The burden of disease due to COVID-19 in Florianópolis, Santa Catarina, Brazil, over a one-year period

COVID-19 has had a powerful impact on society with high rates of morbidity and mortality. The use of an epidemiological indicator that estimates the burden of a disease by aggregating early mortality and non-fatal cases in a single measure has the potential to assist in the planning of more appropriate actions at different levels of health care. The scope of this article is to estimate the burden of disease due to COVID-19 in Florianópolis/SC from April 2020 through March 2021. An ecological study was carried out with data from notification and deaths by COVID-19 in the period of 12 months. The burden indicator called Disability-Adjusted Life Years (DALY) was used, obtained by adding the Years of Life Lost (YLL) to the Years of healthy life lost due to disability (YLD). A total of 78,907 confirmed COVID-19 cases were included. Of these, 763 died during the period under study. Overall, 4,496.9 DALYs were estimated, namely a rate of 883.8 DALYs per 100,000 inhabitants. In males, there were 2,693.1 DALYs, a rate of 1,098.0 DALYs per 100,000 males. In women, there were 1,803.8 DALYs, a rate of 684.4 DALYs per100,000 women. The age group most affected in both sexes was 60 to 69 years. The burden of COVID-19 was high in the city studied. The highest rates were in females and in the 60-69 age group.

What is the impact of national public expenditure and its allocation on neonatal and child mortality? A machine learning analysis

BACKGROUND

Understanding the impact of national public expenditure and its allocation on child mortality may help governments move towards target 3.2 proposed in the 2030 Agenda. The objective of this study was to estimate the impacts of governmental expenditures, total, on health, and on other sectors, on neonatal mortality and mortality of children aged between 28 days and five years.

METHODS

This study has an ecological design with a population of 147 countries, with data between 2012 and 2019. Two steps were used: first, the Generalized Propensity Score of public spending was calculated; afterward, the Generalized Propensity Score was used to estimate the expenditures' association with mortality rates. The primary outcomes were neonatal mortality rates (NeoRt) and mortality rates in children between 28 days and 5 years (NeoU5Rt).

RESULTS

The 1% variation in Int$ Purchasing Power Parity (Int$ PPP) per capita in total public expenditures, expenditure in health, and in other sectors were associated with a variation of -0.635 (95% CI -1.176, -0.095), -2.17 (95% CI -3.051, -1.289) -0.632 (95% CI -1.169, -0.095) in NeoRt, respectively The same variation in public expenditures in sectors other than health, was associates with a variation of -1.772 (95% CI -6.219, -1.459) on NeoU5Rt. The results regarding the impact of total and health public spending on NeoU5Rt were not consistent.

CONCLUSION

Public investments impact mortality in children under 5 years of age. Likely, the allocation of expenditures between the health sector and the other social sectors will have different impacts on mortality between the NeoRt and the NeoU5Rt.

Socioeconomic inequality in hospital case fatality rate and care among children and adolescents hospitalized for COVID-19 in Brazil

OBJECTIVE

To analyze the association of hospital case fatality rate and care received by children and adolescents hospitalized for COVID-19 with the gross domestic product (GDP) per capita of Brazilian municipalities and regions of residence.

METHODS

Data were collected from the Influenza Epidemiological Surveillance Information System and the Brazilian Institute of Geography and Statistics. The dichotomous outcomes analyzed were hospital case fatality rate of COVID-19, biological samples collected for COVID-19 diagnosis, X-rays, computed tomography (CT) scans, use of ventilatory support, and intensive care unit hospitalization. The covariates were municipal GDP per capita and the Brazilian region of residence. Poisson regression was used for the outcomes recorded in 2020 and 2021 in Brazil, covering the two COVID-19 waves in the country, adjusted for age and gender.

RESULTS

The hospital case fatality rate was 7.6%. In municipalities with lower GDP per capita deciles, the case fatality rate was almost four times higher among children and twice as high in adolescents compared to cities with higher deciles. Additionally, residents of municipalities with lower GDP per capita had fewer biological samples collected for diagnosis, X-ray examinations, and CT scans. We found regional disparities associated with case fatality rate, with worse indicators in the North and Northeast regions. The findings remained consistent over the two COVID-19 waves.

CONCLUSION

Municipalities with lower GDP per capita, as well as the North and Northeast regions, had worse indicators of hospital case fatality rate and care.

