Desigualdade econômica e risco de infecção e morte por COVID-19 no Brasil

Spatial dynamics of COVID-19 in São Paulo: A cellular automata and GIS approach

This study examines the spread of COVID-19 in São Paulo, Brazil, using a combination of cellular automata and geographic information systems to model the epidemic's spatial dynamics. By integrating epidemiological models with georeferenced data and social indicators, we analyse how the virus propagates in a complex urban setting, characterized by significant social and economic disparities. The research highlights the role of various factors, including mobility patterns, neighbourhood configurations, and local inequalities, in the spatial spreading of COVID-19 throughout São Paulo. We simulate disease transmission across the city's 96 districts, offering insights into the impact of network topology and district-specific variables on the spread of infections. The study seeks to fine-tune the model to extract epidemiological parameters for further use in a statistical analysis of social variables. Our findings underline the critical importance of spatial analysis in public health strategies and emphasize the necessity for targeted interventions in vulnerable communities. Additionally, the study explores the potential of mathematical modelling in understanding and mitigating the effects of pandemics in urban environments.

First year of COVID-19 in Brazil: Factors associated with the spread of COVID-19 in small and large cities

AIM

To test the association between sociodemographic and social characteristics with COVID-19 cases and deaths in small and large Brazilian cities.

METHODS

This ecological study included COVID-19 data available in State Health Secretaries (managed by brasil.io API) and three national databases (IBGE, DATASUS and Embrapa). Temporal spread of COVID-19 in Brazil during the first year considered as outcome: a) days until 1st case in each city since 1st in the country; b) days until 1,000 cases/100,000 inhabitants since 1st case in each city; c) days until 1st death until 50 deaths/100,000 inhabitants. Covariates included geographic region, city social and environmental characteristics, housing conditions, job characteristics, socioeconomic and inequalities characteristics, and health services and coverage. The analysis were stratified by city size into small (<100,000 inhabitants) and large cities (≥100,00 inhabitants). Multiple linear regressions were performed to test associations of all covariates to adjust to potential confounders.

RESULTS

In small cities, the first cases were reported after 82.2 days and 1,000 cases/100,000 were reported after 117.8 days, whereas in large cities these milestones were reported after 32.1 and 127.7 days, respectively. For first death, small and large cities took 121.6 and 36.0 days, respectively. However, small cities were associated with more vulnerability factors to first case arrival in 1,000 cases/100,000 inhabitants, first death and 50 deaths/100,000 inhabitants. North and Northeast regions positively associated with faster COVID-19 incidence, whereas South and Southeast were least.

CONCLUSION

Social and built environment characteristics and inequalities were associated with COVID-19 cases spread and mortality incidence in Brazilian cities.

Individual and contextual factors associated with the survival of patients with severe acute respiratory syndrome by COVID-19 in Brazil

OBJECTIVE

To analyze the influence of individual and contextual factors of the hospital and the municipality of care on the survival of patients with Severe Acute Respiratory Syndrome due to COVID-19.

METHODS

Hospital cohort study with data from 159,948 adults and elderly with Severe Acute Respiratory Syndrome due to COVID-19 hospitalized from January 1 to December 31, 2022 and reported in the Influenza Epidemiological Surveillance Information System. The contextual variables were related to the structure, professionals and equipment of the hospital establishments and socioeconomic and health indicators of the municipalities. The outcome was hospital survival up to 90 days. Survival tree and Kaplan-Meier curves were used for survival analysis.

RESULTS

Hospital lethality was 30.4%. Elderly patients who underwent invasive mechanical ventilation and were hospitalized in cities with low tax collection rates had lower survival rates compared to other groups identified in the survival tree (p<0.001).

CONCLUSION

The study indicated the interaction of contextual factors with the individual ones, and it shows that hospital and municipal characteristics increase the risk of death, highlighting the attention to the organization, operation, and performance of the hospital network.

Pandemics, Income Inequality, and Refugees: The Case of COVID-19

Refugees are more vulnerable to COVID-19 due to factors such as low standard of living, accommodation in crowded households, difficulty in receiving health care due to high treatment costs in some countries, and inability to access public health and social services. The increasing income inequalities, anxiety about providing minimum living conditions, and fear of being unemployed compel refugees to continue their jobs, and this affects the number of cases and case-related deaths. The aim of the study is to analyze the impact of refugees and income inequality on COVID-19 cases and deaths in 95 countries for the year 2021 using Poisson regression, Negative Binomial Regression, and Machine Learning methods. According to the estimation results, refugees and income inequalities increase both COVID-19 cases and deaths. On the other hand, the impact of income inequality on COVID-19 cases and deaths is stronger than on refugees.

Health condition, income loss, food insecurity and other social inequities among migrants and refugees during the COVID-19 pandemic in Brazil

BACKGROUND

Brazil is the destination of many international migrants and refugees and, given the circumstances of their entry into the country, many face difficulties due to the absence of targeted policies. Thus, the objective of this study was to survey the social impact of COVID-19 on international migrants and refugees regarding income loss, food insecurity and other social inequities, and to identify explanatory factors on these aspects.

METHODS

This is a cross-sectional, analytical study. We used a validated instrument applied by trained interviewers. Descriptive analysis and binary logistic regression were performed to identify factors associated with income loss and food insecurity.

RESULTS

A total of 360 individuals from sub-Saharan African and South American countries participated in the study. Individuals who were white, black/brown, yellow, had an occupation/employment, and earned less than one minimum wage were more likely to lose income. Those who reported no income, received less than one minimum wage, and were diagnosed with COVID-19 were more likely to be food insecure.

CONCLUSIONS

The study advances knowledge by identifying factors associated with income loss, food insecurity, and individuals' difficulty in accessing health services and social support measures in Brazil.

Inequalities in the receipt of healthcare practitioner counseling for adults after COVID-19 in southern Brazil

Health counseling is a prevention and health promotion action, especially in the context of a pandemic, for both preventing disease and maintaining health. Inequalities may affect receipt of health counseling. The aim was to provide an overview of the prevalence of receiving counseling and to analyze income inequality in the receipt of health counseling.

