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Machado CV, Pereira AMM, Freitas CMD, Souza MSE, Tobar S, Oliveira SCD. The response to COVID-19 in Argentina, Brazil, and Mexico: challenges to national coordination of health policies. CAD SAUDE PUBLICA 2024; 40:e00055023. [PMID: 39082560 PMCID: PMC11290836 DOI: 10.1590/0102-311xen055023] [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: 03/23/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 08/02/2024] Open
Abstract
The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President's denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government's initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.
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Affiliation(s)
| | | | | | - Michele Souza E Souza
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Sebastián Tobar
- Centro de Relações Internacionais em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Suelen Carlos de Oliveira
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- Universidade do Grande Rio, Mesquita, Brasil
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Araújo JMD, Ferreira MAM. State capacity impact on COVID-19 mortality in Brazil. CAD SAUDE PUBLICA 2024; 40:e00171523. [PMID: 39082562 PMCID: PMC11290834 DOI: 10.1590/0102-311xen171523] [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: 09/08/2023] [Revised: 02/02/2024] [Accepted: 03/11/2024] [Indexed: 08/02/2024] Open
Abstract
This study addresses the State's capacity to combat the COVID-19 pandemic and contributes to the literature on crisis management in health care. We analyzed whether the capacity level impacted the State response to COVID-19 in Brazilian healthcare regions in 2020 using a set of statistical analysis techniques and public health impact analysis, including propensity score matching (PSM). Results revealed that a low COVID-19 mortality was associated with participation in municipal health consortia, schooling level of municipal health managers and the resources allocated by the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ). Conversely, the number of intensive care units (ICU) and life-sustaining equipment available were associated with higher mortality, as locations with a larger population concentrated operational capacity to treat the most severe cases. In conclusion, the different levels of State capacity in health regions led to different outcomes in combating the pandemic. This reinforces the importance of discussing State capacity and crisis management, since the COVID-19 confrontation in Brazil related to the level of existing resources concerning health system capacity, bureaucratic capacity and participation in consortia for sharing inputs and ensuring the provision of health services to the population.
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Tureck F, Chioro A, Tofani LFN, Lima CL, Vieira ADCS, Andreazza R. Innovations produced in Primary Health Care during the COVID-19 pandemic: an integrative literature review. CIENCIA & SAUDE COLETIVA 2024; 29:e07022023. [PMID: 38896673 DOI: 10.1590/1413-81232024296.07022023] [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: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 06/21/2024] Open
Abstract
Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to keep up its provision of regular services as well. This article identifies the main arrangements made to provide PHC care in the context of the COVID-19 pandemic. An integrative literature review of articles found in PubMed, SciELO and LILACS databases was performed using the descriptors "Primary Health Care" and "COVID-19". Findings were analyzed considering three questions: Information and Communication Technologies (ICT), Organizations of Work Processes and Non-COVID Chronic Diseases. The use of different forms of ICT to provide PHC is highlighted regarding patients with respiratory symptoms and chronic patients. Changes in team composition, service flows, physical spaces and working hours were also introduced. Although strategies aimed at monitoring chronic patients and at remote care may have helped minimize deterioration of their health, the decrease in the number of visits performed during this period could have resulted in an increased demand for PHC in post-pandemic years.
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Affiliation(s)
- Fernando Tureck
- Escola de Medicina, Universidade do Contestado. Av. Nereu Ramos 1071, Jardim do Moinho. 89300-000 Mafra SC Brasil.
| | - Arthur Chioro
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Luís Fernando Nogueira Tofani
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Carolina Loyelo Lima
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Amanda da Cruz Santos Vieira
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Rosemarie Andreazza
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
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da Costa Miranda AL, da Paixão ART, Pedroso AO, do Espírito Santo Lima L, Parente AT, Botelho EP, Polaro SHI, de Oliveira E Silva AC, Reis RK, Ferreira GRON. Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon. Sci Rep 2024; 14:8776. [PMID: 38627601 PMCID: PMC11021420 DOI: 10.1038/s41598-024-59461-1] [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: 10/10/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.
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Grants
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- 12/2021 support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program - Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- PAPQ/UFPA 2024 Pós- graduação of the Federal University of Para, Support Program for qualified production -2024 (PAPQ-2024, in Portuguese)
- support from Emergency selection IV No. 12/2021 of the Postgraduate Development Program – Impacts of the Pandemic belonging to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Affiliation(s)
| | | | - Andrey Oeiras Pedroso
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14040-092, Brasil
| | | | | | - Eliã Pinheiro Botelho
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal Do Pará, Belém, 66075-110, Brasil
| | | | | | - Renata Karina Reis
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14040-092, Brasil
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de Araújo AJ, de Siqueira Silva Í, de Figueirêdo RC, Lopes RH, Silva CRDV, de Goes Bay Junior O, Lester RT, da Costa Uchôa SA. Alignment and specifics of Brazilian health agencies in relation to the international premises for the implementation of digital health in primary health care: a rhetorical analysis. FRONTIERS IN SOCIOLOGY 2024; 9:1303295. [PMID: 38390288 PMCID: PMC10881658 DOI: 10.3389/fsoc.2024.1303295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
Digital health and sustainable development goals have had strong impacts with the COVID-19 pandemic. In Brazil, the health crisis scenario required changes in social welfare programs and policies, based on recommendations from international agencies, such as the UN and WHO. This study aims to analyze the alignment of the arguments of Brazilian and international organizations for the adoption of digital health in Primary Health Care based on the COVID-19 pandemic. This is a qualitative documentary study of the rhetorical analysis type, based on Perelman and Obrechts-Tyteca's Theory of Argumentation. The search for documents was carried out by two independent researchers, between December 2021 and June 2022, through the websites of the World Health Organization, the Pan American Health Organization, the Brazilian Ministry of Health, and the Federal Councils of Medicine and Brazilian nursing, with the terms "digital health," "telehealth," "telemedicine," "e-health," "telehealth," "telenursing," "telemedicine," and "digital health." Twenty official documents were analyzed and identified in terms of context, authorship, authenticity, reliability, nature, and key concepts. The international and Brazilian arguments emphasize the applicability of Information and Communication Technologies (ICTs) in the health field. In logical arguments, based on the structure of reality, international agencies emphasize the overlap between health needs and the conditions for the applicability of ICTs. In Brazil, however, there was a need to regulate the digital practices of health professionals. In the international discourse, in the structuring of reality, there are illustrations of the relationship between the context of the health crisis caused by COVID-19 and the concrete conditions for the applicability of digital health; while in the Brazilian discourse, the need to strengthen an environment conducive to digital health is explicit. The Brazilian alignment in relation to the international premises is evident. Yet, there is a need, socially and economically sustainable, to strengthen the inclusion of digital health in PHC policy.
