Brazil's COVID-19 response.
Ontology highlight
ABSTRACT:
SUBMITTER: Pontes MRN
PROVIDER: S-EPMC7498218 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
Publications
Brazil's COVID-19 response.
Pontes Mauro R N MRN Lima Julio Pereira JP
Lancet (London, England) 20200901 10254
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Project description:ObjectiveTo study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with in-hospital mortality related to the disease.MethodsCross-sectional study, based on secondary data on COVID-19 hospitalizations that occurred in the SUS between late February through June. Patients aged 18 years or older with primary or secondary diagnoses indicative of COVID-19 were included. Bivariate analyses were performed and generalized linear mixed models (GLMM) were estimated with random effects intercept. The modeling followed three steps, including: attributes of the patients; elements of the care process; and characteristics of the hospital and place of hospitalization.Results89,405 hospitalizations were observed, of which 24.4% resulted in death. COVID-19 patients hospitalized in the SUS were predominantly male (56.5%) with a mean age of 58.9 years. The length of stay ranged from less than 24 hours to 114 days, with a mean of 6.9 (±6.5) days. Of the total number of hospitalizations, 22.6% reported ICU use. The odds on in-hospital death were 16.8% higher among men than among women and increased with age. Black individuals had a higher likelihood of death. The behavior of the Charlson and Elixhauser indices was consistent with the hypothesis of a higher risk of death among patients with comorbidities, and obesity had an independent effect on increasing this risk. Some states, such as Amazonas and Rio de Janeiro, had a higher risk of in-hospital death from COVID-19. The odds on in-hospital death were 72.1% higher in municipalities with at least 100,000 inhabitants, though being hospitalized in the municipality of residence was a protective factor.ConclusionThere was broad variation in COVID-19 in-hospital mortality in the SUS, associated with demographic and clinical factors, social inequality, and differences in the structure of services and quality of health care.
| S-EPMC7728222 | biostudies-literature
Project description:The COVID-19 pandemic required a wide range of adaptations to the way that water sector operated globally. This paper looks into the impact of the COVID-19 pandemic on Brazilian water sector and evaluates the water sector's organisational resilience from the lens of water professionals. This study uses British Standard (BS 65000:2014)'s Resilience Maturity Scale method to evaluate organisational resilience in water sector under two defined scenarios of before and during the pandemic. For this purpose, the self-assessment framework developed by Southern Water in the United Kingdom (based on BS 65000:2014), comprising of the core resilience elements of Direction, Awareness, Alignment, Learning, Strengthening, and Assurance, are used for evaluations. A qualitative-quantitative surveying method is used for data collection. A total of 14 responses to the whole questionnaire were received from May 2021 to August 2021, each representing one water company in Brazil (four local companies and ten state-owned ones). The analyses identified COVID-19 as a threat multiplier particularly to already existing financial challenges due to the pre-existing threats in water sector. Bad debt and the COVID-19 emergency measures are recognised as the main challenges by 21 % and 14 % of the survey respondents. The state-owned and local companies scored an almost similar maturity level 3, 35 % and 34 % respectively, while the local companies scored much lower at maturity level 4 i.e., 26 % as opposed to 47 % in state-owned sector. This indicates that COVID-19 has a greater impact on local companies and the needs to increase preparedness. This study replicates an international experience to raise awareness on water sector's resiliency in Brazil and how it can be improved to withstand future external shocks. It sheds light on how and what existing challenges can be exacerbated facing a global shock and proposes opportunities for improvement of resilience maturity in water sector in Brazil.