METHODS

This was a cross-sectional telephone survey study with individuals aged 18 years or older with diagnosis of symptomatic COVID-19 using RT-PCR testing between December 2020 and March 2021. They were asked about receipt of health counseling. Inequalities were assessed using the Slope Index of Inequality (SII) and Concentration Index (CIX) measures. We used the Chi-square test to assess the distribution of outcomes according to income. Adjusted analyses were performed using Poisson regression with robust variance adjustment.

RESULTS

A total of 2919 individuals were interviewed. Low prevalence of health counseling by healthcare practitioner was found. Participants with higher incomes were 30% more likely to receive more counseling.

CONCLUSIONS

These results serve as a basis for aggregating public health promotion policies, in addition to reinforcing health counseling as a multidisciplinary team mission to promote greater health equity.

Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil

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.

Prevalence of flu-like syndrome in healthcare workers in Brazil: a national study, 2020

OBJECTIVE

To evaluate the prevalence of reported symptoms of flu-like syndrome (FS) among HCW and compare HCW and non-HCW on the chance of reporting these symptoms, this study analyzed data of a population-based survey conducted in Brazil.

METHODS

A cross-sectional analysis was performed with self-reported data from the Brazilian National Household Sample Survey (PNAD Covid-19) from May 2020. The authors analyzed a probability sample of 125,179 workers, aged 18 to 65, with monthly income lower than US$ 3 500. The variable HCW or non-HCW was the covariate of interest and having reported FS symptoms or not was the outcome variable. Authors tested interactions of HCW with other covariates. A logit model - when controlling for sociodemographic, employment, and geographic characteristics - investigated the chance of HCW reporting FS compared to non-HCW.

RESULTS

HCW have a significant effect (odds ratio of 1.369) on reporting FS symptoms when compared to non-HCW. HCW account for 4.17% of the sample, with a higher frequency of FS (3.38%) than observed for non-HCW (2.43%). Female, non-white and older individuals had higher chance to report FS.

CONCLUSIONS

The HCW had a higher chance of reporting symptoms than non-HCW aged over 18 years in the labor force. These results emphasize guidelines for preventive measures to reduce workplace exposures in the healthcare facilities. The prevalence is disproportionately affecting HCW women and HCW non-whites. In the regions North and Northeast the steeper progression is consistent with the hypothesis of socioeconomic factors, and it explains the greater prevalence in HCW and non-HCW living in those territories.

Association of government effectiveness, logistics performance, IT systems and income with COVID-19 mortality

The COVID-19 pandemic has unprecedentedly shaken the public health system worldwide. It has been one of the greatest humanitarian crises faced by all countries, regardless of their economic prosperity. However, some countries have been able to minimize the deaths caused by the coronavirus even in the face of a large number of cases, while others have failed to control the death rate even in a comparatively small number of cases. This study explores possible causes of this disparity using cross-sectional data from 126 countries associated with demography, governance, income level, the extent of ICT maturity and the geographical divide. The results of this study suggest that while government effectiveness is negatively associated with the COVID-19 death rate, the logistics performance of governments is positively linked to the COVID-19 mortality rate. The ICT maturity proxied through online service delivery did not confirm its association with the COVID-19 mortality rate. This study informs that poverty and the location of countries do not necessarily influence COVID-19 deaths. Hence, it behoves governments to focus on improving government effectiveness and putting in place more effective and efficient mobility systems, healthcare supply chains and digital administration to address the global health crisis posed by the COVID-19 pandemic and mitigate its harsh effects, including mortality.

Association of sociodemographic characteristics, mental health, and sleep quality with COVID-19 fear in an elderly Brazilian population

 Aim: This study determined whether COVID-19 fear is correlated with sociodemographic characteristics, general health, mental health, and sleep quality in an elderly Brazilians. Methods: Elderly people aged ≥ 60 years replied to an online survey containing questions about their sociodemographic characteristics; general health; levels of stress, anxiety, and depression; sleep quality; and COVID fear. Results: Data were statistically analyzed using descriptive statistics (α = 5%). In total, 705 elderly people with mean age of 66 ± 5 years, and most (82.7%) respondents were women, graduated and from southeastern Brazil. COVID-19 fear correlated positively and moderately with sleep quality and symptoms of depression, anxiety, and stress (all p < 0.001). It was associated with females. Elderly people from northern and northeastern Brazil and diabetics had increased COVID-19 fear (all p < 0.05). Conclusion: The fear of COVID-19 exists among Brazilian female old people, diabetics, increases anxiety and stress symptoms, and worsen sleep quality in elderly people.

Spatial-temporal distribution of incidence, mortality, and case-fatality ratios of coronavirus disease 2019 and its social determinants in Brazilian municipalities

The COVID-19 pandemic caused impact on public health worldwide. Brazil gained prominence during the pandemic due to the magnitude of disease. This study aimed to evaluate the spatial-temporal dynamics of incidence, mortality, and case fatality of COVID-19 and its associations with social determinants in Brazilian municipalities and epidemiological week. We modeled incidence, mortality, and case fatality rates using spatial-temporal Bayesian model. "Bolsa Família Programme" (BOLSAFAM) and "proportional mortality ratio" (PMR) were inversely associated with the standardized incidence ratio (SIR), while "health insurance coverage" (HEALTHINSUR) and "Gini index" were directly associated with the SIR. BOLSAFAM and PMR were inversely associated with the standardized mortality ratio (SMR) and standardized case fatality ratio (SCFR). The highest proportion of excess risk for SIR and the SMR started in the North, expanding to the Midwest, Southeast, and South regions. The highest proportion of excess risk for the SCFR outcome was observed in some municipalities in the North region and in the other Brazilian regions. The COVID-19 incidence and mortality in municipalities that most benefited from the cash transfer programme and with better social development decreased. The municipalities with a higher proportion of non-whites had a higher risk of becoming ill and dying from the disease.