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Affiliation(s)
| | | | | | | | | | | | - Richard T Lester
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Bousquat A, Giovanella L, Facchini L, Mendonça MHM, Nedel FB, Cury G, dos Santos Mota PH, Schenkman S, Chueiri PS, Alves MCGP. The Brazilian primary health care response to the COVID-19 pandemic: individual and collective approaches. Front Public Health 2023; 11:1212584. [PMID: 38145080 PMCID: PMC10748390 DOI: 10.3389/fpubh.2023.1212584] [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: 04/26/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives Brazil's PHC wide coverage has a potential role in the fight against COVID, especially in less developed regions. PHC should deal with COVID-19 treatment; health surveillance; continuity of care; and social support. This article aims to analyze PHC performance profiles during the pandemic, in these axes, comparing the five Brazilian macro-regions. Methods A cross-sectional survey study was carried out, using stratified probability sampling of PHC facilities (PHCF). A Composite Index was created, the Covid PHC Index (CPI). Factor analysis revealed that collective actions contrastingly behaved to individual actions. We verified differences in the distributions of CPI components between macro-regions and their associations with structural indicators. Results Nine hundred and seven PHCF participated in the survey. The CPI and its axes did not exceed 70, with the highest value in surveillance (70) and the lowest in social support (59). The Individual dimension scored higher in the South, whereas the Collective dimension scored higher in the Northeast region. PHCF with the highest CPI belong to municipalities with lower HDI, GDP per capita, population, number of hospitals, and ICU beds. Conclusion The observed profiles, individually and collectively-oriented, convey disputes on Brazilian health policies since 2016, and regional structural inequalities.
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Affiliation(s)
- Aylene Bousquat
- Department of Politics, Management and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Luiz Facchini
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | | | - Fulvio Borges Nedel
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Geraldo Cury
- Department of Social and Preventive Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Simone Schenkman
- Department of Politics, Management and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Patricia Sampaio Chueiri
- Faculdade Israelita de Ciências da Saúde Albert Einstein Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Maria Cecilia Goi Porto Alves
- Department of Health, Institute of Health, Government of the State of São Paulo, Institute of Health, São Paulo, Brazil
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Fernandes TF, Lima CCME, Silva PLND, Rossi-Barbosa LAR, Pinho LD, Caldeira AP. Working conditions and mental health of community health workers in the COVID-19 pandemic. CIENCIA & SAUDE COLETIVA 2023; 28:2931-2940. [PMID: 37878935 DOI: 10.1590/1413-812320232810.09802023] [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: 04/30/2022] [Accepted: 06/01/2023] [Indexed: 10/27/2023] Open
Abstract
This study examined the prevalence of anxiety and depression associated with Community Health Workers' (CHWs') working conditions in the context of the COVID-19 pandemic. This cross-sectional study was carried out in the north of Minas Gerais, Brazil by applying a questionnaire addressing sociodemographic conditions, command of technologies and working conditions during the pandemic, as well as the State-Trait Anxiety Inventory and the Patient Health Questionnare-9 (PHQ-9). Descriptive and multiple Poisson regression analyses were performed with robust variance, to a 5% level of significance (p < 0.05) for the final model. A total of 1,220 CHWs from 36 municipalities participated in the study. Prevalences were 41.8% and 31.6% for anxiety and depression, respectively, while 22.5% of the group displayed symptoms of both conditions. Being female, up to 40 years old, having more than 500 users registered for monitoring, and inadequate supply of personal protective equipment were associated with anxiety and depression among the CHWs. Prevalence of anxiety and depression was high among CHWs during the pandemic and working conditions figured prominently among the associated factors.
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Affiliation(s)
- Tatiana Fróes Fernandes
- Universidade Estadual de Montes Claros. Av. Rui Braga s/n, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | | | | | | | - Lucineia de Pinho
- Universidade Estadual de Montes Claros. Av. Rui Braga s/n, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Antônio Prates Caldeira
- Universidade Estadual de Montes Claros. Av. Rui Braga s/n, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
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Kleber Cabral Silva H, Silva Cardoso C, Di Lorenzo Oliveira C, Carrilho Menezes A, Avelar Maia Seixas AF, Machado Rocha G. Validation of a Satisfaction Scale with a Telemedicine COVID-19 Service: Satis-COVID. Telemed J E Health 2023; 29:1514-1522. [PMID: 37022788 DOI: 10.1089/tmj.2022.0473] [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: 04/07/2023] Open
Abstract
Objectives: Despite being a widespread tool, telehealth was significantly incorporated during the COVID-19 pandemic period, but it still lacks analysis methodologies, greater digital security, and satisfaction assessment instruments that are still little explored and validated. The objective is to assess user satisfaction through the validation of a satisfaction scale with a telemedicine COVID-19 service (TeleCOVID). Methods: Cross-sectional study of a cohort of confirmed COVID-19 cases evaluated and monitored by the TeleCOVID team. To study the scale's measurement qualities, a factorial analysis was performed to test the validity of the construct. Correlation between items and the global scale was assessed using Spearman's correlation coefficient, and the instrument's internal consistency was assessed using Cronbach's alpha coefficient. Results: There were 1,181 respondents evaluating the care received from the TeleCOVID project. A total of 61.6% were female, and 62.4% aged between 30 and 59 years. The correlation coefficients indicated a good correlation between the items present in the instrument. The internal consistency of the global scale was high (Cronbach's alpha = 0.903) and the item-total correlations for the scale ranged from 0.563 to 0.820. The average overall user satisfaction was 4.58, based upon a 5-point Likert scale where 5 is the highest level of satisfaction. Conclusions: The results presented here show how much telehealth can contribute to improving access, resolutibility, and quality of care to the population in general in Public Health Care. In view of the results found, it can be said that the TeleCOVID team offered excellent care and fulfilled its proposed objectives. The scale fulfills its objective of evaluating the quality of teleservice, bringing good results in terms of validity and reliability, in addition to showing high levels of user satisfaction.
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Silva MFGD, Nobre LN, Silva ED. Animated Videos Based on Food Processing for Guidance of Brazilian Adults: Validation Study. Interact J Med Res 2023; 12:e49092. [PMID: 37695656 PMCID: PMC10520766 DOI: 10.2196/49092] [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: 05/17/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Ultraprocessed foods (UPFs) contribute almost one-fifth of the calories consumed by the Brazilian population. This consumption has been favored by aspects such as the ease of acquisition and low cost of this food group. Initiatives focused on supporting and promoting healthy eating practices have been implemented. Among them, the availability of educational resources is an important strategy to maximize the effectiveness of these actions in the field of food and nutrition education (FNE). OBJECTIVE This study aims to describe the development and validation process of animated videos based on the NOVA food classification for FNE actions aimed at Brazilian adults. METHODS This methodological study was developed in the following 4 phases: planning, preproduction, production, and postproduction. In the planning phase, a literature review was con-ducted on the topic and to define the content to be covered. The design of the material was based on the cognitive theory of multimedia learning. In the preproduction phase, video scripts were developed and evaluated by 7 content specialists. In the production phase, videos were developed based on the assessed scripts and then assessed by 3 multimedia production specialists. In the postproduction phase, the videos were evaluated by 15 representatives of the target audience. All results obtained in the evaluation phases were analyzed using the content validity index (CVI). RESULTS We developed 3 animated videos covering the following themes: food processing levels, food categories according to processing levels, and UPFs and their impact on health. In the evaluation by the content specialists, the scripts of videos 1, 2, and 3 obtained CVIs at the scale level and average method equal to 0.96, 0.98, and 0.98, respectively. When the animated videos were evaluated by multimedia production specialists and representatives of the target audience, these indexes were equal to 1.0. These results attest to the videos' adequacy and quality in communicating the addressed content. CONCLUSIONS The animated videos developed and validated in this study proved to be adequate for their purpose. Thus, it is expected that they will be an important instrument for FNE actions aimed at an adult audience and for disseminating the Dietary Guidelines for the Brazilian Population.
