Itinerários terapêuticos de pessoas hospitalizadas por covid-19 no SUS: um estudo quantiqualitativo no Distrito Federal / Therapeutic itineraries of people hospitalized for COVID-19 in the SUS: quantitative and qualitative study in the Federal District

RESUMO Os estudos sobre itinerários terapêuticos revelam modelos de cuidado e decisões tomadas pelas pessoas em situações de adoecimento e podem contribuir para o planejamento de políticas e serviços de saúde mais efetivos, especialmente em emergências como a pandemia de covid-19. O objetivo desta pesquisa foi descrever os itinerários terapêuticos de pacientes hospitalizados por covid-19 em um hospital público do Distrito Federal e explorar associações com determinantes sociais da saúde. Trata-se de um estudo de caso integrado, com triangulação de evidências quantitativas e qualitativas obtidas a partir da análise do banco de dados de um estudo observacional transversal com 233 adultos internados entre maio/2020 e dezembro/2021. A maioria homens, idosos, pretos ou pardos, com baixo nível de renda e escolaridade e múltiplas comorbidades, que procuraram atendimento na atenção especializada e conseguiram acesso rápido ao sistema de saúde. Os fatores que influenciaram a escolha do primeiro serviço foram: ocupação, região de moradia, classe econômica e escolaridade. Já os determinantes da facilidade de acesso foram: tipo de serviço buscado primeiro, gravidade do caso e contexto socioeconômico. Os resultados confirmam a influência de determinantes sociais nas experiências de adoecimento e podem subsidiar reflexões relacionadas à organização do acesso ao SUS em emergências sanitárias.

ABSTRACT Studies on therapeutic itineraries reveal models of care and decisions taken by people in situations of illness and can contribute to the planning of effective health policies and services, especially in emergencies such as the COVID-19 pandemic. The aim of this research was to describe the itineraries of patients hospitalized for COVID-19 in a public hospital in the Federal District and explore associations with social determinants of health. This is an integrated case study, with triangulation of quantitative and qualitative evidence obtained from the analysis of raw data from a cross-sectional observational study with 233 adults hospitalized between May/2020 and December/2021. The majority were men, elderly, black or brown, with low income and education levels and multiple comorbidities, who sought care in specialized care and obtained quick access to the health system. The factors that influenced the choice of the first service sought were: occupation, region of residence, economic class and education. The determinants of ease of access were: type of service first sought, severity of the case and socioeconomic context. The results confirm the influence of social determinants on illness experiences and can support reflections related to the organization of access to the SUS in health emergencies.

Costs of hospital admissions due to COVID-19 in the federal capital of Brazil: a study based on hospital admission authorizations.

This is a cost analysis study based on hospital admissions, conducted from the perspective of the Brazilian Unified Health System (SUS), carried out in a cohort of patients hospitalized at the University Hospital of Brasília (UHB) due to Severe Acute Respiratory Infections (SARI) caused by COVID-19, from April 1, 2020, to March 31, 2022. An approach based on macro-costing was used, considering the costs per patient identified in the Hospital Admission Authorizations (HAA). Were identified 1,015 HAA from 622 patients. The total cost of hospitalizations was R$ 2,875,867.18 for 2020 and 2021. Of this total, 86.41 % referred to hospital services and 13.59 % to professional services. The highest median cost per patient identified was for May 2020 (R$ 19,677.81 IQR [3,334.81-33,041.43]), while the lowest was in January 2021 (R$ 1,698.50 IQR [1,602.70-2,224.11]). The high cost of treating patients with COVID-19 resulted in a high economic burden of SARI due to COVID-19 for UHB and, consequently, for SUS.

Artesunate-mefloquine therapy for uncomplicated Plasmodium falciparum malaria: an updated systematic review and meta-analysis of efficacy and safety.

To provide a continuous update on the safety and efficacy of artesunate-mefloquine (ASMQ) compared with other artemisinin combination therapy (ACT) schemes used in the treatment of uncomplicated malaria caused by Plasmodium falciparum, this study updated and expanded the results of the systematic literature review published in 2016. Only randomised controlled clinical trials published from 1 January 2001 to 12 June 2023 from five databases were included in this study. The results related to efficacy, expressed through RR, were summarized in meta-analyses, performed according to the compared ACTs and with the intention-to-treat and per-protocol analyses. The results related to safety were synthesized in a descriptive manner. Thirty-two studies were included, of which 24 had been analysed in the 2016 review and eight new ones were added. Although the methodological quality of most studies was considered moderate, the body of evidence gathered indicates that ASMQ continues to be safe and effective for the treatment of uncomplicated infections caused by P. falciparum compared with other ACTs. However, the inclusion of two new studies, which identified failure rates exceeding 10%, suggests a possible reduction in the efficacy of ASMQ in the analysed locations. The incidence of serious adverse effects, such as seizure, encephalopathy and cardiac arrhythmia, was infrequent in both the ASMQ group and the comparison groups. After including new evidence, ASMQ is still recommended as a first-line treatment of uncomplicated malaria caused by P. falciparum, although local aspects need to be considered.