Ethnic/Racial Disparity in Mortality from COVID-19: Data for the Year 2020 in Brazil

The study aimed to investigate ethnic/racial disparities in COVID-19 mortality in Brazilian federative units and their respective capitals in 2020. Population data and number of COVID-19 deaths were extracted by skin color (white, black, brown and indigenous) from all Brazilian states and their respective capitals. The mortality rate of COVID-19 by ethnicity in Brazilian states was higher between people from brown skin color, followed by indigenous and black. Only in one state, in the Federal District and in the federal capital, age-standardized mortality rates were higher among white's people. There is a high percentage of deaths from COVID-19 higher than expected among non-white individuals, especially in south-central states and capitals of the country. Mortality from COVID-19 affect ethnic-racial groups unevenly in Brazil and the number of excess deaths among non-whites was over 9000. Urgent government measures are needed to reduce the racial disparity in health indicators in Brazil.

[Social vulnerability, survival, and hospital lethality by COVID-19 in patients aged 50 years and over: retrospective cohort of cases in Brazil in 2020 and 2021]

The outcome of SARS-CoV-2 infection is not only associated with age and comorbidities but is also aggravated by social vulnerability. This study aims to analyze - according to social vulnerability - survival and hospital lethality by COVID-19 in the first 100 days from symptoms to death in individuals aged 50 years or older hospitalized in Brazil. This is a retrospective cohort from Epidemiological Week 11 of 2020 to week 33 of 2021. The Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) provided clinical and epidemiological data. The Geographic Index of the Socioeconomic Context for Health and Social Studies (GeoSES) measured social vulnerability. The Kaplan-Meier curve and the adjusted proportional risk model by Cox were used for survival, with hazard ratio (HR) and 95% confidence intervals (95%CI). Among the 410,504 cases, overall lethality was of 42.2% in general and 51.4% in the most vulnerable. We found a higher lethality according to worse socioeconomic status in all categories by age group; the double is registered for 50-59 years. The adjusted Cox model showed a 32% increase in risk of death (HR = 1.32; 95%CI: 1.24-1.42). Moreover, men, older adults, black or indigenous adults, with multiple comorbidities, and subjected to invasive ventilation, have a higher risk of death after hospitalization. Intersectoral policy measures need to be targeted to alleviate the effects of the COVID-19 pandemic aggravated by social vulnerability.

Proximity matrix indicates heterogeneity in the ability to face child malnutrition and pandemics in Brazil: An ecological study

Background

Among the social inequalities that continue to still surpasses the basic rights of several citizens, political and environmental organizations decisively "drag" the "ghost" of hunger between different countries of the world, including Brazil. The COVID-19 pandemic has increased the difficulties encountered in fighting poverty, which has led Brazil to a worrying situation regarding its fragility in the fight against new pandemics.

Objectives

The present study aims to estimate, compare, and report the prevalence of mortality due to child malnutrition among the macro-regions of Brazil and verify possible associations with the outcome of death by COVID-19. This would identify the most fragile macro-regions in the country with the greatest need for care and investments.

Methods

The prevalence of mortality was determined using data from the federal government database (DataSus). Child malnutrition was evaluated for the period from 1996 to 2017 and COVID-19 was evaluated from February to December 2020. The (dis)similarity between deaths from malnutrition and COVID-19 was evaluated by proximity matrix.

Results

The North and Northeast regions have above average number of deaths than expected for Brazil (p < 0.05). A prospective analysis reveals that the distribution of the North and Northeast macro-regions exceeds the upper limit of the CI in Brazil for up to the year 2024 (p < 0.05). The proximity matrix demonstrated the close relationship between deaths from COVID-19 and malnutrition for the Northern region followed by the Northeast region.

Conclusions

There are discrepancies in frequencies between macro-regions. Prospective data indicate serious problems for the North and Northeast regions for the coming years. Therefore, strategies to contain the outcome of health hazards must be intensified in the macro-regions North and Northeast of the country.

Solidariedade, cidadania e justiça social: percepções de atores sociais sobre as respostas públicas à COVID-19

Resumo Trata-se de uma análise qualitativa das percepções de atores sociais sobre as respostas públicas durante a pandemia de COVID-19. Foram conduzidas entrevistas semiestruturadas com 11 representantes da sociedade civil indicados por lideranças de movimentos sociais. Para garantir a análise de uma diversidade de vozes, também realizamos a sistematização de artigos de opinião de autoria de organizações humanitárias e lideranças da sociedade civil, publicados em jornais de grande circulação. Nossa análise se inspirou nos princípios éticos da justiça social, solidariedade e cidadania. Utilizamos da análise temática, na qual dois temas principais emergiram: 1) as populações desproporcionalmente afetadas seguem invisibilizadas para cuidados e proteções; 2) há um projeto intencional de aniquilamento das populações consideradas indesejáveis. Para cuidados e mitigação dos efeitos durante emergências sanitárias, os movimentos comunitários devem ser incorporados como parte essencial das respostas. Cuidado, solidariedade e participação cidadã são centrais para a construção de respostas para proteção em saúde dentro do marco da justiça social. As respostas para transformação do futuro pós-pandêmico se localizam nas iniciativas da sociedade civil e de lideranças comunitárias dentro dos territórios.

Solidarity, citizenship and social justice: perceptions of social actors about public responses to COVID-19

Abstract This qualitative study aimed to analyze the social actors’ perceptions of public responses during the COVID-19 pandemic. We conducted semi-structured interviews with eleven civil society representatives and social movement leaders. We also performed triangulation based on the systematization of opinion papers authored by humanitarian organizations and civil society leaders and published in large-circulation newspapers. Our analysis was inspired by the ethical principles of social justice, solidarity, and citizenship. Two main themes emerged from the thematic analysis: 1) disproportionately affected populations remain invisible to care and protection; 2) there is an intentional project to annihilate “undesirable” populations. Community movements must be incorporated as an essential part of the responses to provide care and protection and mitigate the effects during health emergencies. Care, solidarity, and social participation are central to building health protection responses within the framework of social justice. The responses to transforming the future in the aftermath of the pandemic will occur through the initiatives of civil society and community leaders within the territories.

