practice, to target better public health interventions such as surveillance and prevention, health service delivery, and the optimal use of diagnostic tools. The review was conducted according to PRISMA 2020 Statement and used several quality criteria to include studies. The publications chosen to compose this review were gathered from Science Direct, Web of Science, Springer, Scopus, ACM Digital Library, and PubMed databases. Then, studies published between 2015 and 2022 were selected. The review identified 1,991 studies. After applying inclusion, exclusion, and study quality assessment criteria, 26 primary studies were included in the final analysis. The results show different computational approaches, including countless Machine Learning algorithmic models, and three sub-areas of application in the context of syphilis: surveillance (61.54%), diagnosis (34.62%), and health policy evaluation (3.85%). These computational approaches are promising and capable of being tools to support syphilis control and surveillance actions.
Collapse
Affiliation(s)
- Gabriela Albuquerque
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Felipe Fernandes
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ingridy M. P. Barbalho
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Daniele M. S. Barros
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Philippi S. G. Morais
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Antônio H. F. Morais
- Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Marquiony M. Santos
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Leonardo J. Galvão-Lima
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ana Isabela L. Sales-Moioli
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - João Paulo Q. Santos
- Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Paulo Gil
- Department of Informatics Engineering, Center for Informatics and Systems of the University of Coimbra, Universidade de Coimbra, Coimbra, Portugal
| | - Jorge Henriques
- Department of Informatics Engineering, Center for Informatics and Systems of the University of Coimbra, Universidade de Coimbra, Coimbra, Portugal
| | - César Teixeira
- Department of Informatics Engineering, Center for Informatics and Systems of the University of Coimbra, Universidade de Coimbra, Coimbra, Portugal
| | - Thaisa Santos Lima
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Ministry of Health, Esplanada dos Ministérios, Brasília, Brazil
| | - Karilany D. Coutinho
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Talita K. B. Pinto
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ricardo A. M. Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| |
Collapse
|
40
|
Miranda AE, Santos PC, Coelho RA, Pascom ARP, de Lannoy LH, Ferreira ACG, Gaspar PC, Maciel EL, Barreira D, Pereira GFM. Perspectives and challenges for mother-to-child transmission of HIV, hepatitis B, and syphilis in Brazil. Front Public Health 2023; 11:1182386. [PMID: 37663837 PMCID: PMC10470844 DOI: 10.3389/fpubh.2023.1182386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Eliminating mother-to-child transmission (MTCT) of HIV, hepatitis B, and syphilis is a challenge in Brazil. Many policies have been implemented since 1986, but important gaps remain. This study aimed to describe the trends of MTCT in Brazil and evaluate the gaps and perspectives in this scenario. Methods This is a descriptive study conducted with secondary data publicly available in the information systems of the Brazilian Ministry of Health regarding data on HIV, syphilis, and hepatitis B in pregnant women and children from 2011 to 2021. Results HIV and hepatitis B have had constant rates over the years in pregnant women, with the detection rates around 2.5/1,000 live birth (LB) and 0.5/1.000LB, respectively. The same did not happen with syphilis, which has shown an increasing line in the last decade. In 2011, the detection rate of syphilis in pregnancy was 4.7/1,000LB, and in 2021 it reached 27.1/1,000LB. Regarding the trends in children, an important decrease was observed in HIV/AIDS (incidence rate from 0.18/1,000 in 2011 to 0.04/1,000 in 2021) and Hepatitis B (incidence rate from 0.9/1,000LB in 2011 to 0.5/1,000LB in 2021). For congenital syphilis, there is a continuous increase, being 3.3/1,000LB in 2011 and 9.9/1,000LB in 2021. Data from the HIV clinical monitoring showed that antiretroviral treatment coverage among pregnant women identified increased slightly between 2011 and 2021, in Brazil, from 92.3% to 94.3%. For syphilis, 82.5% of pregnant women were treated with benzathine penicillin, and 88.7% in 2011. The historical series of hepatitis B vaccination coverage in children has decreased over the years; it was 96% in 2013 and 76% in 2021. Conclusion These data show many gaps and some perspectives in the MTCT program in Brazil. The country is close to reaching MTCT HIV elimination, but there are many challenges regarding HBV and syphilis. These data can be used to organize the strategies to improve the Brazilian response to MTCT elimination of HIV, hepatitis B, and syphilis.