Desigualdade socioeconômica na letalidade e no cuidado hospitalar de crianças e adolescentes internados por COVID-19 no Brasil

RESUMO Objetivo: Analisar a associação entre a letalidade e o cuidado hospitalar recebido por crianças e adolescentes internados por COVID-19 e o produto interno bruto (PIB) per capita dos municípios brasileiros e a região de residência. Métodos: Os dados foram extraídos do Sistema de Informação de Vigilância Epidemiológica da Gripe e do Instituto Brasileiro de Geografia e Estatística. Analisaram-se como desfechos dicotômicos a letalidade hospitalar por COVID-19, a coleta de amostra biológica para diagnóstico de COVID-19, a realização de exames raio X e tomografia, o uso de suporte ventilatório e a internação em unidade de terapia intensiva. As covariáveis foram o PIB municipal per capita e a região brasileira de residência. Foi realizada regressão de Poisson para os desfechos registrados em 2020 e 2021 no Brasil e segundo o período compreendido em duas ondas de COVID-19 no país, ajustando-a por idade e sexo. Resultados: A letalidade hospitalar foi de 7,6%. Nos municípios dos menores decis de PIB per capita a letalidade foi quase quatro vezes maior entre crianças e duas vezes mais elevada entre adolescentes quando comparada àquela dos maiores decis. Adicionalmente, os residentes de municípios com menor PIB per capita realizaram menos coleta de amostra biológica para diagnóstico, exames de raio X e tomografias. Foram encontradas disparidades regionais associadas à letalidade, com piores indicadores nas regiões Norte e Nordeste. Os achados mantiveram-se consistentes durante as duas ondas de COVID-19. Conclusão: Em municípios com menor PIB per capita e das regiões Norte e Nordeste houve piores indicadores de letalidade e cuidado hospitalar.

Overall survival analyses of female malignancies in Southern Brazil during 2008-2017: A closer look at breast, cervical and ovarian cancer

Background

The aim of this study was to report the overall survival and baseline factors associated with OS for breast, cervical and ovarian cancer in Florianópolis, Southern Brazil, a region with quality-of-life indicators comparable to high-income countries.

Methods

Cohort study was performed from probabilistic record linkage of the Mortality Information System and the Population-based cancer registry of Florianópolis. It was included breasts, cervical and ovarian cancer diagnosis during the period of 2008-2012 with a follow up of 60 months. Cox regression and Kaplan-Meier method were used for associations with overall survival and risk factors.

Findings

1857 cases of the three malignancies were included in the analysis. We identified 202 deaths in breast cancer subjects, 53 for cervical cancer and 51 for ovarian cancer. Metastatic disease at diagnosis was present in 31%, 9.6%, and 55% of the cases, respectively. Overall survival was statistically correlated with age, educational level and stage for breast cancer; age and stage for cervical cancer; age and stage for ovarian cancer.

Interpretation

Metastatic disease and age are the main prognostic factors for the malignancies studied, as they were associated with both overall survival and risk of death. Better screening and preventive tests for early diagnosis are needed.

Funding

Support of Research and Innovation in the State of Santa Catarina, Research Program for the Unified Health System (FAPESC/MS-DECIT/CNPQ/SES-SC-PPSUS); the Brazilian National Research Council (CNPq); and the Coordination for the Improvement of Higher Education Personnel (CAPES).

Predição de visitas domiciliares na atenção primária

Introdução: Espera-se, nos próximos anos, um novo perfil de demanda para o Sistema Único de Saúde em consequência do envelhecimento populacional e do aumento da prevalência de doenças crônicas. Diante disso, faz-se necessário o uso de ferramentas para estimar a demanda futura por serviços. Modelos para a análise de séries temporais como o Autoregressive Integrated Moving Average (ARIMA) podem auxiliar. Objetivo: Estimar a demanda por visitas domiciliares na Atenção Primária à Saúde (APS) do Sistema Único de Saúde, em Florianópolis (SC). Métodos: Estudo ecológico de séries temporais que utilizou o ARIMA para projeções. Adotaram-se as visitas domiciliares realizadas pela APS, registradas do prontuário eletrônico da Secretaria de Saúde do município, de janeiro de 2015 a fevereiro de 2019. As projeções dos 20 meses seguintes foram realizadas para o município e para cada um de seus 49 Centros de Saúde. Resultados: A previsão aponta, em agosto de 2019, a máxima de 702 visitas, seguida de queda para 573 visitas em dezembro de 2019 e posterior recuperação, com estimativa de 632 para outubro de 2020. A previsão para cada Centro de Saúde indicou variações na demanda entre unidades com o mesmo número de equipes de Saúde da Família (ESF), entre 11,3 e 1,3 visitas/ESF, no 20o mês. Conclusões: O ARIMA possibilitou a realização das projeções de visitas domiciliares no município, indicando queda na demanda de visitas domiciliares. O método pode ser de grande valia para a projeção de outras demandas no mesmo município ou em outros que possuam dados de série histórica. Estudos futuros podem expandir a análise nesse sentido, bem como comparar o ARIMA com modelos como a suavização exponencial.

