Hospitalization, mortality and public healthcare expenditure in Brazil during the COVID-19 crisis: vulnerabilities in the spotlight

ABSTRACT BACKGROUND: Multiple opinion-based communications have highlighted the actions of the Brazilian government during the pandemic. Nevertheless, none have appraised public data to identify factors associated with worsening of the healthcare system. OBJECTIVE: To analyze and collate data from public health and treasury information systems in order to understand the escalating process of weakening of Brazilian healthcare and welfare since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. DESIGN AND SETTING: Secondary data study conducted using multiple public databases administered by the Brazilian federal government. METHODS: We processed information from multiple national databases and appraised health and economic-related data. RESULTS: Based on our analyses, there were substantial reductions in inpatient hospital admissions and in the numbers of patients seeking primary care services, along with a decrease in immunization coverage. Moreover, we observed a considerable decline in government transfers to hospital services (reduction of 82.0%) and a diminution of public outlays in several healthcare-related subfunctions ("hospital and outpatient care", "primary care", "prophylactic and therapeutic support" and "epidemiological surveillance"). We observed an increase in the overall mortality rate over the period analyzed, especially regarding all group-based diseases. Notably, there were remarkable differences among geographic, racial, gender and other parameters, thus revealing the impact of vulnerabilities on COVID-19 outcomes. CONCLUSION: This assessment of documentation of public expenditure and the shrinkage of investment in sensitive areas of the healthcare system in Brazil emphasized areas that still require collective attention in order to guarantee national welfare.

Pre-hospital Care for Suspected Stroke Patients, Cared for by Mobile Emergency Care Units in Northern Minas Gerais

Abstract Background Stroke management require rapid identification, assessment, and transport of patients to qualified health care centers. However, there is little description in the literature on the multiple challenges associated with the pre-hospital transport of suspected stroke patients. Objective To characterize the pre-hospital care provided to suspected stroke patients by the Brazilian Emergency Medical Service (SAMU in Portuguese), by means of a descriptive case study. Methods This is a descriptive study of a series of cases. Data from the SAMU regarding the responses to emergency calls from suspected stroke patients were collected. Independent reviewers confirmed the diagnostic hypothesis and all discordances were assessed using kappa statistics. Clinical data and transport times were described as frequency and proportion or central tendency and dispersion measures. Normality of continuous variable distribution was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used for comparison of medians, with a 5% significance level. Results During the studied period, 556 suspected stroke patients were treated. The kappa index was 0.82 (95% CI 0.737 to 0.919) CI. In 74.7% of the cases, the symptom onset time was not recorded. The median time elapsed between the call for emergency services and the ambulance arrival was 18 minutes, and the median transport time was 38 minutes. A total of 34% of the patients were taken to referral hospitals for stroke. Conclusion This study revealed a low level of knowledge regarding the need to determine the exact time of symptom onset of suspected stroke patients. Also, the study showed the low rate of patients taken to referral hospitals. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Clinical characteristics and outcomes among Brazilian patients with severe acute respiratory syndrome coronavirus 2 infection: an observational retrospective study

ABSTRACT BACKGROUND: Since February 2020, data on the clinical features of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and their clinical evolution have been gathered and intensively discussed, especially in countries with dramatic dissemination of this disease. OBJECTIVE: To assess the clinical features of Brazilian patients with SARS-CoV-2 and analyze its local epidemiological features. DESIGN AND SETTING: Observational retrospective study conducted using data from an official electronic platform for recording confirmed SARS-CoV-2 cases. METHODS: We extracted data from patients based in the state of Pernambuco who were registered on the platform of the Center for Strategic Health Surveillance Information, between February 26 and May 25, 2020. Clinical signs/symptoms, case evolution over time, distribution of confirmed, recovered and fatal cases and relationship between age group and gender were assessed. RESULTS: We included 28,854 patients who were positive for SARS-CoV-2 (56.13% females), of median age 44.18 years. SARS-CoV-2 infection was most frequent among adults aged 30-39 years. Among cases that progressed to death, the most frequent age range was 70-79 years. Overall, the mortality rate in the cohort was 8.06%; recovery rate, 30.7%; and hospital admission rate (up to the end of follow-up), 17.3%. The average length of time between symptom onset and death was 10.3 days. The most commonly reported symptoms were coughing (42.39%), fever (38.03%) and dyspnea/respiratory distress with oxygen saturation < 95% (30.98%). CONCLUSION: Coughing, fever and dyspnea/respiratory distress with oxygen saturation < 95% were the commonest symptoms. The case-fatality rate was 8.06% and the hospitalization rate, 17.3%.