Collapse
Affiliation(s)
- Angelica E. Miranda
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Patricia C. Santos
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ronaldo A. Coelho
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ana Roberta P. Pascom
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Leonor Henriette de Lannoy
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ana Cristina Garcia Ferreira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Pamela Cristina Gaspar
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
- Post-graduation Program in Public Health, University of Brasilia, Brasília, Brazil
| | - Ethel Leonor Maciel
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Draurio Barreira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Gerson Fernando Mendes Pereira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| |
Collapse
|
41
|
Godin A, Pescarini JM, Raja AI, Paixao ES, Ichihara MY, Sato APS, Smeeth L, Barreto ML, Brickley EB. Municipality-level measles, mumps, and rubella (MMR) vaccine coverage and deprivation in Brazil: A nationwide ecological study, 2006 to 2020. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002027. [PMID: 37527234 PMCID: PMC10393142 DOI: 10.1371/journal.pgph.0002027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023]
Abstract
To better understand the declining rates of routine childhood vaccination in Brazil, we investigated the association between measles, mumps, and rubella (MMR) first dose vaccine coverage and deprivation at the municipality level. Using routinely collected data from 5565 Brazilian municipalities from 2006 to 2020, we investigated the association between municipality-level MMR vaccine first dose coverage (i.e., as a continuous variable and as a percentage of municipalities attaining the 95% target coverage) in relation to quintiles of municipality-level deprivation, measured by the Brazilian Deprivation Index (Índice Brasileiro de Privação, IBP), and geographic regions. From 2006 to 2020, the mean municipality-level MMR vaccine coverage declined across all deprivation quintiles and regions of Brazil, by an average of 1.2% per year. The most deprived quintile of municipalities had higher coverage on average, but also the steepest declines in coverage (i.e., an annual decline of 1.64% versus 0.61% in the least deprived quintile) in the period of 2006-2020, and the largest drop in coverage at the beginning of the COVID-19 pandemic (2019-2020). Across all deprivation quintiles and regions (except for the Southeast region), less than 50% of municipalities in Brazil met the 95% MMR coverage target in 2020.The decrease in MMR first dose vaccine coverage in Brazil is widespread, but steeper declines have been observed in the most deprived municipalities. To promote vaccine equity and prevent future outbreaks, further research is urgently needed to understand the causal mechanisms underlying the observed associations between municipality-level MMR vaccine coverage and deprivation.
Collapse
Affiliation(s)
- Audrey Godin
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julia M Pescarini
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Enny S Paixao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil
| | - Ana Paula S Sato
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
42
|
Andrade DAP, Veneziani AC, Paiva CE, dos Reis R, Filho CAF, Sanches AON, Barroso AWA, Paz ACMC, Kons GCDM, Preto DD, Budib MCB, Safro MA, Pinto GSF, Bilibio JP, Souza CDP. Discrepancies in breast cancer's oncological outcomes between public and private institutions in the southeast region of Brazil: a retrospective cohort study. Front Oncol 2023; 13:1169982. [PMID: 37441430 PMCID: PMC10333566 DOI: 10.3389/fonc.2023.1169982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Background Brazil is a middle-income country with inequalities in its healthcare system. The disparities between public and private services affect the diagnosis and treatment of patients with breast cancer. The aim of this study is to assess whether disease-free survival (DFS) and overall survival (OS) are different in public and private specialized centers. Patient and methods A retrospective cohort study with 1,545 breast cancer patients diagnosed from 2003 to 2011 at Barretos Cancer Hospital-BCH (public group, N = 1,408) and InORP Oncoclinicas (private group, N = 137) was conducted. A 1:1 propensity score matching (PSM) analysis was used to adjust the differences between the groups' characteristics (n = 137 in each group). Results The median age at diagnosis was 54.4 years. Estimated DFS rates at 1, 5, and 10 years were 96.0%, 71.8%, and 59.6%, respectively, at BCH and 97.8%, 86.9%, and 78%, respectively, at InORP (HR: 2.09; 95% confidence interval [CI], 1.41-3.10; p < 0.0001). Estimated OS rates at 1, 5, and 10 years were 98.1%, 78.5%, and 65.4%, respectively, at BCH and 99.3%, 94.5%, and 91.9%, respectively, at InORP (HR: 3.84; 95% CI, 2.16-6.82; p < 0.0001). After adjustment by PSM, DFS and OS results in 1, 3, and 5 years remained worse in the public service compared to the private service. Conclusion Patients treated in a public center have worse DFS and OS after a follow-up period of more than 5 years. These results were corroborated after carrying out the PSM.