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Affiliation(s)
| | - Luciana Neri Nobre
- Department of Nutrition, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Edson da Silva
- Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
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Zajkowski LA, Scarparo RK, Silva HGE, Celeste RK, Kopper PMP. Impact of COVID-19 pandemic on completed treatments and referrals during urgent dental visits. Braz Oral Res 2023; 37:e087. [PMID: 37672420 DOI: 10.1590/1807-3107bor-2023.vol37.0087] [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: 04/24/2023] [Indexed: 09/08/2023] Open
Abstract
This ecological study assessed the impact of the COVID-19 pandemic on completed treatments (CTs) and referrals during urgent dental visits to primary health care units in Brazil, and their associations with socioeconomic, geodemographic, and pandemic index factors in Brazilian municipalities. The difference in rates of procedures 12 months before and during the pandemic was calculated. Data were extracted at baseline from health information systems of all municipalities that provided urgent dental care (n = 5,229 out of 5,570). Multiple logistic regression predicted the factors associated with referrals and CTs. The number of dental urgencies increased from 3,987.9 to 4,272.4 per 100,000 inhabitants. The rates of referrals decreased in 44.1% of the municipalities, while 53.9% had lower rates of CTs. Municipalities with a greater number of oral health teams in the primary health care system (OR = 1.52, 95%CI:1.21-1.91) and with specialized services (OR = 1.80, 95%CI:1.50-2.16) were more likely to decrease referrals during the pandemic. Higher HDI and GDP per capita were associated with a larger decrease in referrals and smaller decrease in CTs. The calamity generated by the long pandemic period resulted in a greater demand for urgent visits. Less developed and larger cities seem to have been more likely to not complete treatments during urgent visits in primary dental care units in times of calamity. Primary dental care offices in smaller and less developed municipalities should be better equipped to provide appropriate assistance and to improve the problem-solving capacity of dental services during emergencies.
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Affiliation(s)
- Luciéli Andréia Zajkowski
- Universidade Federal do Rio Grande do Sul - UFRGS, Graduate Program in Dentistry, Porto Alegre, RS, Brazil
| | | | - Heloisa Grehs E Silva
- Universidade Federal do Rio Grande do Sul - UFRGS, Graduate Program in Dentistry, Porto Alegre, RS, Brazil
| | - Roger Keller Celeste
- Universidade Federal do Rio Grande do Sul - UFRGS, Graduate Program in Dentistry, Porto Alegre, RS, Brazil
| | - Patrícia Maria Poli Kopper
- Universidade Federal do Rio Grande do Sul - UFRGS, Graduate Program in Dentistry, Porto Alegre, RS, Brazil
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Melo RRDRB, Leal ASLG, Soares GB. Possibilities and limits of Prenatal Care for Men in a city in Northeastern Brazil. CIENCIA & SAUDE COLETIVA 2023; 28:2261-2271. [PMID: 37531534 DOI: 10.1590/1413-81232023288.06472023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/17/2023] [Indexed: 08/04/2023] Open
Abstract
Men's Prenatal Care is a strategy to expand and promote the health of these people. We evaluated how the Family Health teams (eSF) conduct this artifice as a care strategy for the male population in Recife-PE, Brazil. This evaluative, cross-sectional, qualitative study involved nurses, doctors, dentists, nursing technicians, and community health workers. We applied a semi-structured questionnaire, followed by six focus groups with the eSF with the largest number of respondents in the first stage to deepen the development of the strategy. The thematic content analysis proposed by Bardin was performed. The evaluation matrix developed identified the main strengths and difficulties in the strategy's structure, work process, and results. We observed that, while accepted as an excellent strategy, we identified a resistance that permeates from structural to cultural issues, hindering the proposal to expand access to actions and services to promote men's health, preserving the biomedical model. Care refers to the unfolding of care already provided to pregnant women but faces limiting obstacles for its sustainability.
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Affiliation(s)
- Risia Raphaely do Rêgo Barros Melo
- Programa de Pós-Graduação em Saúde da Família, Rede Nordeste de Formação em Saúde da Família (RENASF), Universidade Federal da Paraíba (UFPB). R. Pajussara 110, Condomínio Vila Jardim, Edifício Araras, apto. 1001, Tejipió. 50920-120 Recife PE Brasil.
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Prado NMDBL, Vilasbôas ALQ, Nunes CA, Aleluia ÍRS, Aquino R. Organization of primary health care and surveillance in response to COVID-19 in municipalities in the Northeast of Brazil. CIENCIA & SAUDE COLETIVA 2023; 28:1325-1339. [PMID: 37194868 DOI: 10.1590/1413-81232023285.18052022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/25/2023] [Indexed: 05/18/2023] Open
Abstract
The aim of this study was to analyze the organization and development of primary health care and surveillance, including normative frameworks and the implementation of local health actions. Qualitative descriptive multiple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were categorized into the following two dimensions: approach to the organization of the pandemic response; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department compounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of permanent arrangements that strengthen intersectoral collaboration.
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Affiliation(s)
- Nília Maria de Brito Lima Prado
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia. R. Hormindo Barros 58, Quadra 17, Lote 58, Candeias. 45.029-094 Vitória da Conquista BA Brasil.
| | | | | | | | - Rosana Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
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Mavragani A, Santana Alves PG, Costa R, Eiras PC, Nader de Araujo L, Pereira AJR, Carvalho C, Malik AM. User Experience Regarding Digital Primary Health Care in Santarém, Amazon: Evaluation of Patient Satisfaction and Doctor's Feedback. JMIR Form Res 2023; 7:e39034. [PMID: 36630164 PMCID: PMC9878359 DOI: 10.2196/39034] [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: 04/26/2022] [Revised: 10/05/2022] [Accepted: 11/05/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND With the arrival of the pandemic, telemedicine has been widely used to provide medical care and can be used to assist patients in regions far from urban centers that are difficult to access, such as riverside communities in the Brazilian Amazon region. A telemedicine project connecting São Paulo, a mega-metropolis, to Paysandú, a riverside district in the Amazon, was built to serve the local population where access to the nearest medical care is 6 hours away by speedboat. OBJECTIVE This study aims to assess the feedback from patients and doctors regarding the use of telemedicine in outpatient care at Paysandú, a riverside district in the Amazon. METHODS This is a single-center study following the guidelines "Evaluating digital health products" from Public Health England, with local adaptations for the project and the Brazilian reality, that was conducted between São Paulo and Santarém in Brazil. A survey was carried out with patients who were treated by a doctor in the city of São Paulo, about 2500 km from the local basic health unit, between September 27 to December 15, 2021. At the end of each teleconsultation, the attending physician answered an administrative survey form, and the patient answered a satisfaction survey. RESULTS A total of 111 patients completed the satisfaction survey from a total of 220 consultations carried out during the period (95% CI margin error 0.22%). According to the survey, more than 95% of patients were satisfied with the service, 87.4% (n=97) had previous experience with videoconferencing, and 76.6% (n=85) reported that their demand was fully solved. Additionally, according to the hired doctor's feedback, the average duration of the consultations was between 15 and 20 minutes. Of the 220 teleconsultations performed, 90.9% (n=200) of the demands were solved with support from the local health team, and 99.1% (n=218) of the appointments had a problem with audio or video. CONCLUSIONS This teleconsultation project between São Paulo and Paysandú showed that it is possible to offer medical care from more developed locations to communities far from urban centers, as is the case with Paysandú District. Beyond the feasibility of the infrastructure, acceptance and satisfaction among patients were high. This health care supply model has proven to be functional and should be expanded nationally or perhaps internationally to regions lacking medical assistance. Escalation of the project does not seem too difficult once infrastructure issues are solved.