Costs of hospital admissions due to COVID-19 in the federal capital of Brazil: a study based on hospital admission authorizations

ABSTRACT This is a cost analysis study based on hospital admissions, conducted from the perspective of the Brazilian Unified Health System (SUS), carried out in a cohort of patients hospitalized at the University Hospital of Brasília (UHB) due to Severe Acute Respiratory Infections (SARI) caused by COVID-19, from April 1, 2020, to March 31, 2022. An approach based on macro-costingwas used,considering thecosts perpatient identified in the Hospital Admission Authorizations (HAA). Were identified 1,015 HAA from 622 patients. The total cost of hospitalizations was R$ 2,875,867.18 for 2020 and 2021. Of this total, 86.41 % referred to hospital services and 13.59 % to professional services. The highest median cost per patient identified was for May 2020 (R$ 19,677.81 IQR [3,334.81-33,041.43]), while the lowest was in January 2021 (R$ 1,698.50 IQR [1,602.70-2,224.11]). The high cost of treating patients with COVID-19 resulted in a high economic burden of SARI due to COVID-19 for UHB and, consequently, for SUS.

Another piece of the Zika puzzle: assessing the associated factors to microcephaly in a systematic review and meta-analysis.

BACKGROUND: Although it is known that Zika virus (ZIKV) infection during pregnancy may lead to microcephaly in the fetus, the prognostic factors associated with this tragic disorder remain unclear. We conducted a systematic review and meta-analysis to assess the prognostic factors associated with the incidence of microcephaly in congenital ZIKV infection. METHODS: We conducted a comprehensive search in Ovid MEDLINE, Ovid MEDLINE (R) Epub ahead of print, Embase, Embase Classic, Web of Science, CINAHL, Cochrane CENTRAL, LILACS, and various thesis databases to identify human studies reporting microcephaly associated with congenital ZIKV infection. We requested primary data from the authors of the included studies to calculate summary estimates and conduct the meta-analysis of the most prevalent factors. RESULTS: We screened 4106 titles and abstracts, and identified 12 studies for inclusion in the systematic review. The assessment of ZIKV infection and the definition of microcephaly varied among studies. A total of 6154 newborns/fetuses were enrolled; of those, 1120 (18.20%) had a diagnostic of ZIKV infection, of which 509 (45.45%) were diagnosed with microcephaly. Nine studies addressed the link between congenital ZIKV infection and neurological findings in newborns/fetuses. Half of the studies provided primary data. Three out of 11 factors of interest seem to be prognostic factors of microcephaly: infant's sex - males compared to females: Relative Risk (RR) 1.30, 95% Confidence Interval (95% CI) 1.14 to 1.49; the stage of pregnancy when infection occurred - infection in the first trimester of pregnancy compared to infection at other stages of pregnancy: RR 1.41, 95% CI 1.09 to 1.82; and asymptomatic infection compared to symptomatic infection during pregnancy: RR 0.68; 95% CI 0.60 to 0.77. CONCLUSION: Our findings support the female-biased resistance hypothesis and reinforce the risk associated with the stage of pregnancy when ZIKV infection occurs. Continued surveillance of ZIKV infection during pregnancy is needed to identify additional factors that could contribute to developing microcephaly in affected fetuses. PROTOCOL REGISTRATION: This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD 42018088075.