Collapse
Affiliation(s)
- Diocésio Alves Pinto Andrade
- Clinical Oncology Department, InORP Oncoclínicas Group, Oncology Institute of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | - Carlos Eduardo Paiva
- Clinical Oncology Department, Division of Breast and Gynecologic, Barretos Cancer Hospital, Barretos, Brazil
| | - Ricardo dos Reis
- Gynecologic Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Carlos Alberto Fruet Filho
- Clinical Oncology Department, InORP Oncoclínicas Group, Oncology Institute of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | | | | | | | - Daniel D’Almeida Preto
- Clinical Oncology Department, Division of Urology, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | | | - Cristiano de Pádua Souza
- Clinical Oncology Department, Division of Breast and Gynecologic, Barretos Cancer Hospital, Barretos, Brazil
| |
Collapse
|
43
|
Rotta I, Lima T, Tonin FS. Role of community pharmacy and pharmacists in self-care in Brazil. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 10:100274. [PMID: 37181500 PMCID: PMC10173763 DOI: 10.1016/j.rcsop.2023.100274] [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: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
Global healthcare systems, including the National Health System in Brazil - one of the largest public models in the world -, continue to evolve, as well as populations' health needs, currently shaped on individuals feeling a greater desire to manage their own health. Self-care practices are part of several public policies and clinical guidelines in Brazil including the National Policy on Complementary and Integrative Practices, the National AIDS Control Program, the National Policy for Women's Health, and the Guidelines for Care of People with Chronic Diseases. There are over 100,700 community pharmacies, in the country (89.2% privately owned) employing 234,300 pharmacists, representing an important delivery point for self-care, as they are the first point of access to care for most patients. Self-medication is a common practice in Brazil (prevalence rates of self-medication ranging from 16.1% to 35.0%), especially with non-prescription/over-the-counter medicinal products (65.0%). In fact, these products represent over 25% of volume marketed of medicines, summing revenues of USD 1.9 billion per year. Studies demonstrated a positive budget impact as important savings for the National Health System due to reductions of unnecessary medical appointments and loss of working days. In addition to minor ailments management, other self-care services provided by community pharmacies that are frequently sought by Brazilian citizens (20-25% of cases) are smoking cessation and weight management (costs per service ranging from around USD 5.00-12.00). However, pharmacy services are not yet as fully integrated in Brazil to the same extent as in other countries. Barriers such as standardization of processes (from services' design, implementation, and evaluation in practice), pharmacist remuneration for the provision of services and the amount to be charged for the service are still a matter of controversy. For more rapid and sustainable advances in these practices, communication among various stakeholders, professional practice and healthcare regulations, standardization of services and financing of self-care (both publicly and privately) are urgently needed. This paper provides an overview of some self-care services provided by community pharmacies in Brazil and call attention to the ongoing challenges to move the National Health system forward.