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Affiliation(s)
| | | | - Raquel Costa
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paula Cruz Eiras
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Carlos Carvalho
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Maria Malik
- Fundação Getúlio Vargas Escola de Administração de Empresas de São Paulo, São Paulo, Brazil
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Santana MDP, Alves AM, Gama ICS, Parduci NV, Larroque MM, Luchesi BM. Impactos da ausência do Núcleo de Apoio à Saúde da Família no contexto da pandemia de COVID-19. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A COVID-19 trouxe um panorama desafiador e incerto para o mundo — especialmente no Brasil, em que, por conta do descrédito de medidas comprovadamente efetivas e políticas negacionistas, o cenário pandêmico tem sido devastador. Apesar disso, o País conta com muitas potencialidades para o enfrentamento da crise sanitária, notadamente por meio da Atenção Primária à Saúde. Um dos destaques seriam os Núcleos de Apoio à Saúde da Família, que poderiam atender às demandas multidimensionais da população, evidenciando-se aquelas causadas ou agravadas pela pandemia. No entanto, os Núcleos de Apoio à Saúde da Família, criados em 2008, foram intensamente prejudicados pela Portaria nº 2.979, de novembro de 2019, e da Nota Técnica nº 3/2020, da Secretaria de Atenção Primária à Saúde, que representaram, em síntese, a desestruturação da Atenção Primária à Saúde. Assim, objetivamos demonstrar a importância dos Núcleos de Apoio à Saúde da Família e os impactos de sua ausência no cenário pós-pandêmico.
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Falope O, Nyaku MK, O'Rourke C, Hermany LV, Plavchak B, Mauskopf J, Hartley L, Kruk ME. Resilience learning from the COVID-19 pandemic and its relevance for routine immunization programs. Expert Rev Vaccines 2022; 21:1621-1636. [PMID: 36063485 DOI: 10.1080/14760584.2022.2116007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The COVID-19 pandemic represents a threat that has posed a challenge to public health response and threatens immunization programs globally. Despite recommendations to continue routine immunization services, disruptions have been observed to these and mass vaccination campaigns. This may result in setbacks to immunization initiative successes and a rise in cases of vaccine-preventable diseases. AREAS COVERED We conducted a systematic literature review to identify studies globally that described how indicators of health system resilience, defined using the Resilient Health System Framework, enabled routine immunizations to continue during the COVID-19 pandemic. A systematic search was conducted in Embase, Web of Science, PsychInfo, medRxiv, bioRxiv, and the gray literature between 1 January 2020, and 12 November 2021. Information was extracted from the studies identified describing how the specific elements of resiliency (being aware, diverse, self-regulating, integrated, and adaptive) were applied to their routine immunization programs. EXPERT OPINION Our study demonstrates the use of tools that contributed to immunization program resilience during the COVID-19 pandemic in all geographic regions and for countries with different income levels. These tools may help inform preparations for other immunization programs to catch up from the COVID-19 pandemic or mitigate the impact of future threats.
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Affiliation(s)
| | | | | | | | | | | | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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16
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Cohidon C, El Hakmaoui F, Senn N. The role of general practitioners in managing the COVID-19 pandemic in a private healthcare system. Fam Pract 2022; 39:586-591. [PMID: 34537836 PMCID: PMC9295602 DOI: 10.1093/fampra/cmab112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The canton of Vaud's public health authorities, in Switzerland, invited general practitioners (GPs) to participate in managing suspected COVID-19 patients and continue caring for their non-COVID-19 patients. However, this course of action was not mandatory. The present study's objective was to describe and understand how involved GPs were in dealing with the COVID-19 pandemic's first wave. METHODS This mixed-methods study combined a retrospective quantitative survey and a qualitative explanatory investigation. All of the canton's GPs were invited to participate in the quantitative survey via an online questionnaire including sections on: specific organization regarding COVID-19 activities and suspected COVID-19 patients, activities relating to non-COVID-19 patients, consequences on the practice's professional staff, and opinions about the public health authorities' pandemic crisis management. The qualitative investigation involved interviews with 10 volunteer GPs. RESULTS The participation rate was 41%. One third of GPs chose not to reorganize their practice for the specific management of suspected COVID-19 patients. The number of weekly activities and interventions decreased by over 50% at 44% of practices, mostly due to a lack of patients. Even in an extraordinary crisis, GPs maintained their choice of whether to become involved, as their private and independent status allowed them to do. However, those who chose to be involved felt frustrated that the public health authorities did not recognize them as major health providers in the management of the pandemic. CONCLUSION This study illustrated the complexity and limitations of a primary care system based completely on private healthcare providers.
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Affiliation(s)
- Christine Cohidon
- Department of Family Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Fatima El Hakmaoui
- Department of Family Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Department of Family Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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Campolino LM, Bernardes JM, Alonso MS, Gómez-Salgado J, Ruiz-Frutos C, Domínguez-Salas S, Días A. Communication, information, and knowledge in the pandemic by COVID-19 in Brazil. Medicine (Baltimore) 2022; 101:e29559. [PMID: 35839006 PMCID: PMC11132353 DOI: 10.1097/md.0000000000029559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022] Open
Abstract
As coronavirus disease 2019 (COVID-19) is asserting itself as a health crisis, it is necessary to assess the knowledge and perceptions of people about the disease. The aim of this study is to assess the knowledge of the general population about COVID-19 and how the media influence this knowledge. This is a cross-sectional study with 5066 participants who answered an online questionnaire between April and May 2020. Data analysis was performed using descriptive statistics and logistic regression models. Over 75% have obtained a high degree of knowledge regarding signs, symptoms, and transmission, 95% stated to check the veracity of the information received, and also showed that the total knowledge about COVID-19 was associated with the level of instruction, with the perception of the quality of information disseminated by the media, and with the risk perception. Despite the high level of knowledge of participants, the results pointed to the need to reinforce information for individuals with less education and the importance of avoiding denialism that reduces the risk perception about COVID-19.