| S-EPMC9361783 | biostudies-literature
Project description: Not available
| S-EPMC8279962 | biostudies-literature
Project description:PurposeDuring the COVID-19 pandemic, patients with cancer are at increased risk of not having timely diagnosis and access to cancer treatment. The present study evaluated the COVID-19 pandemic impact on radiotherapy activity in Brazil.MethodsA national-level study was performed to evaluate the RT utilization for prostate, breast, head & neck (HN), Gynecology (GYN), Gastrointestinal (GI), lung cancers, and bone/brain metastases. The data on the RT executed was extracted from the Brazilian Ministry of Health database. The NON-COVID period was considered the control group, and the comparison groups were COVID-2020 (without vaccine) and COVID-2021 (with vaccine).ResultsWe collected the data of 238,355 procedures executed on three periods. Significant difference in the RT utilization between NON-COVID and COVID-2020 were observed for prostate cancer, bone and brain metastases (-12.3%, p=0.02, +24%, p=0.02 and +14%, p=0.04, respectively). Comparing 2 equivalents months from NON-COVID-2019 (ref), COVID-2020, and COVID-2021, a significant increase was identified for bone and brain metastases (2020 +21%, and 2021 +32%), and (2020 +20%, and 2021 +14%). A stable drop occurred for prostate cancer (2020 -11% and 2021 -10%), and a variation was observed for breast (2020 +8%, and 2021 -1%) and lung cancer (2020 +10%, and 2021 -3%). For other cancers, non-significant changes were observed when comparing 2020 and 2021.ConclusionThe RT activity was heterogeneously affected with a substantial increase for bone and brain metastases and a meaningful decline for prostate cancer.Policy summaryWith a significant increase in the use of palliative radiotherapy for bone and brain metastases and a meaningful reduction in curative radiotherapy for prostate cancer, we hope these findings can help governments, RT services, medical communities, and other stakeholders develop strategies to mitigate the impact of the present and future pandemics. Finally, despite the changes imposed by the COVID pandemic, it is imperative to enhance screening, increase cancer diagnosis at an early stage, and improve access to all cancer treatments, including radiotherapy.
| S-EPMC9540705 | biostudies-literature
Project description:The transport network between cities is key in understanding epidemic outbreaks, especially in a vast country like Brazil with 5569 cities spread out over 8.5 million square kilometers. In order to study the COVID-19 spread in Brazil, we built a transport network where each city is a node and the edges are connections by land and air. Our findings have shown that by adding air connections, the average path length substantially decreases (70%) while the clustering coefficient remains almost unchanged, very typical of small-world networks. The airways are shortcuts connecting previously distant cities and hubs, therefore shrinking the distances in the network. Also, the cities with airports are central nodes, which makes them dissemination hotspots and key targets for interventions.
| S-EPMC9906601 | biostudies-literature
Project description:The COVID-19 pandemic brings to light the reality of the Brazilian health system. The underreporting of COVID-19 deaths in the state of Minas Gerais (MG), where the second largest population of the country is concentrated, reveals government unpreparedness, as there is a low capacity of testing in the population, which prevents the real understanding of the general panorama of SARS-CoV-2 dissemination. The goals of this research are to analyze the causes of deaths in different Brazilian government databases (Civil Registry Transparency Portal and InfoGripe) and to assess whether there are sub-records showing an unexpected increase in the frequency of deaths from causes clinically similar to COVID-19. A descriptive and quantitative analysis of the number of deaths by COVID-19 and similar causes was performed in different databases. Our results demonstrate that different official sources had a discrepancy of 109.45% between these data referring to the same period. There was also a 758.57% increase in SARI deaths in 2020, when compared to the average of previous years. Finally, it was shown that there was an increase in the rate of pneumonia and respiratory insufficiency (RI) by 6.34 and 6.25%, respectively. In conclusion, there is an underreporting of COVID-19 deaths in MG due to the unexplained excess of deaths caused by SARI, respiratory insufficiency, and pneumonia compared to previous years.