Collapse
Affiliation(s)
- Inajara Rotta
- Department of Pharmacy, Federal University of Paraná, Curitiba, Brazil
| | - Tácio Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro, Seropedica, Brazil
| | - Fernanda S. Tonin
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Corresponding author at: H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, Parque das Nações, 1990-096 Lisbon, Portugal.
| |
Collapse
|
44
|
Vieira YP, Rocha JQS, Dutra RP, Nunes LDS, Duro SMS, Saes MDO. Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil. BMC Health Serv Res 2023; 23:542. [PMID: 37231427 DOI: 10.1186/s12913-023-09476-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Evidence on inequalities in the health services use is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the specialized health use services according to health insurance and income, following COVID-19 in individuals residing in Southern Brazil. METHODS This was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package. RESULTS 2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with specialist doctors after diagnosis of COVID-19. Individuals with health insurance were more likely to use specialized services. The probability of using specialized services was up to three times higher among the richest compared to the poorest. CONCLUSIONS There are socioeconomic inequalities in the specialized services use by individuals following COVID-19 in the far south of Brazil. It is necessary to reduce the difficulty in accessing and using specialized services and to extrapolate the logic that purchasing power transposes health needs. The strengthening of the public health system is essential to guarantee the population's right to health.
Collapse
Affiliation(s)
- Yohana Pereira Vieira
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil.
| | - Juliana Quadros Santos Rocha
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Rinelly Pazinato Dutra
- Postgraduate Programme in Public Health, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | | | | | - Mirelle de Oliveira Saes
- Postgraduate Programme in Health sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| |
Collapse
|
45
|
Roza TH, Seibel GDS, Recamonde-Mendoza M, Lotufo PA, Benseñor IM, Passos IC, Brunoni AR. Suicide risk classification with machine learning techniques in a large Brazilian community sample. Psychiatry Res 2023; 325:115258. [PMID: 37263086 DOI: 10.1016/j.psychres.2023.115258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
Even though suicide is a relatively preventable poor outcome, its prediction remains an elusive task. The main goal of this study was to develop machine learning classifiers to identify increased suicide risk in Brazilians with common mental disorders. With the use of clinical and sociodemographic baseline data (n = 4039 adult participants) from a large Brazilian community sample, we developed several models (Elastic Net, Random Forests, Naïve Bayes, and ensemble) for the classification of increased suicide risk among individuals with common mental disorders. 1120 participants (27.7%) presented increased suicide risk. The Random Forests model achieved the best AUC ROC (0.814), followed by Naive Bayes (0.798) and Elastic Net (0.773). Sensitivity varied from 0.922 (Naive Bayes) to 0.630 (Random Forests), while specificity varied from 0.792 (Random Forests) to 0.473 (Naive Bayes). The ensemble model presented an AUC ROC of 0.811, sensitivity of 0.899, and specificity of 0.510. Features representing depression symptoms were the most relevant for the classification of increased suicide risk. Some of our models presented good performance metrics in the classification of increased suicide risk in the investigated sample, which can provide the means to early preventive interventions.
Collapse
Affiliation(s)
- Thiago Henrique Roza
- Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil; Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Gabriel de Souza Seibel
- Institute of Informatics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Mariana Recamonde-Mendoza
- Institute of Informatics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Bioinformatics Core, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Paulo A Lotufo
- Department of Internal Medicine, Faculty of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Isabela M Benseñor
- Department of Internal Medicine, Faculty of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Andre Russowsky Brunoni