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Affiliation(s)
- Luana Moura Campolino
- Department of Public Health, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, Brazil
| | - João Marcos Bernardes
- Public (Collective) Health Grade Program, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, Brazil
| | - Melissa Spröesser Alonso
- Public (Collective) Health Grade Program, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, Brazil
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Sara Domínguez-Salas
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
| | - Adriano Días
- Department of Public Health, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, Brazil
- Public (Collective) Health Grade Program, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, Brazil
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Silva TMRD, Nogueira de Sá ACMG, Prates EJS, Rodrigues DE, Silva TPRD, Matozinhos FP, Vieira EWR. Yellow fever vaccination before and during the covid-19 pandemic in Brazil. Rev Saude Publica 2022; 56:45. [PMID: 35703600 PMCID: PMC9165638 DOI: 10.11606/s1518-8787.2022056004503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the number of yellow fever vaccine doses administered before and during the covid-19 pandemic in Brazil. METHODS This is an ecological, time series study based on data from the National Immunization Program. Differences between the median number of yellow fever vaccine doses administered in Brazil and in its regions before (from April/2019 to March/2020) and after (from April/2020 to March/2021) the implementation of social distancing measures in the country were assessed via the Mann-Whitney test. Prais-Winsten regression models were used for time series analyses. RESULTS We found a reduction in the median number of yellow fever vaccine doses administered in Brazil and in its regions: North (-34.71%), Midwest (-21.72%), South (-63.50%), and Southeast (-34.42%) (p < 0.05). Series showed stationary behavior in Brazil and in its five regions during the covid-19 pandemic (p > 0.05). Brazilian states also showed stationary trends, except for two states which recorded an increasing trend in the number of administered yellow fever vaccine doses, namely: Alagoas State (before: β = 64, p = 0.081; after: β = 897, p = 0.039), which became a yellow fever vaccine recommendation zone, and Roraima State (before: β = 68, p = 0.724; after: β = 150, p = 0.000), which intensified yellow fever vaccinations due to a yellow fever case confirmation in a Venezuelan State in 2020. CONCLUSION The reduced number of yellow fever vaccine doses administered during the covid-19 pandemic in Brazil may favor the reemergence of urban yellow fever cases in the country.
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Affiliation(s)
- Tércia Moreira Ribeiro da Silva
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | | | - Elton Junio Sady Prates
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | | | - Thales Philipe Rodrigues da Silva
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Ed Wilson Rodrigues Vieira
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
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Jahangir MS, Gadda ZH, Ganayee SA. Marginalized COVID-19 patients and their significant others in Kashmir (India): manifesting the hidden structural vulnerabilities. Health Promot Int 2022; 37:daac069. [PMID: 35788300 PMCID: PMC9278216 DOI: 10.1093/heapro/daac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Using a qualitative approach, this study aimed to undertake an in-depth exploration of the experiences of COVID-19 patients and their significant others among the economically weaker sections in Kashmir. The study was conducted on 18 participants of different households solely from rural Kashmir while using the purposive sampling technique to recruit the participants and the principle of data saturation to determine the sample size. Data were collected using semi-structured in-depth interviews and analyzed through Braun and Clarke's thematic analysis framework. From the data analysis, six overarching themes of diagnosis, healthcare, treatment, survival thereof, social support and stigma were arrived at, which delineated the direct or indirect experiences of participants with COVID-19. The findings of the study revealed that the economically weaker sections of rural Kashmir are deprived of requisite healthcare facilities, which further intensifies their vulnerabilities to COVID-19 and associated health issues. They lie at the core of acute health disadvantage amid the COVID-19 crisis, and are hence drifted toward extreme marginality and socioeconomic adversity.
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Affiliation(s)
- Mohmad Saleem Jahangir
- Department of Sociology, University of Kashmir, Srinagar-190006, Jammu and Kashmir, India
| | - Zakir Hussain Gadda
- Department of Sociology, University of Kashmir, Srinagar-190006, Jammu and Kashmir, India
| | - Shameem Ahamad Ganayee
- Department of Sociology, University of Kashmir, Srinagar-190006, Jammu and Kashmir, India
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Werneck GL. The COVID-19 pandemic: challenges in assessing the impact of complex and multidimensional problems on the health of populations. CAD SAUDE PUBLICA 2022; 38:PT045322. [PMID: 35442259 DOI: 10.1590/0102-311xpt045322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Guilherme Loureiro Werneck
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Celuppi IC, Meirelles BHS, Lanzoni GMDM, Geremia DS, Metelski FK. Management in the care of people with HIV in primary health care in times of the new coronavirus. Rev Saude Publica 2022; 56:13. [PMID: 35384997 PMCID: PMC8963745 DOI: 10.11606/s1518-8787.2022056003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/04/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To understand management practices in the care of people living with the human immunodeficiency virus (HIV) in primary health care in a Brazilian capital, in times of the new coronavirus (covid-19) pandemic. METHOD Qualitative research, anchored in the methodological-analytical framework of the grounded theory, constructivist aspect. Data were collected by using intensive online interviews with nurses from health centers and managers of the municipal health department. Data collection and analysis occurred concomitantly in two phases of analysis: initial and focused coding. RESULTS They point to the development of best care practices, with emphasis on initiatives for coordination of care, decentralization of clinical management for primary health care services, establishment of protocols and flows, agreement of intersectoral partnerships, use of groups and social networks, use of tools such as teleconsultation and health surveillance spreadsheet and formation of support networks. CONCLUSION The Brazilian capital restructured its network of health services with the implementation of clinical and management protocols, seeking to maintain care for people living with HIV. We highlighted the incorporation of non-face-to-face care technologies and the facilitation of routines, as strategies for expanding access.
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Affiliation(s)
- Ianka Cristina Celuppi
- Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Programa de Pós-Graduação em Enfermagem. Florianópolis, SC, Brasil
| | | | | | - Daniela Savi Geremia
- Universidade Federal da Fronteira Sul. Faculdade de Enfermagem. Chapecó, SC, Brasil
| | - Fernanda Karla Metelski
- Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Programa de Pós-Graduação em Enfermagem. Florianópolis, SC, Brasil.,Universidade do Estado de Santa Catarina. Centro de Educação Superior do Oeste. Departamento de Enfermagem. Chapecó, SC, Brasil
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22
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Gomes LB. Schwarcz LM, Starling HM. A bailarina da morte: a gripe espanhola no Brasil. São Paulo: Companhia das Letras; 2020. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022274.44012020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Silva TMRD, Nogueira de Sá ACMG, Beinner MA, Abreu MNS, Matozinhos FP, Sato APS, Vieira EWR. Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil. Int J Public Health 2022; 67:1604224. [PMID: 35431762 PMCID: PMC9008128 DOI: 10.3389/ijph.2022.1604224] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.
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Affiliation(s)
- Tércia Moreira Ribeiro Da Silva
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Mark Anthony Beinner
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Fernanda Penido Matozinhos
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ed Wilson Rodrigues Vieira
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Reichert APDS, Guedes ATA, Soares AR, Brito PKH, Bezerra ICDS, Silva LCLD, Dias TKC, Santos NCCDB. Repercussões da pandemia da Covid-19 no cuidado de lactentes nascidos prematuros. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo O estudo objetivou compreender as repercussões da pandemia da Covid-19 no cuidado de lactentes prematuros, na perspectiva de mães e profissionais de saúde. Método Foram realizadas entrevistas semiestruturadas nos meses de junho e julho de 2020, por meio de ligação telefônica, com 14 mães e quatro profissionais de saúde do serviço de follow-up de uma maternidade pública da Paraíba, Brasil. Resultados A partir da análise temática indutiva, os impactos da pandemia no cuidado ao lactente nascido prematuro, foram: sobrecarga e afastamento dos profissionais dos serviços de saúde, desativação temporária da unidade mãe canguru, descontinuidade da assistência ao prematuro, medo materno de expor a criança à Covid-19 e baixa condição socioeconômica. Foram elencadas estratégias de enfrentamento para o cuidado dos lactentes durante a pandemia, como: maior espaçamento das consultas, acompanhamento por meio telefônico e cumprimento das medidas de biossegurança. Conclusão e implicações para a prática A pandemia exigiu adaptações na assistência, tornando necessárias novas formas de cuidado a essas crianças, como exemplo, as consultas de acompanhamento remotas, a fim de garantir o seu direito à vida e saúde.