Spatiotemporal clusters and the socioeconomic determinants of COVID-19 in Toronto neighbourhoods, Canada

The aim of this study is to identify spatiotemporal clusters and the socioeconomic drivers of COVID-19 in Toronto. Geographical, epidemiological, and socioeconomic data from the 140 neighbourhoods in Toronto were used in this study. We used local and global Moran's I, and space-time scan statistic to identify spatial and spatiotemporal clusters of COVID-19. We also used global (spatial regression models), and local geographically weighted regression (GWR) and Multiscale Geographically weighted regression (MGWR) models to identify the globally and locally varying socioeconomic drivers of COVID-19. The global regression model identified a lower percentage of educated people and a higher percentage of immigrants in the neighbourhoods as significant predictors of COVID-19. MGWR shows the best fit model to explain the variables affecting COVID-19. The findings imply that a single intervention package for the entire area would not be an effective strategy for controlling COVID-19; a locally adaptable intervention package would be beneficial.

COVID-19 Post-Exposure Evaluation (COPE) Study: Assessing the Role of Socio-Economic Factors in Household SARS-CoV-2 Transmission within Campania Region (Southern Italy)

Campania is the sixth poorest region of Italy, and it is the region with the highest income inequality. The secondary attack rates of SARS-CoV-2 among households are found to be substantially heterogeneous among published studies and are influenced by socio-economic factors. We conducted a retrospective study to describe the role of socio-economic factors in the household transmission of SARS-CoV-2 among patients living in Campania Region and referring to "Federico II" Hospital. We interviewed 413 subjects followed-up for COVID-19 between the 8 March 2020 and the 24 May 2021 with the aim to collect demographic, clinical, economic, and social data regarding their household and the index cases. The variables associated with SARS-CoV-2 attack rate higher than 50% among households were higher age (p = 0.023) and higher Charlson Comorbidity Index of the index case (p = 0.023) and, for household characteristics, higher number of families per house (p = 0.02), location of the houses in Naples' suburbs (Chi² = 5.3, p = 0.02) and in Caserta City area (Chi² = 4, p = 0.04), and renting the house compared to owning it (Chi² = 5.83, p = 0.01). This study confirms the finding described by other authors that household transmission of SARS-CoV-2 is correlated with the income inequality of the analyzed geographical area as well as with the indicators of health and economic wealth of the families, and this correlation also applies to the Campania Region.

Fear of Covid-19 and health-related outcomes: results from two Brazilian population-based studies

Fear is a reaction that can influence multiple aspects of health and life. During the Covid-19 pandemic, there have been serious pathophysiological, social, behavioral and mental consequences that can be related to fear. This study aimed to assess the fear of Covid-19 and its association with sociodemographic, behavioral and health variables. Data were gathered from two cross-sectional population-based studies conducted in 2020 with adults from two cities from Southern Brazil. The Fear of Covid-19 scale was used to evaluate fear of Covid. Exposure variables were socioeconomic, demographic, health and pandemic-related factors. Adjusted Poisson regression was performed to assess the association between fear of Covid-19 and the exposure variables. A total of 2,152 subjects were assessed. Higher fear of Covid-19 was found among women and in individuals with symptoms of Covid-19. Living alone, being richer, and testing positive for Covid-19 were associated with lower prevalence of fear. Higher prevalence of fear of Covid-19 was related to worse sleep quality, worse health perception, sadness, higher stress, depressive symptoms, and suicidal ideation. There was a linear association between fear of Covid-19 and health outcomes. The results provide evidence that fear of Covid-19 seems to be associated with socioeconomic, demographic, health and pandemic-related factors.

Were the socio-economic determinants of municipalities relevant to the increment of COVID-19 related deaths in Brazil in 2020?

BACKGROUND

The COVID-19 pandemic in Brazil has been showing a pattern of distribution of related deaths associated with individual socioeconomic status (SES). However, little is known about the role of SES in the distribution of the mortality rate in different population, from an ecological perspective.

OBJECTIVE

The objective of this study was to evaluate the role of socioeconomic factors in the distribution of the COVID-19-related mortality rate among Brazilian municipalities in 2020.

METHODS

We conducted a retrospective, cross-sectional, observational, population-wide, and ecological study, using data of COVID-19-related deaths from the Influenza Epidemiological Surveillance Information System database (SIVEP-Gripe) and SES from the Social Vulnerability Index (SVI), the Human Development Index (HDI), the Geographic Index of the Socioeconomic Context and Social Studies (GeoSES), and 2010 Demographic Census (IBGE/Brazil). We computed crude, age- and sex-standardized, and the latter offset by the time of exposure to the epidemic mortality rates. To determine socioeconomic factors associated with mortality rates we used log-linear models with state codes as a random effect and Haversine variance-covariance matrix.

RESULTS

191,528 deaths were related to COVID-19 and distributed in 4,928 (88.55%) Brazilian municipalities. Whatever the socioeconomic indexes used, the R2 were very small to explain SMRT. Consistent across all socioeconomic indexes used, high-income, more educated, and well infrastructure municipalities generally had higher mortality rates.

CONCLUSION

Excluding the effect of demographic structure and pandemic timing from mortality rates, the contribution of SES to explain differences in COVID-19-related mortality rates among municipalities in Brazil became very low. The impact of SES on COVID-19-related mortality may vary across levels of aggregation. Urban infrastructure, which includes mobility structures, more complex economic activities and connections, may have influenced the average municipal death rate.

Adequacy of Antenatal Care during the COVID-19 Pandemic: Observational Study with Postpartum Women

OBJECTIVE

 The present study aimed to evaluate the antenatal care adequacy for women who gave birth at the University Hospital of Santa Catarina in Florianopolis (Brazil) during the COVID-19 pandemic, and to evaluate the association of adequacy with sociodemographic, clinical, and access characteristics.

METHODS

 Data were collected between October and December 2020, including 254 patients who delivered in the University Hospital from Federal University of Santa Catarina and answered our questionnaires. Additional data were obtained from patients' antenatal booklets. Antenatal care was classified as adequate, intermediate, or inadequate according to the number of appointments, gestational age at the beginning of follow-up, and tests results. We carried out a descriptive statistical analysis and a bivariate/with odds ratio analysis on maternal sociodemographic, clinical and health access variables that were compared with antenatal adequacy.

