Covid-19 impacts: Ethnic and regional inequalities in sickle cell disease patient care in Brazil.

Brazil is a continental country with significant socioeconomic and ethnic inequalities. It is important to understand how these differences are reflected in health care, especially during the COVID-19 pandemic. We investigated the potential impacts of the reduced number Transcranial Doppler Ultrasound (TCD) tests performed in Brazil during the COVID-19 pandemic, and its reflections according to region and race/color for patients with Sickle Cell Disease (SCD). This study performed data queries from the Brazilian Ministry of Health, literature research, and quantitative analysis using descriptive statistical analysis. We found evidence for a decrease in the number of TCD tests performed during the pandemic (-83 %) relative to the same non-pandemic period, and disparities in tests given in five regions in Brazil. Our data show, that in absolute numbers, most people with SCD are brown, but the highest prevalence of cases was among blacks. We also found evidence for racial discrimination when performing TCD test, which leads us to believe that the Brazilian Unified Health System (SUS) may be susceptible to racism when treating this disease. The implications of these findings serve as a warning to other countries with high indices of mixed ancestry in formulating health care policies for patients with SCD.

Distribution of COVID-19 cases and health resources in Brazil's Amazon region: a spatial analysis. / Distribuição da COVID-19 e dos recursos de saúde na Amazônia Legal: uma análise espacial.

Spatial analysis can help measure the spatial accessibility of health services with a view to improving the allocation of health care resources. The objective of this study was to analyze the spatial distribution of COVID-19 detection rates and health care resources in Brazil's Amazon region. We conducted an ecological study using data on COVID-19 cases and the availability of health care resources in 772 municipalities during two waves of the pandemic. Local and global Bayesian estimation were used to construct choropleth maps. Moran's I was calculated to detect the presence of spatial dependence and Moran maps were used to identify disease clusters. In both periods, Moran's I values indicate the presence of positive spatial autocorrelation in distributions and spatial dependence between municipalities, with only a slight difference between the two estimators. The findings also reveal that case rates were highest in the states of Amapá, Amazonas, and Roraima. The data suggest that health care resources were inefficiently allocated, with higher concentrations of ventilators and ICU beds being found in state capitals.

O método de análise espacial permite mensurar a acessibilidade espacial dos serviços de saúde para alocação dos recursos de forma eficiente e eficaz. Diante disso, o objetivo deste estudo foi analisar a distribuição espacial das taxas de COVID-19 e dos recursos de saúde na Amazônia Legal. Estudo ecológico realizado com casos de COVID-19 e os recursos de saúde nos 772 municípios em dois picos da pandemia. Utilizou-se o método bayesiano global e local para elaboração de mapas coropléticos, com cálculo do índice de Moran para análise da dependência espacial e utilização do Moran map para identificação dos clusters da doença. Os índices de Moran calculados para os dois períodos demonstraram autocorrelação espacial positiva dessa distribuição e dependência espacial entre os municípios nos dois períodos, sem muita diferença entre os dois estimadores. Evidenciaram-se maiores taxas da doença nos estados do Amapá, Amazonas e Roraima. Em relação aos recursos de saúde, observou-se alocação de forma ineficiente, com maior concentração nas capitais.

Distribuição da COVID-19 e dos recursos de saúde na Amazônia Legal: uma análise espacial / Distribution of COVID-19 cases and health resources in Brazil's Amazon region: a spatial analysis

Resumo O método de análise espacial permite mensurar a acessibilidade espacial dos serviços de saúde para alocação dos recursos de forma eficiente e eficaz. Diante disso, o objetivo deste estudo foi analisar a distribuição espacial das taxas de COVID-19 e dos recursos de saúde na Amazônia Legal. Estudo ecológico realizado com casos de COVID-19 e os recursos de saúde nos 772 municípios em dois picos da pandemia. Utilizou-se o método bayesiano global e local para elaboração de mapas coropléticos, com cálculo do índice de Moran para análise da dependência espacial e utilização do Moran map para identificação dos clusters da doença. Os índices de Moran calculados para os dois períodos demonstraram autocorrelação espacial positiva dessa distribuição e dependência espacial entre os municípios nos dois períodos, sem muita diferença entre os dois estimadores. Evidenciaram-se maiores taxas da doença nos estados do Amapá, Amazonas e Roraima. Em relação aos recursos de saúde, observou-se alocação de forma ineficiente, com maior concentração nas capitais.

Abstract Spatial analysis can help measure the spatial accessibility of health services with a view to improving the allocation of health care resources. The objective of this study was to analyze the spatial distribution of COVID-19 detection rates and health care resources in Brazil's Amazon region. We conducted an ecological study using data on COVID-19 cases and the availability of health care resources in 772 municipalities during two waves of the pandemic. Local and global Bayesian estimation were used to construct choropleth maps. Moran's I was calculated to detect the presence of spatial dependence and Moran maps were used to identify disease clusters. In both periods, Moran's I values indicate the presence of positive spatial autocorrelation in distributions and spatial dependence between municipalities, with only a slight difference between the two estimators. The findings also reveal that case rates were highest in the states of Amapá, Amazonas, and Roraima. The data suggest that health care resources were inefficiently allocated, with higher concentrations of ventilators and ICU beds being found in state capitals.