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25
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Carneiro LL, Vieira EWR, Duarte ED, da Rocha NB, Velasquez-Melendez G, Caminhas W. COVID-19 pandemic impact on follow-up of child growth and development in Brazil. Front Pediatr 2022; 10:947493. [PMID: 36405844 PMCID: PMC9669785 DOI: 10.3389/fped.2022.947493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study investigated the impact of the COVID-19 pandemic on the primary health care (PHC) services to follow-up the child growth and development (CGD) in Brazil. METHODS A cross-sectional study was conducted using secondary data related visits to assess the growth and development of children up to five years between Apr-2017 to Mar-2021. Differences between monthly rate of visits (per thousand inhabitants up to five) during the pandemic (Apr-2020 to Mar-2021) and before (Apr-2017 to Mar-2020) were analyzed using paired t test and control diagrams (averages ± 1.96 standard deviation). RESULTS A total of 39,599,313 visits for monitoring CGD was studied. The average monthly rate of visits dropped from 61.34 (per thousand) before the pandemic to 39.70 in the first 12 months of the pandemic (p < 0.001). In all states, except Rio Grande do Sul, there was a significant reduction, with differences ranging from -14.21% in São Paulo to -59.66% in Ceará. The Northeast region was the most impacted, being lower than expected in all 12 first months of pandemic. CONCLUSIONS The number of visits to follow-up the CGD in PHC in Brazil decreased during the first year of the COVID-19 pandemic, varying over the months and between states and regions.
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Affiliation(s)
- Lucas Lima Carneiro
- Department of Electrical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ed Wilson Rodrigues Vieira
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Elysângela Dittz Duarte
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Najara Barbosa da Rocha
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo Velasquez-Melendez
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Walmir Caminhas
- Department of Electrical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Patiño-Escarcina JE, Medina MG. Vigilância em Saúde no âmbito da atenção primária para enfrentamento da pandemia da Covid-19: revisão documental. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-11042022e108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A implementação de medidas não farmacológicas para o combate à pandemia da doença pelo coronavírus 2019 tem sido fundamental. No Brasil, é mister pensar na integração Atenção Primária à Saúde (APS) com as ações de Vigilância em Saúde. O objetivo desta revisão foi analisar os documentos normativos produzidos pelo governo federal para o combate à pandemia da Covid-19 sobre a Vigilância em Saúde no âmbito da atenção primária. Foi realizada uma revisão dos documentos oficiais publicados pelo governo federal à temática, em que foram identificados 21 documentos. Destaca-se maior apoio à implementação de ações de detecção e notificação dos casos e contatos intramuros do que à busca ativa na comunidade, às ações educativas no território, às ações de engajamento com a comunidade, ao fortalecimento à adesão às medidas preventivas, à melhoria do fluxo de informações ou ao apoio aos equipamentos sociais da comunidade. Pouco se tem produzido sobre a articulação da APS com as equipes de vigilância do município. Esses achados reforçam o alertado por outros autores sobre a insuficiente importância atribuída à APS no País, especialmente quanto à Vigilância em Saúde. O Brasil tem uma das piores gestões da crise sanitária, sendo urgente fortalecer as ações de vigilância.
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Patiño-Escarcina JE, Medina MG. Health Surveillance within the Primary Healthcare scope to face the Covid-19 pandemics: a document review. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-11042022e108i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Health Surveillance strategies are crucial to organize a strong national response against the coronavirus disease 2019. In Brazil, it is necessary to think about the integration of the Primary Health Care (PHC) and local Health Surveillance. This review aims to analyze the normative documents produced by the Federal Government on this topic. Official documents published by the Federal Government were reviewed, finding 21 related. It was identified a greater support for implementation of intramural actions related to detection and notification of cases and contacts than for active search of community Covid-19 cases, local educational actions, community engagement, strengthening adherence to preventive measures, improvement of information sharing, or support of community’s social facilities. Little was produced about the articulation of PHC with local surveillance teams. Our findings reinforce what was found by other authors, who attested the insufficient importance attributed to PHC in Brazil, especially with regard to Health Surveillance actions. Unfortunately, our country has stood out for one of the worst managements of the health crisis in the world, and there is an urgent need to strengthen surveillance actions based on a strong, capillary, and community-based PHC.
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Stralen ACV, Carvalho CL, Girardi SN, Massote AW, Cherchiglia ML. Estratégias internacionais de flexibilização da regulação da prática de profissionais de saúde em resposta à pandemia da COVID-19: revisão de escopo. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311x00116321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A COVID-19 foi classificada como pandemia pela Organização Mundial da Saúde (OMS) em 11 de março de 2020. Diante da sua acelerada propagação, governantes, comunidades e serviços de saúde estão tendo que agir na mesma velocidade para ampliar a capacidade da força de trabalho em saúde. Este estudo objetivou, a partir do método revisão de escopo [scoping review], identificar as principais estratégias relacionadas a medidas de flexibilização de regulações que regem as práticas de profissionais de saúde que vêm sendo adotadas e/ou recomendadas internacionalmente. O estudo seguiu as etapas propostas pelo Instituto Joanna Briggs. Para a construção da questão de pesquisa, utilizou-se o método PCC (população, conceito e contexto). A busca se baseou nas seguintes bases de dados: PubMed, Scopus e Base de Dados da OMS; e na literatura cinzenta. Foram identificados 36 documentos, classificados nas seguintes estratégias: (1) ampliação de escopo de prática; (2) transferência de funções de uma categoria profissional para outra; (3) autorização para atendimento e faturamento via telemedicina; (4) licenciamento e recrutamento de profissionais não ativos; (5) recrutamento de profissionais de outras regiões/estado; (6) mudanças na formação e oferta de treinamento. Uma das estratégias mais importantes em resposta a situações de escassez de profissionais de saúde tem sido e a disponibilidade para adaptar, ampliar e redistribuir as atividades dos profissionais, de modo a atender as rápidas mudanças. Esta revisão reflete a importância em se realizarem reformas nas regulações profissionais de forma a otimizar a força de trabalho em saúde existente para que esta possa atender às demandas constantes de necessidade da população.
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Number of doses of Measles-Mumps-Rubella vaccine applied in Brazil before and during the COVID-19 pandemic. BMC Infect Dis 2021; 21:1237. [PMID: 34886804 PMCID: PMC8655492 DOI: 10.1186/s12879-021-06927-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/26/2021] [Indexed: 12/23/2022] Open
Abstract
Background Due to the social isolation measures adopted in an attempt to mitigate the risk of transmission of SARS-CoV-2, there has been a reduction in vaccination coverage of children and adolescents in several countries and regions of the world. Objective Analyze the number of doses of vaccine against Measles-Mumps-Rubella (MMR) applied before and after the beginning of mitigation measures due to COVID-19 pandemic in Brazil.