- Department of Psychiatry and Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| |
Collapse
|
46
|
Prado ADS, Kohls E, Baldofski S, Bianchi AS, Trindade LIP, Freitas JDL, Rummel-Kluge C. How are Brazilian university students coping with the COVID-19 pandemic? Results of an online survey on psychosocial well-being, perceived burdens, and attitudes toward social distancing and vaccination. PLoS One 2023; 18:e0284190. [PMID: 37099492 PMCID: PMC10132549 DOI: 10.1371/journal.pone.0284190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/24/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic caused significant disruption to education systems worldwide, increasing pre-existing concerns regarding university students' mental health. Brazil was among the countries most affected by COVID-19 cases and deaths and was considered a pandemic epicenter. This study aimed to investigate Brazilian university students' mental health status and perceived burdens during the COVID-19 pandemic. MATERIAL AND METHODS From November 2021 to March 2022, a cross-sectional and anonymous online survey was conducted among students of a Brazilian federal university. Mental health status (depressive symptoms, alcohol and drug consumption) and social and emotional aspects in the pandemic context (social support, perceived stress, loneliness, resilience, and self-efficacy) were assessed with standardized measures. Students' attitudes toward the COVID-19 pandemic and vaccination and perceived burdens of the pandemic were also investigated. RESULTS A total of N = 2,437 students completed the online survey. The PHQ-9 mean sum score was 12.85 (SD = 7.40), while n = 1,488 (61.10%) participants reported a sum score of 10 or more, indicating clinically relevant depressive symptoms. Further, n = 808 (33.1%) of the total sample reported suicidal thoughts. Levels of depressive symptoms, perceived stress, and loneliness were higher among undergraduate/bachelor students than doctoral students. Almost all participants (97.3%) reported being fully vaccinated against COVID-19. Multiple regression analyses showed that being single, having an income decreased during the pandemic, having a previous mental illness, having a chronic somatic condition, not finding positive aspects in the pandemic, lower self-efficacy, lower social support, lower resilience, and higher experienced loneliness were significantly associated with higher levels of depression. CONCLUSIONS The study showed high levels of depressive symptoms and suicidal ideation among Federal University of Parana students. Therefore, health care providers and universities need to recognize and address mental health issues; psychosocial policies must be enhanced to mitigate the impact of the pandemic on students' mental health and wellbeing.
Collapse
Affiliation(s)
- Aneliana da Silva Prado
- Faculty of Life Sciences, Wilhelm Wundt Institute for Psychology, Leipzig University, Leipzig, Sachsen, Germany
- Department of Psychology, Federal University of Parana, Curitiba, Parana, Brazil
- Campus Curitiba, Federal Institute of Education, Science and Technology of Parana, Curitiba, Parana, Brazil
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Sachsen, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Sachsen, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Sachsen, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Sachsen, Germany
| | | | | | | | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Sachsen, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Sachsen, Germany
| |
Collapse
|
47
|
de Oliveira Andrade R. Brazil's struggle to reconstruct healthcare post-Bolsonaro. BMJ 2023; 381:805. [PMID: 37094844 DOI: 10.1136/bmj.p805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
|
48
|
de Almeida MFB, Sanudo A, Areco KN, Balda RDCX, Costa-Nobre DT, Kawakami MD, Konstantyner T, Marinonio ASS, Miyoshi MH, Bandiera-Paiva P, Freitas RMV, Morais LCC, Teixeira MLP, Waldvogel B, Kiffer CRV, Guinsburg R. Temporal Trend, Causes, and Timing of Neonatal Mortality of Moderate and Late Preterm Infants in São Paulo State, Brazil: A Population-Based Study. CHILDREN 2023; 10:children10030536. [PMID: 36980094 PMCID: PMC10047302 DOI: 10.3390/children10030536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 320/7–366/7 weeks gestation without congenital anomalies from 2004–2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 320/7–366/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais–Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.