Social, Economic, and Regional Determinants of Mortality in Hospitalized Patients With COVID-19 in Brazil.

On May 10, 2021, Brazil ranked second in the world in COVID-19 deaths. Understanding risk factors, or social and ethnic inequality in health care according to a given city population and political or economic weakness is of paramount importance. Brazil had a seriousness COVID-19 outbreak in light of social and economic factors and its complex racial demographics. The objective of this study was to verify the odds of mortality of hospitalized patients during COVID-19 infection based on their economic, social, and epidemiological characteristics. We found that odds of death are greater among patients with comorbidities, neurological (1.99) and renal diseases (1.97), and immunodeficiency disorders (1.69). While the relative income (2.45) indicates that social factors have greater influence on mortality than the comorbidities studied. Patients living in the Northern macro-region of Brazil face greater chance of mortality compared to those in Central-South Brazil. We conclude that, during the studied period, the chances of mortality for COVID-19 in Brazil were more strongly influenced by socioeconomic poverty conditions than by natural comorbidities (neurological, renal, and immunodeficiency disorders), which were also very relevant. Regional factors are relevant in mortality rates given more individuals being vulnerable to poverty conditions.

Climatic factors associated with economic determinants significantly affect the spread of COVID-19 in tropical Brazil.

OBJECTIVE: This study investigates the spatial differences in the occurrence of COVID-19 in Brazilian Tropical Zone and its relationship with climatic, demographic, and economic factors based on data from February 2020 to May 2021. METHODS: A Linear Regression Model with the GDP per capita, demographic density and climatic factors from 5.534 Brazilian cities with (sub)tropical climate was designed and used to explain the spread of COVID-19 in Brazil. MAIN RESULTS: The model shows evidence that economic, demographic and climate factors maintain a relationship with the variation in the number of cases of COVID-19. The Köppen climate classification defines climatic regions by rainfall and temperature. Some studies have shown an association between temperature and humidity and the survival of SARS-CoV-2. In this cohort study, Brazilian cities located in tropical regions without a dry season (monthly rainfall > 60 mm) showed a greater prevalence than in cities located in tropical regions with a dry season (some monthly rainfall < 60 mm). CONCLUSION: Empirical evidence shows that the Brazil's tropical-climate cities differ in the number (contamination rate) of COVID-19 cases, mainly because of humidity. This study aims to alert the research community and public policy-makers to the trade-off between temperature and humidity for the stability of SARS-COV-2, and the implications for the spread of the virus in tropical climate zones.

Trajetória da Política Nacional de Educação Permanente em Saúde no Brasil / Trajectory of the National Policy of Permanent Education in Health in Brazil / Trayectoria de la Política Nacional de Educación Permanente en Salud en Brasil

Resumo A Política Nacional de Educação Permanente em Saúde estabelece como pressuposto a centralidade nos processos de trabalho para nortear as atividades de qualificação dos trabalhadores da saúde. O presente estudo tem por objetivo discutir a trajetória de institucionalização da Política Nacional de Educação Permanente em Saúde de acordo com a percepção dos atores representativos dessa política pública (gestores federais, gestores estaduais e municipais, e pesquisadores), considerando os 16 anos de sua institucionalização até o ano deste estudo (2004-2020). Trata-se de pesquisa qualitativa, com a aplicação do método Delphi. Os resultados obtidos mostraram que a Política se encontra frágil quanto à sua implantação. No que se refere aos impactos, constatou-se que ela oportunizou o estreitamento da relação entre os serviços de saúde e as instituições de ensino, e promoveu mudanças significativas nos processos de trabalho em equipe, independentemente da sua composição.

Abstract The Brazilian National Policy of Permanent Education in Health establishes as an assumption the centrality in the work processes to guide the qualification activities of health workers. The present study aims to discuss the trajectory of institutionalization of the National Policy of Permanent Education in Health according to the perception of the representative actors of this public policy (federal managers, state and municipal managers, and researchers), considering the 16 years of its institutionalization until the year of this study (2004-2020). This is a qualitative research, with the application of the Delphi method. The results showed that the policy is fragile regarding its implementation. Regarding the impacts, it was found that it facilitated the strengthening of the relationship between health services and educational institutions, and promoted significant changes in teamwork processes, regardless of their composition.