Methods The data collected refer to the number of doses of the MMR vaccine applied monthly to the target population residing in Brazil: cahildren, aged 12 months (first dose) and children, aged 9 years (second dose), from April 2019 to December 2020. Differences in MMR vaccine doses from April 2019 to March 2020 (before the start of mitigation measures) and April 2020 to September 2020 (after the start of the mitigation measures) were evaluated. Spatial analysis identified clusters with a high percentage of reduction in the median of applied doses no Brazil. Results There was a reduction in the median of doses applied in the Regions North (− 33.03%), Northeast (− 43.49%) and South (− 39.01%) e nos Estados Acre (− 48.46%), Amazonas (− 28.96%), Roraima (− 61.91%), Paraíba (− 41.58%), Sergipe (− 47.52%), Rio de Janeiro (-59.31%) and Santa Catarina (− 49.32) (p < 0.05). High-high type spatial clusters (reduction between 34.00 and 90.00%) were formed in the five regions of Brazil (Moran’s I = 0.055; p = 0.01). Conclusion A reduction in the number of MMR vaccine doses was evidenced as a possible effect by the restrictive actions of COVID-19 in Brazil.
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de Campos EAR, ten Caten CS, de Paula IC. End-of-use and end-of-life medicines-insights from pharmaceutical care process into waste medicines management. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:58170-58188. [PMID: 34105077 PMCID: PMC8187138 DOI: 10.1007/s11356-021-14661-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/27/2021] [Indexed: 06/10/2023]
Abstract
End-of-use and end-of-life medicines waste management has been a challenge for public and private managers in different countries. Reverse logistics is a waste management strategy whose application to public pharmaceutical care processes faces legal restrictions and incertitude. Nevertheless, reverse logistics of end-of-use and end-of-life medicines may be both a saving and an environmental strategy in developing countries that manage health under limited resources. How to overcome restrictions to reverse logistics mainly in the context of primary health level? This study aims to investigate the most relevant critical factors for implementing medicine waste management in pharmaceutical care process. The unit analysis is the primary health level process in a developing country capital. Considering the characteristics of the issue at hand, it was designed a qualitative study. Data was collected through semi-structured interviews. The interviewees were key individuals who work directly with the process-from administering medicine to patients to managing waste at the end of the medicine's lifespan or after its use. Results indicated that despite reverse logistics arising from end users is legally forbidden, another type of reverse flow emerged from process analysis. The reverse flow, named reassignment flow, consists of still useful end-of-use medicines exchanged among the 10 government-ran pharmacies and over 140 health centers, where healthcare professionals administer and offer guidance on how to use them correctly. Another result was the identification of the most critical factors in implementing reverse logistics strategies in the public management context. The factors mentioned included aspects pertaining to management, information technology, infrastructure, and government, but they differ from the private context management, in which decision-makers has more freedom. Due to the barriers named by interviewees, the political barriers and complexity of primary health system, results of this investigation point to (i) reinforcing the reassignment flows inside pharmaceutical care logistics cycle, for saving purposes, and (ii) further development of a specific management unit to perform reverse logistics of end-of-use medicines arising from consumers, for environmental purposes. In times of shortage or resources caused by the COVID-19 pandemic, to know the critical factors is a step necessary in overcoming the current restrictions in direction of a well-succeeded medicines reverse logistics, either of reassignment or from final consumers. These results clarify the literature on end-of-use and end-of-life medicines reverse logistics. It also provides managers of 5000 municipalities in the country a perspective on the most relevant critical factors involved in their decision-making process, concerning the reuse of end-of-use medicines or the adequate disposal of end-of-life medicines in the environment.
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Bispo Júnior JP, Santos DBD. [COVID-19 as a syndemic: a theoretical model and foundations for a comprehensive approach in health]. CAD SAUDE PUBLICA 2021; 37:e00119021. [PMID: 34644754 DOI: 10.1590/0102-311x00119021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/13/2021] [Indexed: 01/22/2023] Open
Abstract
This essay aims to present and discuss the theoretical framework for the COVID-19 syndemic. The first part presents the foundations and principles of syndemic theory. For the purposes of this essay, syndemic was defined as a process of synergic interaction between two or more diseases, in which the effects are mutually enhanced. We discussed the three principal typologies of syndemic interaction: mutually causal epidemics; epidemics interacting synergically; and serial causal epidemics. In the second part, COVID-19 is analyzed as a syndemic resulting from the interaction between various groups of diseases and the socioeconomic context. The theoretical model considered the interaction between COVID-19 and chronic noncommunicable diseases, infectious and parasitic diseases, and mental health problems. The essay addressed how social iniquities and conditions of vulnerability act at various levels to increase the effect of COVID-19 and other pandemics. The last section discusses the need for comprehensive, multisector, and integrated responses to COVID-19. A model for intervention was presented that involves the patient care and socioeconomic dimensions. In the sphere of patient care, the authors defend the structuring of strong and responsive health systems, accessible to the entire population. The economic and social dimension addressed the issue of reclaiming the ideals of solidarity, the health promotion strategy, and emphasis on social determinants of health. In conclusion, the lessons learned from the syndemic approach to COVID-19 call on government and society to develop policies that link clinical, sanitary, socioeconomic, and environmental interventions.
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Giovanella L, Martufi V, Ruiz DC, Mendonça MHMD, Bousquat A, Aquino R, Medina MG. A contribuição da Atenção Primária à Saúde na rede SUS de enfrentamento à Covid-19. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202113014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A centralidade no cuidado individual a casos graves descurou a abordagem populacional comunitária necessária ao enfrentamento da pandemia de Covid-19 no Sistema Único de Saúde (SUS). Neste ensaio, argumenta-se que a Estratégia Saúde da Família (ESF), com suas equipes multiprofissionais e enfoque comunitário e territorial, tem potencial para atuar na abordagem comunitária necessária ao enfrentamento da epidemia. A partir de experiências locais e internacionais, analisa quatro campos de atuação da Atenção Primária à Saúde (APS) no SUS no enfrentamento da Covid-19: vigilância nos territórios; cuidado individual dos casos confirmados e suspeitos de Covid-19; ação comunitária de apoio aos grupos vulneráveis; e continuidade dos cuidados rotineiros da APS. Reconhecem-se limites dessa atuação decorrentes de mudanças recentes na Política Nacional de Atenção Básica que afetam o modelo assistencial da vigilância em saúde. Conclui-se ser necessário ativar os atributos comunitários das equipes multiprofissionais da ESF e do Núcleo de Apoio à Saúde da Família; associar-se às iniciativas solidárias das organizações comunitárias e articular-se intersetorialmente; e garantir a continuidade das ações de promoção, prevenção e cuidado, criando novos processos de trabalho na vigilância em saúde, no apoio social e sanitário aos grupos vulneráveis e na continuidade da atenção rotineira para quem dela precisa.
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Giovanella L, Bousquat A, Schenkman S, Almeida PFD, Sardinha LMV, Vieira MLFP. The Family Health Strategy coverage in Brazil: what reveal the 2013 and 2019 National Health Surveys. CIENCIA & SAUDE COLETIVA 2021; 26:2543-2556. [PMID: 34133633 DOI: 10.1590/1413-81232021266.1.43952020] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
This paper examines the evolution of Brazil's Family Health Strategy coverage from the findings of the 2013 and 2019 National Health Survey censuses. Indicators included Family Health Clinic coverage of residents and households, frequency of visits by Community Health Workers, and usual source of care, all stratified by rural and urban areas, Brazilian regions, states, education of the household head, and income quintile. In 2019, 60.0% of households were enrolled in a Family Health Clinic, and population coverage was 62.6%. Coverage was higher in rural than in urban areas in the Northeast and South regions. Between 2013 and 2019, coverage increased by 11.6%, while monthly health worker visits decreased. Coverage was highest among the most vulnerable population, as defined by the household head education level or by the family income. Availability of usual source of care was highest among those enrolled in a Family Health Clinic. The 2019 National Health Survey findings confirm that Brazil's Family Health Strategy continues to be an equitable policy and the main SUS' Primary Health Care model. However, recent changes in the national policy guidance, which are weakening the community approach and the priority given to the Family Health Strategy Program, may jeopardize those gains.