| S-EPMC7769942 | biostudies-literature
Project description:BackgroundAs of December 31, 2020, Brazil had the second-highest burden of COVID-19 worldwide. Given the absence of federal government coordination, it was up to the local governments to maintain healthcare provision for non-COVID health issues. In this descriptive study, we aimed to discuss the SUS functionality and resilience, describing the impact of the pandemic on non-COVID health services delivery while considering the regional inequalities of the allocation of financing health system, health infrastructure and health workforce.MethodsWe used input-output framework based on the World Health Organization (WHO) Health System Building Blocks to estimate health system functionality and resilience. An ecological assessment was designed to calculated mean relative changes to compare the first year of the pandemic in Brazil with the previous one. All data used in this study were anonymized and made available by the Brazilian Ministry of Health. Input indicators were categorized in health system financing (federal funding received as well as expenditure of both state and city governments), health system's infrastructure (hospital beds) and health workforce (healthcare workers positions). Output indicators were categorized into nine different groups of service delivery procedures. To explore the relationship between the variation in procedures with socioeconomic conditions, we used the Socioeconomic Vulnerability Index (SVI).FindingsState governments had a 38·6% increase in federal transfers, while municipal governments had a 33·9% increase. The increase of ICU beds reached its peak in the third quarter of 2020, averaging 72·1% by the end of the year. The country also saw an increase in jobs for registered nurses (13·6%), nurse assistants (8·5%), physiotherapists (7·9%), and medical doctors (4·9%). All procedures underwent expressive reduction: Screenings (-42·6%); Diagnostic procedures (-28·9%); Physician appointments (-42·5%); Low and medium complexity surgeries (-59·7%); High complexity surgeries (-27·9%); Transplants (-44·7%); Treatments and clinical procedures due to injuries of external causes (-19·1%); Irrepressible procedures (-8·5%); and Childbirths (-12·6%). The most significant drop in procedures happened in the first quarter of the pandemic, followed by progressive increase; most regions had not yet recovered by the end of 2020. State-level changes in numbers of procedures point towards a negative trend with SVI.InterpretationThe Brazilian Government did not consider that socioeconomically vulnerable states were at a higher risk of being impacted by the overburden of the health system caused by the COVID-19, which resulted in poorer health system functionality for those vulnerable states. The lack of proper planning to improve health system resilience resulted in the decrease of a quarter of the amount of healthcare procedures increasing the already existing health disparities in the country.FundingMCTIC/CNPQ/FNDCT/MS/SCTIE/DECIT No 07/2020.
| S-EPMC8896985 | biostudies-literature
Project description: Not available
| S-BSST563 | biostudies-other
Project description:The ongoing SARS-CoV-2 pandemic has resulted in over 6.3 million deaths and 560 million COVID-19 cases worldwide. Clinical management of hospitalised patients is complex due to the heterogeneous course of COVID-19. Low-dose radiotherapy (LD-RT) is known to dampen localised chronic inflammation, and has been suggested to be used to reduce lung inflammation in COVID-19 patients. However, it is unknown whether SARS-CoV-2 alters the radiation response and associated radiation exposure related risk. We generated gene expression profiles from circulating leukocytes of hospitalised COVID-19 patients and healthy donors. The p53 signalling pathway was found to be dysregulated, with mRNA levels of p53, ATM and CHK2 being lower in COVID-19 patients. Several key p53 target genes involved in cell cycle arrest, apoptosis and p53 feedback inhibition were up-regulated in COVID-19 patients, while other p53 target genes were downregulated. This dysregulation has functional consequences as the transcription of p53-dependant genes (CCNG1, GADD45A, DDB2, SESN1, FDXR, APOBEC) was reduced 24 h after X-ray exposure ex-vivo to both low (100 mGy) or high (2 Gy) doses. In conclusion, SARS-CoV-2 infection affects a DNA damage response that may modify radiation-induced health risks in exposed COVID-19 patients.
2023-02-01 | GSE223885 | GEO
Project description:ObjectivesThe objective of this study was to assess the impact of the COVID-19 pandemic, after 2 years, on mammographic screening in Brazil evaluating BIRADS® results, breast cancer diagnosis rates, and breast cancer stage.Study designThis was an ecological observational study based on retrospective data from Brazil's mammographic screening program from 2015 to 2023.MethodsData were obtained from the national screening database DATASUS - SISCAN (Cancer System Information) and retrieved in March 2024. Inclusion criteria comprised completeness of mammogram data (incomplete records were excluded), female participants aged 50 to 69 years, and mammograms exclusively performed for screening purposes. The study analyzed the number of mammograms conducted during the specified period, focusing on BIRADS® test results.ResultsOut of 23,851,371 mammograms performed between 2015 and 2023, 15,000,628 were included for analysis. A significant reduction of 39.6% in mammograms was observed in 2020 compared to 2019, followed by a 12.6% decrease in 2021. Notably, a substantial rise in BIRADS categories 4 and 5 examinations was seen post-pandemic. Breast cancer staging analysis revealed a shift towards more advanced stages (III and IV) diagnosed post-pandemic, suggesting potential delays in detection and diagnosis.ConclusionsIn conclusion, the study highlighted significant discrepancies in mammographic screenings and breast cancer diagnosis rates over 9 years. The pandemic reflected significant influence on the timing and stage at diagnosis, suggesting potential delays in detection and diagnosis that resulted in later identification of more advanced disease stages.
| S-EPMC11580094 | biostudies-literature