Collapse
Affiliation(s)
| | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Kelsy N. Areco
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Rita de Cássia X. Balda
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Daniela T. Costa-Nobre
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Mandira D. Kawakami
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Ana Sílvia S. Marinonio
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Milton H. Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Rosa M. V. Freitas
- Fundação Sistema Estadual de Análise de Dados, São Paulo 05508-000, SP, Brazil
| | - Liliam C. C. Morais
- Fundação Sistema Estadual de Análise de Dados, São Paulo 05508-000, SP, Brazil
| | | | | | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
- Correspondence:
| |
Collapse
|
49
|
Wittwer S, Paolotti D, Lichand G, Leal Neto O. Participatory surveillance for COVID-19 trends detection in Brazil: Cross-section study. JMIR Public Health Surveill 2023; 9:e44517. [PMID: 36888908 PMCID: PMC10138922 DOI: 10.2196/44517] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/25/2023] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The ongoing COVID-19 pandemic has emphasized the necessity of a well-functioning surveillance system to detect and mitigate disease outbreaks. Traditional surveillance (TS) usually relies on healthcare providers and generally suffers from reporting lags that prevent immediate response plans. Participatory surveillance (PS), an innovative digital approach whereby individuals voluntarily monitor and report on their own health status via Web-based surveys, has emerged in the past decade to complement traditional data collections approaches. OBJECTIVE This study compares novel PS data on COVID-19 infection rates across nine Brazilian cities with official TS data to examine the opportunities and challenges of using the former, and the potential advantages of combining the two approaches. METHODS The traditional surveillance data for Brazil, prospectively called the TS data, is publicly accessible on GitHub. The participatory surveillance data was collected through the Brazil Sem Corona - a Colab platform. To gather information on an individual's health status, each participant was asked to fill out a daily questionnaire into the Colab app on symptoms as well as exposure. RESULTS We find that high participation rates are key for PS data to adequately mirror TS infection rates. Where participation was high, we document a significant trend correlation between lagged PS data and TS infection rates, suggesting that the former could be used for early detection. In our data, forecasting models integrating both approaches increased accuracy up to 3% relative to a 14-day forecast horizon model based exclusively on TS data. Furthermore, we show that the PS data captures a population that significantly differs from the traditional observation. CONCLUSIONS In the traditional system, the new recorded COVID-19 cases per day are aggregated based on positive lab-confirmed tests. In contrast, the PS data shows a significant share of reports categorized as potential COVID-19 case that are not lab-confirmed. Quantifying the economic value of a PS system implementation remains hard. But scarce public funds as well as persisting constraints to the TS system motivate for a PS system, making it an important avenue for future research. The decision to set up a PS system requires careful evaluation of its expected benefits, relative to the costs of setting up platforms and incentivizing engagement to increase both coverage and consistent reporting over time. The ability to compute such economic trade-offs might be key to have PS become a more integral part of policy toolkits moving forward. These results corroborate previous studies when it comes to the benefits of an integrated and comprehensive surveillance system, but also shed lights on its limitations, and on the need for additional research to improve future implementations of PS platforms. CLINICALTRIAL
Collapse
Affiliation(s)
- Salome Wittwer
- Department of Economics, University of Zurich, Schönberggasse 1, Zurich, CH
| | - Daniela Paolotti
- Data Science for Social Impact and Sustainability, ISI Foundation, Turin, IT
| | - Guilherme Lichand
- Department of Economics, University of Zurich, Schönberggasse 1, Zurich, CH
| | - Onicio Leal Neto
- Department of Computer Science, ETH Zürich, Universitätstrasse 6, Zurich, CH
| |
Collapse
|
50
|
Paschoalotto MAC, Lazzari EA, Rocha R, Massuda A, Castro MC. Health systems resilience: is it time to revisit resilience after COVID-19? Soc Sci Med 2023; 320:115716. [PMID: 36702027 PMCID: PMC9851720 DOI: 10.1016/j.socscimed.2023.115716] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
The concept of health system resilience has been challenged by the COVID-19 pandemic. Even well-established health systems, considered resilient, collapsed during the pandemic. To revisit the concept of resilience two years and a half after the initial impact of COVID-19, we conducted a qualitative study with 26 international experts in health systems to explore their views on concepts, stages, analytical frameworks, and implementation from a comparative perspective of high- and low-and-middle-income countries (HICs and LMICs). The interview guide was informed by a comprehensive literature review, and all interviewees had practice and academic expertise in some of the largest health systems in the world. Results show that the pandemic did modify experts' views on various aspects of health system resilience, which we summarize and propose as refinements to the current understanding of health systems resilience.
Collapse
Affiliation(s)
- Marco Antonio Catussi Paschoalotto
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil.
| | - Eduardo Alves Lazzari
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Rudi Rocha
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Adriano Massuda
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Marcia C Castro
- Harvard T.H. Chan School of Public Health, Harvard University, USA
| |
Collapse
|