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Affiliation(s)
- Ligia Giovanella
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Aylene Bousquat
- Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Simone Schenkman
- Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | | | - Luciana Monteiro Vasconcelos Sardinha
- Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Brasília DF Brasil
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Moreira RDS. Latent class analysis of COVID-19 symptoms in Brazil: results of the PNAD-COVID19 survey. CAD SAUDE PUBLICA 2021; 37:e00238420. [PMID: 33566990 DOI: 10.1590/0102-311x00238420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022] Open
Abstract
The lack of mass testing for COVID-19 diagnosis creates the need to determine the magnitude of the disease based on its clinical symptoms. The study aimed to analyze the profile of COVID-19 symptoms and related aspects in Brazil. The author analyzed the sample of participants from the Brazilian National Household Sample Survey (PNAD-COVID19) conducted in May 2020. Latent class analysis (LCA) was performed with sociodemographic covariables and 11 symptoms reported by 346,181 individuals. Rao-Scott test and standardized residual analysis were used to measure the association with the pattern of health services use. Spatial scan analysis was performed to identify areas at risk of COVID-19 cases. LCA showed six classes of symptoms based on the pattern of answers by participants: (1) all the symptoms; (2) high prevalence of symptoms; (3) predominance of fever; (4) predominance of cough/sore throat; (5) mild symptoms with predominance of headache; and (6) absence of symptoms. Female sex, brown skin color, the North and Northeast regions of Brazil, and all three older age brackets showed stronger association with the class with all the symptoms (class 1). Most use of health services was also by this group of individuals, but with different profiles of use. Spatial analysis showed juxtaposition of this class with areas at greater risk of COVID-19. These finding underline the importance of investigating symptoms for the epidemiological identification of possible cases in a scenario with low population testing rates.
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Affiliation(s)
- Rafael da Silveira Moreira
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil.,Faculdade de Medicina, Universidade Federal de Pernambuco, Recife, Brasil
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Corrêa MD, Moura LD, Almeida LPD, Zirbel I. As vivências interseccionais da violência em um território vulnerável e periférico. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021210001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo A violência é um fenômeno sociocultural que viola direitos e acentua desigualdades sociais. Suas implicações são perceptíveis na vida cotidiana e na saúde da população. Sob o referencial teórico da interseccionalidade e da psicologia sócio-histórica, este artigo discute formas de violência produzidas na intersecção de gênero, raça e classe em uma comunidade periférica e em situação de alta vulnerabilidade localizada na cidade de Cubatão/SP, a partir do relato de quatro lideranças comunitárias. Os dados foram obtidos por meio de três pesquisas realizadas anteriormente e concomitantemente ao contexto da pandemia da covid-19, de junho de 2017 a novembro de 2020, extraídos mediante entrevistas e diários de campo para, depois, serem analisados segundo a Hermenêutica de Profundidade. Os resultados apontam para violências estruturais articuladas a raça, classe e gênero, expressas na inacessibilidade a condições dignas de moradia, alimentação e renda básica. A violência contra mulheres, destacada como resultado, aparece intermediada pelo Estado ou pelo tráfico organizado. Os dados sugerem que as violências são agravadas pela ineficiência da operacionalização das políticas públicas, no que tange à promoção do cuidado à população majoritariamente negra e pobre, indicando que a interseccionalidade é uma ferramenta essencial para a análise e o enfrentamento das desigualdades sociais.
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Affiliation(s)
| | | | | | - Ilze Zirbel
- Universidade Federal de Santa Catarina, Brasil
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Duarte MB, Freitas JVN, Correia RA, Frank MH, Novaes HPDO, Soub JC, Noronha DO, Lloyd-Sherlock P. Health care strategies in long-term care facilities in Bahia State, Brazil. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To describe health care strategies for older people living in long-term care facilities (LTCFs) in Bahia state, Brazil. METHODS: This is an ecological study involving LTCFs identified in Bahia state, which were invited to participate in a survey conducted between April and June 2021. The variables of interest were LTCF characteristics, health care strategies, visits received from national public health system (SUS, in Portuguese) teams, and health care actions taken by SUS. A comparative analysis was performed between LTCFs located in the East macro-region and other parts of the state, in general and also stratified by funding type (private and non-private). RESULTS: The sample consisted of 177 LTCFs, more than half of them were located in the East macro-region, seat of the state capital. Most facilities declared themselves as non-private (68%). Less than one-third of the LTCFs had their own health teams. Although 67% of LTCFs reported some health care provided by SUS, only 49% reported clinical consultations, with even lower percentages for other SUS actions, except for vaccination (91%). The East macro-region had a lower percentage of LTCFs accompanied by a SUS team, and the highest percentage of LTCFs with supplementary health insurance. CONCLUSIONS: This study shows the limited access of LTCF residents to essential health services, due to a general neglect of this population by public health care providers. The inadequacy of public policies to support LTCFs has important consequences for the quality of care offered to residents.
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Giovanella L, Martufi V, Mendoza DCR, Mendonça MHMD, Bousquat A, Aquino R, Medina MG. A contribuição da Atenção Primária à Saúde na rede SUS de enfrentamento à Covid-19. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-11042020e410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
RESUMO A centralidade no cuidado individual a casos graves descurou a abordagem populacional comunitária necessária ao enfrentamento da pandemia de Covid-19 no Sistema Único de Saúde (SUS). Neste ensaio, argumenta-se que a Estratégia Saúde da Família (ESF), com suas equipes multiprofissionais e enfoque comunitário e territorial, tem potencial para atuar na abordagem comunitária necessária ao enfrentamento da epidemia. A partir de experiências locais e internacionais, analisa quatro campos de atuação da Atenção Primária à Saúde (APS) no SUS no enfrentamento da Covid-19: vigilância em saúde nos territórios; cuidado individual dos casos confirmados e suspeitos de Covid-19; ação comunitária de apoio aos grupos vulneráveis no território por sua situação de saúde ou social; e continuidade dos cuidados rotineiros da APS. Reconhecem-se limites dessa atuação decorrentes de mudanças recentes na Política Nacional de Atenção Básica que afetam o modelo assistencial da vigilância em saúde. Conclui-se ser necessário ativar os atributos comunitários das equipes multiprofissionais da ESF e do Núcleo de Apoio à Saúde da Família (Nasf); associar-se às iniciativas solidárias das organizações comunitárias e articular-se intersetorialmente para apoiar a população em suas diversas vulnerabilidades; e garantir a continuidade das ações de promoção, prevenção e cuidado, criando novos processos de trabalho na vigilância em saúde, no apoio social e sanitário aos grupos vulneráveis e na continuidade da atenção rotineira para quem dela precisa.
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