A systematic review of economic evaluations of interventions to tackle tuberculosis in homeless people

[ABSTRACT]. Objective. To analyze economic evaluations of interventions related to tuberculosis (TB) diagnostics/screening, treatment, and prevention in homeless people. Methods. A systematic review was conducted. The eligibility criteria were original studies reporting economic evaluation results. The search was not restricted by language or year. A critical appraisal approach was used. Results. A total of 142 studies were identified, including five research articles (three full economic evaluations and two partial) that were selected for the final review. Most of the studies were conducted in the United States, adopted a public health perspective, and analyzed active TB. Interventions related to diagnostics/screening (the use of interferon-gamma release assay (IGRA) and mobile screening units), treatment (incentives for continuing treatment, and housing programs), and prevention (with the Bacillus Calmette–Guérin (BCG) vaccine) were identified. Conclusions. No high-quality data were found on cost-effectiveness of interventions on TB diagnostics/screening, treatment, or prevention in homeless people. However, active searching for cases via mobile screening, and financial incentives, could help increase treatment adherence, and the use of IGRA helps boost detection. TB in homeless people is neglected worldwide, especially in developing countries, where this disease tends to afflict more people made vulnerable by their precarious living conditions. Public funding mechanisms should be created to develop cross-sectoral actions targeting homeless people, as the complex dynamics of this group tend to hamper prevention and diagnosis of TB and the completion of TB treatment.

[RESUMEN]. Objetivo. Analizar la evaluación económica de intervenciones relacionadas con el diagnóstico y tamizaje, el tratamiento y la prevención de la tuberculosis en las personas sin hogar. Métodos. Se realizó una revisión sistemática en la cual se usó como criterio de selección estudios originales en los que se presentaran los resultados de una evaluación económica. No se restringió la búsqueda por idioma ni por año. Se usó el enfoque de la evaluación crítica. Resultados. Se encontraron en total 142 estudios, entre los cuales había cinco artículos de investigación (tres evaluaciones económicas completas y dos parciales) que se seleccionaron para la revisión final. En la mayoría de los estudios, realizados en los Estados Unidos, se adoptó una perspectiva de salud pública y se analizó la tuberculosis activa. Se encontraron intervenciones relacionadas con el diagnóstico y tamizaje (el uso de la prueba de liberación de interferón gamma —IGRA, por su sigla en inglés— y los equipos móviles de tamizaje), el tratamiento (incentivos para continuar el tratamiento y programas de viviendas) y la prevención (el uso de la vacuna BCG). Conclusiones. No se encontraron datos de calidad alta sobre la costo-efectividad de las intervenciones relacionadas con el diagnóstico o tamizaje, el tratamiento o la prevención de la tuberculosis en personas sin hogar. Sin embargo, la búsqueda activa de casos mediante el uso de equipos móviles para el tamizaje, así como los incentivos financieros, podrían ayudar a aumentar la adhesión al tratamiento; además, el uso de la prueba IGRA ayuda a lograr una mayor detección. La tuberculosis en las personas sin hogar se subestima en todo el mundo, especialmente en los países en desarrollo donde esta enfermedad tiende a afectar a más personas que pasan a ser vulnerables por la precariedad de sus condiciones de vida. Deben crearse mecanismos de financiamiento con fondos públicos para llevar adelante medidas intersectoriales dirigidas a las personas sin hogar, puesto que la compleja dinámica de este grupo tiende a obstaculizar tanto la prevención y el diagnóstico de la tuberculosis como la finalización del tratamiento antituberculoso.

[RESUMO]. Objetivo. Examinar as análises econômicas de intervenções relacionadas à prevenção, detecção precoce/diagnóstico e tratamento da tuberculose (TB) em pessoas sem-teto. Métodos. Foi realizada uma revisão sistemática. Os critérios para inclusão foram estudo original contendo resultados de análise econômica. A busca não foi restrita por idioma ou ano. Foi usada uma abordagem de análise crítica. Resultados. Foram identificados ao todo 142 estudos, dentre eles cinco artigos de pesquisa (três análises econômicas completas e duas parciais) que foram selecionados para a revisão final. A maioria dos estudos foi realizada nos Estados Unidos, partindo de uma perspectiva de saúde pública e com análise de TB ativa. Foram identificadas intervenções relacionadas à detecção precoce/diagnóstico (ensaio de liberação de interferon-gama [IGRA] e unidades móveis para prevenção), tratamento (incentivos para o tratamento continuado e programas de moradia) e prevenção (vacinação com o bacilo de Calmette-Guérin [BCG]). Conclusões. Não foram encontrados dados de alta qualidade sobre o custo-efetividade das intervenções de detecção precoce/diagnóstico, tratamento ou prevenção de TB em pessoas sem-teto. Porém, a busca ativa de casos por meio da triagem em unidades móveis e incentivos financeiros poderiam ajudar a melhorar a adesão ao tratamento e o uso do IGRA intensifica a detecção de infecção. A TB em pessoas sem-teto é uma doença negligenciada em todo o mundo, principalmente nos países em desenvolvimento onde ela costuma afligir um número maior de pessoas por sua vulnerabilidade devido às condições de vida precárias. Mecanismos públicos de financiamento devem ser criados para desenvolver ações intersetoriais voltadas aos sem-teto, porque a dinâmica complexa deste grupo dificulta a prevenção, o diagnóstico e a conclusão do tratamento de TB.