RESULTS

 Antenatal care was considered adequate in 35.8% of cases, intermediate in 46.8%, and inadequate in 17.4%. The following maternal variables were associated with inadequate prenatal care (intermediate or inadequate prenatal care): having black or brown skin colour, having two or more children, being of foreign nationality, not being fluent in Portuguese, and using illicit drugs during pregnancy; the clinical variables were more than 6 weeks between appointments, and not attending high-risk antenatal care; as for access, the variables were difficulties in attending or scheduling appointments, and attending virtual appointments only.

CONCLUSION

 In a sample of pregnant women from a teaching hospital in Florianópolis during the COVID-19 pandemic, antenatal care was considered adequate in 35.8%, intermediate in 46.8%, and inadequate in 17.4% of cases.

Spatial Dynamics and Multiscale Regression Modelling of Population Level Indicators for COVID-19 Spread in Malaysia

As COVID-19 dispersion occurs at different levels of gradients across geographies, the application of spatiotemporal science via computational methods can provide valuable insights to direct available resources and targeted interventions for transmission control. This ecological-correlation study evaluates the spatial dispersion of COVID-19 and its temporal relationships with crucial demographic and socioeconomic determinants in Malaysia, utilizing secondary data sources from public domains. By aggregating 51,476 real-time active COVID-19 case-data between 22 January 2021 and 4 February 2021 to district-level administrative units, the incidence, global and local Moran indexes were calculated. Spatial autoregressive models (SAR) complemented with geographical weighted regression (GWR) analyses were executed to determine potential demographic and socioeconomic indicators for COVID-19 spread in Malaysia. Highest active case counts were based in the Central, Southern and parts of East Malaysia regions of Malaysia. Countrywide global Moran index was 0.431 (p = 0.001), indicated a positive spatial autocorrelation of high standards within districts. The local Moran index identified spatial clusters of the main high–high patterns in the Central and Southern regions, and the main low–low clusters in the East Coast and East Malaysia regions. The GWR model, the best fit model, affirmed that COVID-19 spread in Malaysia was likely to be caused by population density (β coefficient weights = 0.269), followed by average household income per capita (β coefficient weights = 0.254) and GINI coefficient (β coefficient weights = 0.207). The current study concluded that the spread of COVID-19 was concentrated mostly in the Central and Southern regions of Malaysia. Population’s average household income per capita, GINI coefficient and population density were important indicators likely to cause the spread amongst communities.

An Epidemiologic Analysis of Associations between County-Level Per Capita Income, Unemployment Rate, and COVID-19 Vaccination Rates in the United States

The purpose of this longitudinal study was to examine associations between per capita income, unemployment rates, and COVID-19 vaccination rates at the county-level across the United States (U.S.), as well as to identify the interaction effects between county-level per capita income, unemployment rates, and racial/ethnic composition on COVID-19 vaccination rates. All counties in the U.S. that reported COVID-19 vaccination rates from January 2021 to July 2021 were included in this longitudinal study (n = 2857). Pooled ordinary least squares (OLS) with fixed-effects were employed to longitudinally examine economic impacts on racial/ethnic disparities on county-level COVID-19 vaccination rates. County-level per capita income and county-level unemployment rates were both positively associated with county-level COVID-19 vaccination rates across the U.S. However, the associations were divergent in the context of race/ethnicity. Public health efforts to bolster COVID-19 vaccination rates are encouraged to consider economic factors that are associated with decreases in COVID-19 vaccination rates.

Deaths due to COVID-19 in a state of northeastern Brazil: spatiotemporal distribution, sociodemographic and clinical and operational characteristics

BACKGROUND

The detection of spatiotemporal clusters of deaths by coronavirus disease 2019 (COVID-19) is essential for health systems and services, as it contributes to the allocation of resources and helps in effective decision making aimed at disease control and surveillance. Thus we aim to analyse the spatiotemporal distribution and describe sociodemographic and clinical and operational characteristics of COVID-19-related deaths in a Brazilian state.

METHODS

A descriptive and ecological study was carried out in the state of Maranhão. The study population consisted of deaths by COVID-19 in the period from 29 March to 31 July 2020. The detection of spatiotemporal clusters was performed by spatiotemporal scan analysis.

RESULTS

A total of 3001 deaths were analysed with an average age of 69 y, predominantly in males, of brown ethnicity, with arterial hypertension and diabetes, diagnosed mainly by reverse transcription polymerase chain reaction in public laboratories. The crude mortality rates the municipalities ranged from 0.00 to 102.24 deaths per 100 000 inhabitants and three spatiotemporal clusters of high relative risk were detected, with a mortality rate ranging from 20.25 to 91.49 deaths per 100 000 inhabitants per month. The headquarters was the metropolitan region of São Luís and municipalities with better socio-economic and health development.

CONCLUSIONS

The heterogeneous spatiotemporal distribution and the sociodemographic and clinical and operational characteristics of deaths by COVID-19 point to the need for interventions.

O telemonitoramento como estratégia de intervenção da terapia ocupacional com crianças e adolescentes com transtorno do espectro autista no contexto pandêmico

Resumo Introdução A terapia ocupacional tem atuado na perspectiva do cotidiano dos sujeitos e de seus modos de viver, tendo em vista as transformações, impactos e consequências geradas pela pandemia da COVID-19. Dentre as possibilidades de atuação do terapeuta ocupacional, tem-se o telemonitoramento. Objetivo Relatar a experiência de um projeto de extensão universitária no que tange ao telemonitoramento de crianças e adolescentes com Transtorno do Espectro Autista (TEA) e suas famílias. Método A equipe do projeto é composta por uma docente do departamento de terapia ocupacional e alunas de pós-graduação e graduação. Foi realizado um levantamento das demandas e interesses das famílias, sendo posteriormente selecionados treze crianças e dois adolescentes para as ações de telemonitoramento. Resultados As intervenções visaram à organização do cotidiano, rotina e orientação familiar. Aponta-se que o cuidado ofertado não se restringiu ao núcleo familiar, de forma que também foi realizado acompanhamento regular e apoio às equipes escolares. Conclusão O telemonitoramento possibilitou a continuidade do cuidado, promovendo o acolhimento, escuta qualificada e orientação, com base no que tem sido proposto pelas diretrizes de cuidado e políticas públicas.