Impact assessment of emergency care units on hospitalizations for respiratory system diseases in Brazil

Emergency Care Units (UPAs) are part of a national health policy implemented by the Brazilian Government. UPAs are fixed prehospital components of the Brazilian Unified Health System (SUS), whose purpose is to provide resolutive emergency care to patients suffering from acute clinical conditions, and to perform the first care in cases of surgical nature. According to the Ministry of Economy, 750 units are operational throughout the country since 2008, and 332 are under construction. Being a public policy in expansion, it is imperative to assess the impact of such units as part of SUS. However, we found few studies that assessed UPAs' impact, which have examined their specific impact on mortality rates. In our research, we aimed to evaluate the impact of UPAs on hospitalization rates for diseases of the respiratory system. To measure the impact, we used a strategy of Machine Learning through the Bayesian Additive Regression Trees (BART) algorithm. The results point to a decrease in the hospitalization rates by respiratory diseases due to Emergency Care Units. Therefore, these units generate a benefit for the Brazilian health system, being an important element for the care of patients with respiratory diseases.

Tobacco-related neoplasms: survival analysis and risk of death of population data from Florianópolis, SC

OBJECTIVE

To estimate the probability of survival and prognostic factors for tobacco-related neoplasms in a population-based cohort.

METHODS

This is a cohort with data from the Population-Based Cancer Registry of Florianópolis, southern Brazil, from 2008 to 2012. The Stata 16.0 software was used to estimate the probabilities of survival in five years after diagnosis, by the Kaplan Meier method, and the risk of death, by the Cox regression.

RESULTS

A total of 2,829 cancer records related to smoking were included, more prevalent among males, over 70 years of age, nine years or more of schooling, white, with a partner and metastatic diagnosis. The most frequent groupings were colon and rectum (28.7%), trachea, bronchi and lungs (18.6%) and stomach (11.8%). At follow-up, 1,450 died. Pancreatic cancer had the worst probability of survival (14.3%), followed by liver cancer (19.4%).

CONCLUSION

Risk factors for death and survival rates differ across the 13 types of tobacco-related cancers. Early diagnosis and primary prevention are strategies that must be improved to improve survival and decrease the burden related to these types of cancer.

Estimating underdiagnosis of COVID-19 with nowcasting and machine learning

OBJECTIVE

To analyze the underdiagnosis of COVID-19 through nowcasting with machine learning in a Southern Brazilian capital city.

METHODS

Observational ecological design and data from 3916 notified cases of COVID-19 from April 14th to June 2nd, 2020 in Florianópolis, Brazil. A machine-learning algorithm was used to classify cases that had no diagnosis, producing the nowcast. To analyze the underdiagnosis, the difference between data without nowcasting and the median of the nowcasted projections for the entire period and for the six days from the date of onset of symptoms were compared.

RESULTS

The number of new cases throughout the entire period without nowcasting was 389. With nowcasting, it was 694 (95%CI 496-897). During the six-day period, the number without nowcasting was 19 and 104 (95%CI 60-142) with nowcasting. The underdiagnosis was 37.29% in the entire period and 81.73% in the six-day period. The underdiagnosis was more critical in the six days from the date of onset of symptoms to diagnosis before the data collection than in the entire period.

CONCLUSION

The use of nowcasting with machine learning techniques can help to estimate the number of new disease cases.

The potential spread of Covid-19 and government decision-making: a retrospective analysis in Florianópolis, Brazil

OBJECTIVE

To analyze the association between the transmission potential of SARS-CoV-2 and the decisions made by the municipal government of Florianópolis (Brazil) regarding social distancing.

METHODS

We analyzed new cases of COVID-19 identified in Florianópolis residents between February 1 and July 14, 2020, using a nowcasting approach. Decrees related to COVID-19 published in the Official Gazette of the Municipality between February 1 and July 14, 2020 were also analyzed. Based on the actions proposed in the decrees, whether they loosened social distancing measures, or increased or maintained existing restrictions, was analyzed, thus creating a Social Distancing Index. Time-dependent reproduction numbers (Rt) for a period of 14 days prior to each decree were calculated. A matrix was constructed associating the classification of each decree and the Rt values, analyzing the consonance or dissonance between the potential dissemination of SARS-CoV-2 and the actions of the decrees.