A systematic review of economic evaluations of interventions to tackle tuberculosis in homeless people.

OBJECTIVE: To analyze economic evaluations of interventions related to tuberculosis (TB) diagnostics/screening, treatment, and prevention in homeless people. METHODS: A systematic review was conducted. The eligibility criteria were original studies reporting economic evaluation results. The search was not restricted by language or year. A critical appraisal approach was used. RESULTS: A total of 142 studies were identified, including five research articles (three full economic evaluations and two partial) that were selected for the final review. Most of the studies were conducted in the United States, adopted a public health perspective, and analyzed active TB. Interventions related to diagnostics/screening (the use of interferon-gamma release assay (IGRA) and mobile screening units), treatment (incentives for continuing treatment, and housing programs), and prevention (with the Bacillus Calmette-Guérin (BCG) vaccine) were identified. CONCLUSIONS: No high-quality data were found on cost-effectiveness of interventions on TB diagnostics/screening, treatment, or prevention in homeless people. However, active searching for cases via mobile screening, and financial incentives, could help increase treatment adherence, and the use of IGRA helps boost detection. TB in homeless people is neglected worldwide, especially in developing countries, where this disease tends to afflict more people made vulnerable by their precarious living conditions. Public funding mechanisms should be created to develop cross-sectoral actions targeting homeless people, as the complex dynamics of this group tend to hamper prevention and diagnosis of TB and the completion of TB treatment.

A systematic review of economic evaluations of interventions to tackle tuberculosis in homeless people / Evaluación económica de intervenciones para abordar la tuberculosis en las personas sin hogar: revisión sistemática / Revisão sistemática de análises econômicas de intervenções para combater a tuberculose em pessoas sem-teto

ABSTRACT Objective To analyze economic evaluations of interventions related to tuberculosis (TB) diagnostics/screening, treatment, and prevention in homeless people. Methods A systematic review was conducted. The eligibility criteria were original studies reporting economic evaluation results. The search was not restricted by language or year. A critical appraisal approach was used. Results A total of 142 studies were identified, including five research articles (three full economic evaluations and two partial) that were selected for the final review. Most of the studies were conducted in the United States, adopted a public health perspective, and analyzed active TB. Interventions related to diagnostics/screening (the use of interferon-gamma release assay (IGRA) and mobile screening units), treatment (incentives for continuing treatment, and housing programs), and prevention (with the Bacillus Calmette-Guérin (BCG) vaccine) were identified. Conclusions No high-quality data were found on cost-effectiveness of interventions on TB diagnostics/screening, treatment, or prevention in homeless people. However, active searching for cases via mobile screening, and financial incentives, could help increase treatment adherence, and the use of IGRA helps boost detection. TB in homeless people is neglected worldwide, especially in developing countries, where this disease tends to afflict more people made vulnerable by their precarious living conditions. Public funding mechanisms should be created to develop cross-sectoral actions targeting homeless people, as the complex dynamics of this group tend to hamper prevention and diagnosis of TB and the completion of TB treatment.

RESUMEN Objetivo Analizar la evaluación económica de intervenciones relacionadas con el diagnóstico y tamizaje, el tratamiento y la prevención de la tuberculosis en las personas sin hogar. Métodos Se realizó una revisión sistemática en la cual se usó como criterio de selección estudios originales en los que se presentaran los resultados de una evaluación económica. No se restringió la búsqueda por idioma ni por año. Se usó el enfoque de la evaluación crítica. Resultados Se encontraron en total 142 estudios, entre los cuales había cinco artículos de investigación (tres evaluaciones económicas completas y dos parciales) que se seleccionaron para la revisión final. En la mayoría de los estudios, realizados en los Estados Unidos, se adoptó una perspectiva de salud pública y se analizó la tuberculosis activa. Se encontraron intervenciones relacionadas con el diagnóstico y tamizaje (el uso de la prueba de liberación de interferón gamma —IGRA, por su sigla en inglés— y los equipos móviles de tamizaje), el tratamiento (incentivos para continuar el tratamiento y programas de viviendas) y la prevención (el uso de la vacuna BCG). Conclusiones No se encontraron datos de calidad alta sobre la costo-efectividad de las intervenciones relacionadas con el diagnóstico o tamizaje, el tratamiento o la prevención de la tuberculosis en personas sin hogar. Sin embargo, la búsqueda activa de casos mediante el uso de equipos móviles para el tamizaje, así como los incentivos financieros, podrían ayudar a aumentar la adhesión al tratamiento; además, el uso de la prueba IGRA ayuda a lograr una mayor detección. La tuberculosis en las personas sin hogar se subestima en todo el mundo, especialmente en los países en desarrollo donde esta enfermedad tiende a afectar a más personas que pasan a ser vulnerables por la precariedad de sus condiciones de vida. Deben crearse mecanismos de financiamiento con fondos públicos para llevar adelante medidas intersectoriales dirigidas a las personas sin hogar, puesto que la compleja dinámica de este grupo tiende a obstaculizar tanto la prevención y el diagnóstico de la tuberculosis como la finalización del tratamiento antituberculoso.