Telemonitoring as a strategy for the intervention of occupational therapy of children and adolescents with autistic spectrum disorders in the pandemic context

Abstract Introduction Occupational Therapy has acted from the perspective of the subjects' daily lives and their ways of living, given the transformations, impacts, and consequences generated by the pandemic of COVID-19. Among the possibilities of work of the occupational therapist, there is telemonitoring. Objective To report an experience of a university extension project regarding the telemonitoring of children and adolescents with Autistic Spectrum Disorder (ASD) and their families. Method The project team is composed of a teacher from Occupational Therapy Department, and graduate and undergraduate students. A survey of the demands and interests of the families was carried out, and thirteen children and two teenagers were subsequently selected for telemonitoring actions. Results The interventions are aimed at an organization of daily life, routine, and family orientation. It is pointed out that the care offered was not restricted to the family nucleus, so regular monitoring and support for school teams were also carried out. Conclusion Telemonitoring enabled the continuity of care, as well as support for the care network, promoting a welcoming, qualified listening and guidance, based on what has been proposed by the care guidelines and public policies.

A decomposition analysis for socioeconomic inequalities in health status associated with the COVID-19 diagnosis and related symptoms during Brazil's first wave of infections☆

Recent studies have shown that COVID-19 affects different population groups asymmetrically. This work uses data from the National Survey of Households—PNAD COVID-19/IBGE—to quantify the socioeconomic inequality in health during the first wave of COVID-19 infections in Brazil. We use the concentration curve, the concentration index, and a decomposition analysis to verify the factors that most influence the inequalities in the specified health variables. We find a positive concentration index for the incidence rate, indicating a greater concentration of diagnoses (number of tests) among groups with higher income levels. When considering symptoms similar to a COVID-19 infection, inequality practically disappears. Among people with higher income, a pre-existing disease has a more significant contribution to the concentration of COVID-19 in the presence of correlated symptoms than in its diagnosis. Tests of dominance support the findings. Moreover, the decomposition results show that if the inequalities were explained only by race (non-white) and place of living (North and Northeast), there would be a concentration of COVID-19 among the poorest.

SARS-CoV-2 in children with cancer in Brazil: Results of a multicenter national registry

BACKGROUND

Strategies to mitigate the impact of COVID-19 in special populations are complex and challenging. Few studies have addressed the impact of COVID-19 on pediatric patients with cancer in low- and middle-income countries.

METHODS

Multicenter observational cohort study with prospective records and retrospective analyses starting in April 2020 in 21 pediatric oncology centers distributed throughout Brazil.

PARTICIPANTS

Patients under 18 years of age who are infected by the SARS-CoV-2 virus (confirmed diagnosis through reverse transcriptase-polymerase chain reaction [RT-PCR]) while under treatment at pediatric oncology centers. The variables of interest included clinical symptoms, diagnostic and therapeutic measures. The repercussions of SARS-CoV-2 infection on cancer treatment and general prognosis were monitored.

RESULTS

One hundred seventy-nine patients were included (median age 6 [4-13] years, 58% male). Of these, 55.9% had acute leukemia and 34.1% had solid tumors. The presence of SARS-CoV-2 was diagnosed by RT-PCR. Various laboratory markers were analyzed, but showed no correlation with outcome. Children with low or high BMI for age had lower overall survival (71.4% and 82.6%, respectively) than those with age-appropriate BMI (92.7%) (p = .007). The severity of presentation at diagnosis was significantly associated with outcome (p < .001). Overall mortality in the presence of infection was 12.3% (n = 22).

CONCLUSION

In children with cancer and COVID-19, lower BMI was associated with worse prognosis. The mortality in this group of patients (12.3%) was significantly higher than that described in the pediatric population overall (∼1%).

How Do Teleworkers and Organizations Manage the COVID-19 Crisis in Brazil? The Role of Flexibility I-Deals and Work Recovery in Maintaining Sustainable Well-Being at Work

The COVID-19 pandemic has impacted the economic market and labor contexts worldwide. Brazil has suffered one of the worst social and governmental managements of the COVID-19 crisis, forcing workers and organizations to develop coping strategies. This environment can affect both well-being and performance at work. Sustainable well-being at work refers to different patterns of relationships between performance and well-being. It may include eudaimonic (e.g., Meaning of Work-MOW) or hedonic (e.g., emotions) forms of well-being. This study tests the moderating role of recovery from work stress in the relationship between flexibility i-deals and patterns of sustainable well-being at work in Brazilian teleworkers. We relied on two studies to achieve this objective. In Study 1, conducted during the pandemic's first outbreak in Brazil (N = 386), recovery experiences moderated the relationship between i-deals and clusters formed by performance and MOW (eudaimonic happiness). In Study 2, conducted during the second outbreak (N = 281), we identified relationships between clusters of emotions (hedonic happiness) and MOW (eudaimonic) with performance. The results supported the idea that recovery experiences moderated the relationship between i-deals and patterns of sustainable well-being at work differently. Our findings have implications for Human Resource Management and teleworkers, especially for employee behaviors to deal with stress.

Demography, inequalities and Global Health Security Index as correlates of COVID-19 morbidity and mortality

BACKGROUND

During a pandemic, the occurrence of infections and case fatality rates are expected to vary from one country to another due to several variables such as poverty, existing comorbidities, population density, access to health care, availability and quality of health system resources, and environmental factors.

OBJECTIVES

Our aim is to investigate the relationship between various demographic and socioeconomic factors and reported COVID-19 morbidity and mortality indicators in different countries. Also, to determine the position of the countries relative to each other in terms of three indicators including COVID-19 cases, deaths and tests.