RESULTS

A total of 5,374 cases of COVID-19 and 26 decrees were analyzed. Nine decrees increased social distancing measures, nine maintained them, and eight loosened them. Of the 26 actions, 9 were consonant and 17 dissonant with the tendency indicated by the Rt. Dissonance was observed in all of the decrees that maintained the distance measures or loosened them. The fastest expansion in the number of new cases and the greatest amount of dissonant decrees was found in the last two months analyzed.

CONCLUSION

There was an important divergence between municipal measures of social distancing with epidemiological indicators at the time of each political decision.

Do family doctors refer less? Impact of FCM training on the rate of PHC referrals

OBJECTIVE

To evaluate the impact of family medicine residence on the PHC referral rate.

METHODS

This is a cross-sectional descriptive study on 375.645 visits and 34.776 referrals by 123 PHC physicians in 2016, linking the referral rate to the characteristics of doctors (gender, age, family medicine training), patients (gender and age) and service (general population and working population).

RESULTS

Family and community medicine residency training had a significant reduction in PHC referral rate (2.86%), CI:(1.55;4.17), p < 0,0001. This reduction persisted in the multivariate analysis, after adjusting for all the possible confounding variables. No difference was found between the referral rates of doctors with and without family and community medicine (FCM) degree. Concerning referral to specialties, doctors with FCM residence training had lower rates of referral to gynecology, psychiatry and pediatrics and higher rates of referral to ophthalmology.

CONCLUSION

The study showed that FCM residency significantly reduced PHC referral rates.

Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil

OBJECTIVES

To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate.

METHOD

Data were extracted from a historical cohort with 15,879 live births. A model was used that included socioeconomic, behavioral, and health service use risk factors, as well as the Apgar score and biological factors. Risk factors were analyzed by hierarchical logistic regression.

RESULTS

Based on the multivariate analysis, socioeconomic factors showed no association with death. Insufficient prenatal consultations showed an OR of 3.25 (95% CI: 1.70-6.48) for death. Low birth weight (OR 8.42; 95% CI: 3.45-21.93); prematurity (OR 5.40; 95% CI: 2.22-13.88); malformations (OR 4.42; 95% CI: 1.37-12.43); and low Apgar score at the first (OR 6.65; 95% CI: 3.36-12.94) and at the fifth (OR 19.78; 95% CI: 9.12-44.50) minutes, were associated with death.

CONCLUSION

Differing from other studies, socioeconomic conditions were not associated with neonatal death. Insufficient prenatal consultations, low Apgar score, prematurity, low birth weight, and malformations showed an association, reinforcing the importance of prenatal access universalization and its integration with medium and high-complexity neonatal care services.

Assessing families' and patients' attitudes toward brain donation for research purposes in a Brazilian population sample

The neuropathological examination of postmortem human brain tissue is an essential resource for the definitive diagnosis and research on neurodegenerative diseases. Due to the growing need of donated brains to supply the Brain Banks, the understanding of the factors associated with the consent for the donation in our context is an important aspect of the process of brain donation. The verbal answers and the donation consent rate were evaluated in three groups: 30 relatives of patients who underwent verification of the cause of death, 14 patients assisted at a neurology ambulatory outpatient clinic, and 18 patients' relatives. The donation consent rates were of 46.6, 92.8 and 88.8 %, respectively. The main reasons for refusal were the disagreement with the autopsy, philosophical and religious issues, objections from other family members, and the consideration of the wishes of the deceased. The consent was specially motivated by the interest in the advances of scientific knowledge, altruistic reasons and the personal experiences with the disease. Factors as the emotional fragility at the moment of death, the beliefs, family matters, and the lack of knowledge are key elements in the donation process. Future goals include the establishment of a brain donor program with the support of academic institutions, hospitals, scientists, community, patient's associations and autopsy assistants. Approaching patients and relatives in specialized ambulatories clinic during assistance is probably the most efficient mean of obtaining brains for research.

Minitek urea disk test, a sensitive and cost-effective method to screen for Campylobacter pylori in gastric biopsies

One hundred fifty-five biopsy specimens from the gastric mucosa of 81 patients undergoing routine endoscopy procedures were tested for the presence of Campylobacter pylori by three methods: Gram stain, culture, and modified Minitek, a rapid urea disk test (BBL Microbiology Systems, Cockeysville, Md.). Twenty-nine patients were infected with C. pylori. Sensitivities and specificities of detection were 100 and 94% with the Minitek test and 93 and 100% with Gram stain, respectively. Rapid testing by the urea disk is a simple, cost-effective, and accurate method for detecting the presence of C. pylori in gastric biopsy specimens.