RESUMO Objetivo Examinar as análises econômicas de intervenções relacionadas à prevenção, detecção precoce/diagnóstico e tratamento da tuberculose (TB) em pessoas sem-teto. Métodos Foi realizada uma revisão sistemática. Os critérios para inclusão foram estudo original contendo resultados de análise econômica. A busca não foi restrita por idioma ou ano. Foi usada uma abordagem de análise crítica. Resultados Foram identificados ao todo 142 estudos, dentre eles cinco artigos de pesquisa (três análises econômicas completas e duas parciais) que foram selecionados para a revisão final. A maioria dos estudos foi realizada nos Estados Unidos, partindo de uma perspectiva de saúde pública e com análise de TB ativa. Foram identificadas intervenções relacionadas à detecção precoce/diagnóstico (ensaio de liberação de interferon-gama [IGRA] e unidades móveis para prevenção), tratamento (incentivos para o tratamento continuado e programas de moradia) e prevenção (vacinação com o bacilo de Calmette-Guérin [BCG]). Conclusões Não foram encontrados dados de alta qualidade sobre o custo-efetividade das intervenções de detecção precoce/diagnóstico, tratamento ou prevenção de TB em pessoas sem-teto. Porém, a busca ativa de casos por meio da triagem em unidades móveis e incentivos financeiros poderiam ajudar a melhorar a adesão ao tratamento e o uso do IGRA intensifica a detecção de infecção. A TB em pessoas sem-teto é uma doença negligenciada em todo o mundo, principalmente nos países em desenvolvimento onde ela costuma afligir um número maior de pessoas por sua vulnerabilidade devido às condições de vida precárias. Mecanismos públicos de financiamento devem ser criados para desenvolver ações intersetoriais voltadas aos sem-teto, porque a dinâmica complexa deste grupo dificulta a prevenção, o diagnóstico e a conclusão do tratamento de TB.

Evidências científicas no campo da saúde coletiva: da pergunta à formulação de estratégia de busca / Scientific evidence in the field of collective health: from the question to the formultion of search strategy

INTRODUÇÃO: A crescente produção técnica e científica na saúde coletiva ao longo dos anos requer dos profissionais e gestores habilidade para encontrar evidencias úteis para os sistemas de serviços de saúde e suas práticas. OBJETIVO: Auxiliar os leitores a identificar a produção cientifica de forma atualizada e proveniente de diversas fontes de informação. MÉTODOS: Diante da diversidade de fontes de evidências científicas e suas especificidades técnicas, foram descritas as considerações básicas para planejamento e condução de buscas estruturadas. RESULTOS: Foi apresentada uma relação de bases estratégicas na área de Saúde Coletiva e um detalhamento para orientar ao leitor como realizar buscas estruturadas no Pubmed e na Biblioteca Virtual em Saúde (BVS). CONCLUSÃO: A obtenção sistematizada e explícita das evidências para responder a perguntas em saúde coletiva é uma prática que necessita ser estimulada para melhor embasar decisões de políticas, sistemas e serviços de saúde.

INTRODUCTION: The increasing technical and scientific production in public health over the years requires from professionals and managersthe hability to find evidence that is useful for health care services systems and its practices. OBJECTIVE: To assist readers to identify updated scientific production and are from different sources of information. METHODS: Considering the diversity of scientific evidence sources and their technical specificities, basic considerations for planning and conducting structured searches were described. RESULTS: A list of strategic data bases was presented for the Public Health field and a detailed guide was described to the reader of how to carry out structured searches in Pubmed and the Virtual Health Library (BVS). CONCLUSION: A systematized and explicit was obtained from the evidence in order to answer questions concerning public health is a practice that needs to be stimulated to better inform health care decision makers, systems and services.