Saúde Mental de Alunos de Medicina Submetidos à Aprendizagem Baseada em Problemas: Revisão Sistemática da Literatura / Mental Health of Medical Students Submitted to Problem-Based Learning: Systematic Literature Review

Resumo: Introdução: O curso de Medicina possui fatores potencialmente estressantes que podem gerar adoecimento psíquico nos alunos. Métodos curriculares alternativos ao sistema tradicional, como aAprendizagem Baseada em Problemas (ABP), podem ter impacto na saúde mentaldos discentes. O objetivo deste estudo foirealizar uma revisão sistemática de estudos que avaliaram a saúde mental de estudantes de Medicina submetidos ao método ABP. Método: Realizou-se uma busca de alta sensibilidade nas principais bases de dados científicas associadas àsaúde mental (CochraneLibrary, Medline via PubMed, Portal Regional da Biblioteca Virtual em Saúde(BVS), Eric e Embase) com inserção até 22 de setembro de 2019. Os descritos indexados e os termos de identificação foram definidos por especialistas e avaliados pelo grupo de tecnologia da informação da Universidade Estadual do Pará.Os critérios de inclusão para os estudos obtidos por meioda busca foram: artigos apresentados na íntegra, escritos em qualquer língua, publicados no período de 1998 a 2018, com foco na saúde mental de alunos do curso de Medicina submetidos ao método ABP. Excluíram-se os trabalhos que não avaliaram a saúde mental, os artigos em que a amostra não foi submetida à metodologia de ensino ABP e aqueles de revisão literária. Após a seleção, os artigos foram avaliados duplamente por revisores independentes quanto ao risco de viés e à qualidade de evidência mediante a ferramenta Robins-I. Resultados: Identificaram-se 1.261 estudos, dos quais se excluíram 1.251 conforme orientaçãodoprotocolo Prisma, restando dezartigos ao final, os quais foram sintetizados de forma descritiva. Em geral, os estudos têm mostrado que o método de ABP, em comparação com o método tradicional, promove melhor desempenho acadêmico, bem como estimula atividades práticas, fato que gera certo grau de satisfação. Conclusão: Os discentes de Medicina submetidos ao método ABP são associados a resultados adequados de aprendizado e desempenho médico-científico. Entretanto,metodologias científicas mais assertivas, baseadas em critérios metodológicos mais rigorosos,são necessárias para elucidar de forma mais abrangente os benefícios e danos dessa metodologia pedagógica.

Abstract: Introduction: Medical students are subjected to potentially stressful factors that can lead to psychological illness. Alternatives to traditional training methods, such as Problem-Based Learning (PBL), can impact on students' mental health. The aim of this study was to carry out a systematic review of studies that evaluate the mental health of medical students submitted to the Problem-Based Learning (PBL) method. Method: A highly sensitive search was carried out in the main scientific databases associated with mental health (Cochrane Library, MEDLINE via PUBMED, Regional Health Portal (VHL), Eric and EMBASE) with inclusion up to September 22, 2019. Indexed descriptions and identification terms were defined by specialists and evaluated by the information technology group of the StateUniversity of Pará. The inclusion criteria for the study search were: articles presented in full, written in any language, published in the period from 1998 to 2018, focusing on the mental health of medical students submitted to the PBLmethod. Articles that did not assess mental health, articles in which the sample was not submitted to PBL, andreview articleswere excluded. After selection, the articles were assessed twice by independent reviewers for risk of bias and quality of evidence using the ROBINS-I tool. Results: 1261 studies were identified, of which 1251 were excluded following the PRISMA protocol, leaving a final sample of ten articles, which were descriptively summarized.In general, studies have shown that PBL, compared to traditional teaching methods, promotes better academic performance, as well as stimulating practical activities, a fact that generates a certain degree of satisfaction. Conclusion: Medical students submitted to the PBL method are more likely to be associated with better learning outcomes and medical-scientific performance. However, better study designs, based on rigorous systematic methodologies are required in order to elucidate the benefits and harms of this educational methodology.