Resumen La Política Nacional de Educación Permanente en Salud de Brasil establece como presupuesto la centralidad en los procesos de trabajo para orientar las actividades de calificación de los trabajadores de la salud. El presente estudio tiene como objetivo discutir la trayectoria de institucionalización de la Política Nacional de Educación Permanente en Salud según la percepción de los representantes de esa política pública (gestores federales, gestores estatales y municipales e investigadores), considerando los 16 años de su institucionalización hasta el año de este estudio (2004-2020). Se trata de una investigación cualitativa, con la aplicación del método Delphi. Los resultados obtenidos mostraron que la política es frágil en cuanto a su implementación. En lo que se refiere a los impactos, se constató que brindó una oportunidad para fortalecer la relación entre los servicios de salud y las instituciones educativas, y promovió cambios significativos en los procesos de trabajo en equipo, independientemente de su composición.

Mortality and Years of Potential Life Lost Due to COVID-19 in Brazil.

In November 2020, Brazil ranked third in the number of cases of coronavirus disease 2019 (COVID-19) and second in the number of deaths due to the disease. We carried out a descriptive study of deaths, mortality rate, years of potential life lost (YPLL) and excess mortality due to COVID-19, based on SARS-CoV-2 records in SIVEP-Gripe (Ministry of Health of Brazil) from 16 February 2020, to 1 January 2021. In this period, there were 98,025 deaths from COVID-19 in Brazil. Men accounted for 60.5% of the estimated 1.2 million YPLLs. High YPLL averages showed prematurity of deaths. The population aged 45-64 years (both sexes) represented more than 50% of all YPLLs. Risk factors were present in 69.5% of deaths, with heart disease, diabetes and obesity representing the most prevalent comorbidities in both sexes. Indigenous people had the lowest number of deaths and the highest average YPLL. However, in indigenous people, pregnant women and mothers had an average YPLL of over 35 years. The excess mortality for Brazil was estimated at 122,914 deaths (9.2%). The results show that the social impacts of YPLL due to COVID-19 are different depending on gender, race and risk factors. YPLL and excess mortality can be used to guide the prioritization of health interventions, such as prioritization of vaccination, lockdowns, or distribution of facial masks for the most vulnerable populations.

The relationship between (sub)tropical climates and the incidence of COVID-19.

This work explores (non)linear associations between relative humidity and temperature and the incidence of COVID-19 among 27 Brazilian state capital cities in (sub)tropical climates, measured daily from summer through winter. Previous works analyses have shown that SARS-CoV-2, the virus that causes COVID-19, finds stability by striking a certain balance between relative humidity and temperature, which indicates the possibility of surface contact transmission. The question remains whether seasonal changes associated with climatic fluctuations might actively influence virus survival. Correlations between climatic variables and infectivity rates of SARS-CoV-2 were applied by the use of a Generalized Additive Model (GAM) and the Locally Estimated Scatterplot Smoothing LOESS nonparametric model. Tropical climates allow for more frequent outdoor human interaction, making such areas ideal for studies on the natural transmission of the virus. Outcomes revealed an inverse relationship between subtropical and tropical climates for the spread of the novel coronavirus and temperature, suggesting a sensitivity behavior to climates zones. Each 1 °C rise of the daily temperature mean correlated with a -11.76% (t = -5.71, p < 0.0001) decrease and a 5.66% (t = 5.68, p < 0.0001) increase in the incidence of COVID-19 for subtropical and tropical climates, respectively.

Temperature significantly changes COVID-19 transmission in (sub)tropical cities of Brazil.

The coronavirus disease 2019 (COVID-19) outbreak has become a severe public health issue. The novelty of the virus prompts a search for understanding of how ecological factors affect the transmission and survival of the virus. Several studies have robustly identified a relationship between temperature and the number of cases. However, there is no specific study for a tropical climate such as Brazil. This work aims to determine the relationship of temperature to COVID-19 infection for the state capital cities of Brazil. Cumulative data with the daily number of confirmed cases was collected from February 27 to April 1, 2020, for all 27 state capital cities of Brazil affected by COVID-19. A generalized additive model (GAM) was applied to explore the linear and nonlinear relationship between annual average temperature compensation and confirmed cases. Also, a polynomial linear regression model was proposed to represent the behavior of the growth curve of COVID-19 in the capital cities of Brazil. The GAM dose-response curve suggested a negative linear relationship between temperatures and daily cumulative confirmed cases of COVID-19 in the range from 16.8 °C to 27.4 °C. Each 1 °C rise of temperature was associated with a -4.8951% (t = -2.29, p = 0.0226) decrease in the number of daily cumulative confirmed cases of COVID-19. A sensitivity analysis assessed the robustness of the results of the model. The predicted R-squared of the polynomial linear regression model was 0.81053. In this study, which features the tropical temperatures of Brazil, the variation in annual average temperatures ranged from 16.8 °C to 27.4 °C. Results indicated that temperatures had a negative linear relationship with the number of confirmed cases. The curve flattened at a threshold of 25.8 °C. There is no evidence supporting that the curve declined for temperatures above 25.8 °C. The study had the goal of supporting governance for healthcare policymakers.