METHODS

Canonical correlation analysis is used to investigate the intercorrelations between independent variables and the COVID-19 cases and deaths for 92 countries. Countries' performances are measured by MULTIMOORA.

RESULTS

Human Development Index, smoking habits, percentage of elderly population and test frequency are the most significant variables associated with COVID-19 morbidity and mortality according to our study findings. Singapore, New Zealand and Australia are the best performed countries.

CONCLUSIONS

Several significant and unexpected associations exist between socioeconomic factors and the COVID-19 cases and deaths. Singapore, New Zealand and Australia are surrounded by water, have been more successful in the pandemic process compared to other countries.

The Effects of Income Level on Susceptibility to COVID-19 and COVID-19 Morbidity/Mortality: A Nationwide Cohort Study in South Korea

This study aimed to investigate the association of income level with susceptibility to coronavirus disease 2019 (COVID-19) and COVID-19 morbidity and mortality. Using the Korean National Health Insurance COVID-19 Database cohort, medical claim data from 2015 through 2020 were collected. A total of 7943 patients who were diagnosed with COVID-19 from 1 January 2020 to 4 June 2020 were included. A total of 118,914 participants had negative COVID-19 PCR tests. Income levels were classified by 20th percentiles based on 2019 Korean National Health Insurance premiums. The 20th percentile income levels were categorized into three groups (low, middle, and high). The relationship of income level with susceptibility to COVID-19 and COVID-19 morbidity and mortality was analyzed using logistic regression analysis. A high income level was related to lower odds of COVID-19 infection (adjusted odds ratio (aOR) = 0.79, 95% confidence interval (CI) = 0.75-0.83, p < 0.001). The negative association between income level and COVID-19 infection was maintained in all subgroups. Patients with low income levels were susceptible to COVID-19 infection; however, there was no relation of COVID-19 morbidity and mortality with income level in the Korean population.

Changes in car and bus usage amid the COVID-19 pandemic: Relationship with land use and land price

This study aimed to explore the impacts of COVID-19 on car and bus usage and their relationships with land use and land price. Large-scale trip data of car and bus usage in Daejeon, South Korea, were tested. We made a trip-chain-level data set to analyze travel behavior based on activity-based travel volumes. Hexagonal cells were used to capture geographical explanatory variables, and a mixed-effect regression model was adopted to determine the impacts of COVID-19. The modeling outcomes demonstrated behavioral differences between associated with using cars and buses amid the pandemic. People responded to the pandemic by reducing their trips more intensively during the daytime and weekends. Moreover, they avoided crowded or shared spaces by reducing bus trips and trips toward commercial areas. In terms of social equity, trips of people living in wealthier areas decreased more than those of people living in lower-priced areas, especially trips by buses. The findings contribute to the previous literature by adding a fundamental reference for the different impacts of pandemics on two universal transportation modes.

COVID-19 in medium-sized municipalities in the 14 health macro-regions of Minas Gerais, Brazil

The present study focused on the scenario of confirmed cases of SARS-CoV-2 infection in the state of Minas Gerais (MG), Brazil, from March 2020 to March 2021. We evaluated the evolution of COVID-19 prevalence and death in one municipality from each of the 14 health macro-regions of MG state. Socio-demographic characteristics and variables related to the municipalities were analyzed. The raw dataset used in this study was freely sourced from the website Brasil.io. From the raw dataset, two time series were extracted: the cumulative confirmed cases of COVID-19 and cumulative death counts, and they were compared to the state data using a nowcasting approach. In order to make time series comparisons possible, all data was normalized per 100,000 inhabitants. When analyzing in light of colored wave code interventions initiated in August 2020 in MG, for the majority of the municipalities, there was an absence of clear influence on prevalence and deaths. The national holidays in the first semester of 2020 had a small impact on the COVID-19 prevalence of the municipalities, but the holidays in the second semester of 2020 and beginning of 2021 caused important impacts on COVID-19 prevalence. The low number of ICU beds in some municipalities contributed to the higher number of deaths. The analysis showed here is expected to contribute to the improvement of decision making of the MG government, as it opened a huge possibility to have the total macro-regions and state data analyzed.

An immunogenetic view of COVID-19

Meeting the challenges brought by the COVID-19 pandemic requires an interdisciplinary approach. In this context, integrating knowledge of immune function with an understanding of how genetic variation influences the nature of immunity is a key challenge. Immunogenetics can help explain the heterogeneity of susceptibility and protection to the viral infection and disease progression. Here, we review the knowledge developed so far, discussing fundamental genes for triggering the innate and adaptive immune responses associated with a viral infection, especially with the SARS-CoV-2 mechanisms. We emphasize the role of the HLA and KIR genes, discussing what has been uncovered about their role in COVID-19 and addressing methodological challenges of studying these genes. Finally, we comment on questions that arise when studying admixed populations, highlighting the case of Brazil. We argue that the interplay between immunology and an understanding of genetic associations can provide an important contribution to our knowledge of COVID-19.

Enhancing Safety During a Pandemic Using Virtual Care Remote Monitoring Technologies and UML Modeling

OBJECTIVES

This paper describes a methodology for gathering requirements and early design of remote monitoring technology (RMT) for enhancing patient safety during pandemics using virtual care technologies. As pandemics such as COrona VIrus Disease (COVID-19) progress there is an increasing need for effective virtual care and RMT to support patient care while they are at home.

METHODS

The authors describe their work in conducting literature reviews by searching PubMed.gov and the grey literature for articles, and government websites with guidelines describing the signs and symptoms of COVID-19, as well as the progression of the disease. The reviews focused on identifying gaps where RMT could be applied in novel ways and formed the basis for the subsequent modelling of use cases for applying RMT described in this paper.

RESULTS

The work was conducted in the context of a new Home of the Future laboratory which has been set up at the University of Victoria. The literature review led to the development of a number of object-oriented models for deploying RMT. This modeling is being used for a number of purposes, including for education of students in health infomatics as well as testing of new use cases for RMT with industrial collaborators and projects within the smart home of the future laboratory.

CONCLUSIONS

Object-oriented modeling, based on analysis of gaps in the literature, was found to be a useful approach for describing, communicating and teaching about potential new uses of RMT.

Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study

BACKGROUND

After 8 months of the COVID-19 pandemic, Latin American countries have some of the highest rates in COVID-19 mortality. Despite being one of the most unequal regions of the world, there is a scarce report of the effect of socioeconomic conditions on COVID-19 mortality in their countries. We aimed to identify the effect of some socioeconomic inequality-related factors on COVID-19 mortality in Colombia.

METHODS

We conducted a survival analysis in a nation-wide retrospective cohort study of confirmed cases of COVID-19 in Colombia from 2 March 2020 to 26 October 2020. We calculated the time to death or recovery for each confirmed case in the cohort. We used an extended multivariable time-dependent Cox regression model to estimate the HR by age groups, sex, ethnicity, type of health insurance, area of residence and socioeconomic strata.

RESULTS

There were 1 033 218 confirmed cases and 30 565 deaths for COVID-19 in Colombia between 2 March and 26 October. The risk of dying for COVID-19 among confirmed cases was higher in males (HR 1.68 95% CI 1.64 to 1.72), in people older than 60 years (HR 296.58 95% CI 199.22 to 441.51), in indigenous people (HR 1.20 95% CI 1.08 to 1.33), in people with subsidised health insurance regime (HR 1.89 95% CI 1.83 to 1.96) and in people living in the very low socioeconomic strata (HR 1.44 95% CI 1.24 to 1.68).

CONCLUSION

Our study provides evidence of socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regimen and socioeconomic status.

Impact of COVID-19 pandemic on time series of maternal mortality ratio in Bahia, Brazil: analysis of period 2011-2020

BACKGROUND

Most studies on the effects of SARS-CoV-2 infection have been conducted with adults and non-pregnant women. Thus, its impacts on maternal health are not yet fully established. This study aimed to verify the relationship between the maternal mortality ratio and the incidence of COVID-19 in the State of Bahia, Brazil, 2020.

METHODS

This time-series study used publicly available information in Brazil, to obtain data on maternal deaths and live births in Bahia, State, from January 1, 2011, to December 31, 2020. The time trend of Maternal Mortality Ratio (MMR) was analysed through polynomial regression, of order 6. Expected MMR, monthly (Jan-Dec) and annual values for 2020, were predicted by the additive Holt-Winters exponential smoothing algorithm, with 95% confidence interval, based on the time series of the MMR from 2011 to 2019, and the accuracy of the forecasts for 2020 was assessed by checking the smoothing coefficients and the mean errors. According to the statistical forecast, the MMR values ​​recorded in the year 2020 were compared to those expected.

RESULTS

In 2020, the annual MMR in Bahia, Brazil, was 78.23/100,000 live births, 59.46% higher than the expected ratio (49.06 [95% CI 38.70-59.90]). The increase in maternal mortality ratio relative to expected values was observed throughout the 2020 months; however, only after May, when the COVID-19 epidemic rose sharply, it exceeded the upper limit of the 95% CI of the monthly prediction. Of the 144 registered maternal deaths in 2020, 19 (13.19%) had COVID-19 mentioned as the cause of death.

CONCLUSIONS

Our study revealed the increase in maternal mortality, and its temporal relationship with the incidence of COVID-19, in Bahia, Brazil, in 2020. The COVID-19 pandemic may be directly and indirectly related to this increase, which needs to be investigated. An urgent public health action is needed to prevent and reduce maternal deaths during this pandemic, in Brazil.

Global epidemiology and socio-economic development correlates of the reproductive ratio of COVID-19

BACKGROUND

The most commonly cited argument for imposing or lifting various restrictions in the context of the coronavirus disease 2019 (COVID-19) pandemic is an assumed impact on the reproductive ratio of the pathogen. It has furthermore been suggested that less-developed countries are particularly affected by this pandemic. Empirical evidence for this is lacking.

METHODS

Based on a dataset covering 170 countries, patterns of empirical 7-d reproductive ratios during the first months of the COVID-19 pandemic were analysed. Time trends and associations with socio-economic development indicators, such as gross domestic product per capita, physicians per population, extreme poverty prevalence and maternal mortality ratio, were analysed in mixed linear regression models using log-transformed reproductive ratios as the dependent variable.

RESULTS

Reproductive ratios during the early phase of a pandemic exhibited high fluctuations and overall strong declines. Stable estimates were observed only several weeks into the pandemic, with a median reproductive ratio of 0.96 (interquartile range 0.72-1.34) 6 weeks into the analysis period. Unfavourable socio-economic indicators showed consistent associations with higher reproductive ratios, which were elevated by a factor of 1.29 (95% confidence interval 1.15 to 1.46), for example, in the countries in the highest compared with the lowest tertile of extreme poverty prevalence.

CONCLUSIONS

The COVID-19 pandemic has allowed for the first time description of the global patterns of reproductive ratios of a novel pathogen during pandemic spread. The present study reports the first quantitative empirical evidence that COVID-19 net transmissibility remains less controlled in socio-economically disadvantaged countries, even months into the pandemic. This needs to be addressed by the global scientific community as well as international politics.

When informal work and poor work conditions backfire and fuel the COVID-19 pandemic: Why we should listen to the lessons from Latin America

Latin America is among the regions with the highest incidence of COVID-19 where the pandemic is creating a humanitarian crisis. In this Commentary we aim to reveal underlying problems of this crisis, that may be an underestimated global driver of the pandemic and a serious risk to health and healthcare systems. We set the focus on informal work and related poorly regulated sub-contracting which create poor work conditions as one dimension of the social determinants of health. We use the examples of Germany and Brazil, as opposite sides geographically and concerning the pandemic, to highlight a need for greater attention to these risks and for systematic inclusion in health systems resilience. In both countries, informal work may turn into hot spots of COVID-19, thus reinforcing social inequalities on a grand scale both nationally and globally. Our two contrasting country cases thus reveal a global threat that should be treated as such. There is much to learn for Europe and the world from Brazil and Latin America on what happens when informal labour and poor work environments backfire during the COVID-19 pandemic. We should listen carefully to these lessons.