Sociodemographic inequalities in the incidence of COVID-19 in National Household Sample Survey cohort, Brazil, 2020.

OBJECTIVE: To verify the association between sociodemographic factors and the time until the occurrence of new cases of COVID-19 and positive tests for SARS-CoV-2 in Brazil, during the period from May to November 2020, based on a cohort of Brazilians participating in the COVID-19 National Household Sample Survey. METHODS: A concurrent and closed cohort was created using monthly data from the PNAD COVID-19, carried out via telephone survey. A new case was defined based on the report of the occurrence of a flu-like syndrome, associated with loss of smell or taste; and positivity was defined based on the report of a positive test, among those who reported having been tested. Cox regression models were applied to verify associations. The analyzes took into account sample weighting, calibrated for age, gender and education distribution. RESULTS: The cumulative incidence of cases in the overall fixed cohort was 2.4%, while that of positive tests in the fixed tested cohort was 27.1%. Higher incidences were observed in the North region, in females, in residents of urban areas and in individuals with black skin color. New positive tests occurred more frequently in individuals with less education and healthcare workers. CONCLUSION: The importance of prospective national surveys is highlighted, contributing to detailed analyzes of social inequalities in reports focused on public health policies.

Evaluating the relationship between conditional cash transfer programme on preterm births: a retrospective longitudinal study using the 100 million Brazilian cohort.

BACKGROUND: Preterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management. METHODS: A retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32-36), (iii) severe (28-31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management. RESULTS: 1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63-0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59-0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43-0.74). CONCLUSIONS: An income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.

Sociodemographic inequalities in the incidence of COVID-19 in National Household Sample Survey cohort, Brazil, 2020 / Desigualdades sociodemográficas na incidência de COVID-19 em coorte da Pesquisa Nacional por Amostra de Domicílios, Brasil, 2020

ABSTRACT Objective: To verify the association between sociodemographic factors and the time until the occurrence of new cases of COVID-19 and positive tests for SARS-CoV-2 in Brazil, during the period from May to November 2020, based on a cohort of Brazilians participating in the COVID-19 National Household Sample Survey. Methods: A concurrent and closed cohort was created using monthly data from the PNAD COVID-19, carried out via telephone survey. A new case was defined based on the report of the occurrence of a flu-like syndrome, associated with loss of smell or taste; and positivity was defined based on the report of a positive test, among those who reported having been tested. Cox regression models were applied to verify associations. The analyzes took into account sample weighting, calibrated for age, gender and education distribution. Results: The cumulative incidence of cases in the overall fixed cohort was 2.4%, while that of positive tests in the fixed tested cohort was 27.1%. Higher incidences were observed in the North region, in females, in residents of urban areas and in individuals with black skin color. New positive tests occurred more frequently in individuals with less education and healthcare workers. Conclusion: The importance of prospective national surveys is highlighted, contributing to detailed analyzes of social inequalities in reports focused on public health policies.

RESUMO Objetivo: Verificar a associação entre fatores sociodemográficos e o tempo até a ocorrência de novos casos de COVID-19 e de testes positivos para Sars-CoV-2 no Brasil, durante o período de maio a novembro de 2020, com base em uma coorte dos brasileiros participantes da Pesquisa Nacional por Amostra de Domicílios COVID-19. Métodos: Foi constituída uma coorte concorrente e fechada utilizando dados mensais da Pnad COVID-19, realizada por inquérito telefônico. Um caso novo foi definido com base no relato da ocorrência de um quadro de síndrome gripal, associado à perda de olfato ou paladar; e a positividade foi definida com base no relato de um teste positivo, entre os que referiram ter sido testados. Foram aplicados modelos de regressão de Cox para verificar associações, considerando a ponderação amostral, calibrada para a distribuição etária, de sexos e de escolaridade. Resultados: A incidência acumulada de casos na coorte fixa geral foi de 2,4%, enquanto a de testes positivos na coorte fixa testada foi de 27,1%. Verificou-se maiores riscos nas regiões Centro-Oeste, Norte e Nordeste, entre mulheres, residentes em áreas urbanas, pessoas com escolaridade até o ensino médio, com a cor da pele declarada como preta e trabalhadores da área da saúde. Indivíduos com menor escolaridade e profissionais de saúde apresentaram maior frequência de novos testes positivos. Novos testes positivos ocorreram com maior frequência em indivíduos com menor escolaridade e trabalhadores da área da saúde. Conclusão: Foram observados riscos desiguais entre os estratos populacionais comparados. Destaca-se a importância da realização de inquéritos nacionais prospectivos na investigação de iniquidades em saúde.

Participation in Conditional Cash Transfer Program During Pregnancy and Birth Weight-Related Outcomes.

Importance: There is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes. Objective: To investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators. Design, Setting, and Participants: This cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023. Exposure: Live births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery. Main Outcomes and Measures: Low birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as "brown" and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins. Results: A total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88). Conclusions and Relevance: This study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight-related outcomes.

Prevalence of adult smokers in Brazilian capitals according to socioeconomic deprivation.

OBJECTIVE: To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP). METHODS: Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capitals and the Federal District, in the period from 2010 to 2013. The IBP classifies the census sectors according to indicators such as: income less than ½ minimum wage, illiterate population and without sanitary sewage. In the North and Northeast regions, the census sectors were grouped into four categories (low, medium, high and very high deprivation) and in the South, Southeast and Midwest regions into three (low, medium and high deprivation). Prevalence estimates of adult smokers were obtained using the indirect estimation method in small areas. To calculate the prevalence ratios, Poisson models are used. RESULTS: The positive association between prevalence and deprivation of census sector categories was found in 16 (59.3%) of the 27 cities. In nine (33.3%) cities, the sectors with the greatest deprivation had a higher prevalence of smokers when compared to those with the least deprivation, and in two (7.4%) there were no differences. In Aracaju, Belém, Fortaleza, João Pessoa, Macapá and Salvador, the prevalence of adult smokers was three times higher in the group of sectors with greater deprivation compared to those with less deprivation. CONCLUSION: Sectors with greater social deprivation had a higher prevalence of smoking, compared with less deprivation, pointing to social inequalities.

Prevalence of adult smokers in Brazilian capitals according to socioeconomic deprivation / Prevalência de fumantes adultos nas capitais brasileiras, segundo privação socioeconômica

ABSTRACT Objective: To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP). Methods: Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capitals and the Federal District, in the period from 2010 to 2013. The IBP classifies the census sectors according to indicators such as: income less than ½ minimum wage, illiterate population and without sanitary sewage. In the North and Northeast regions, the census sectors were grouped into four categories (low, medium, high and very high deprivation) and in the South, Southeast and Midwest regions into three (low, medium and high deprivation). Prevalence estimates of adult smokers were obtained using the indirect estimation method in small areas. To calculate the prevalence ratios, Poisson models are used. Results: The positive association between prevalence and deprivation of census sector categories was found in 16 (59.3%) of the 27 cities. In nine (33.3%) cities, the sectors with the greatest deprivation had a higher prevalence of smokers when compared to those with the least deprivation, and in two (7.4%) there were no differences. In Aracaju, Belém, Fortaleza, João Pessoa, Macapá and Salvador, the prevalence of adult smokers was three times higher in the group of sectors with greater deprivation compared to those with less deprivation. Conclusion: Sectors with greater social deprivation had a higher prevalence of smoking, compared with less deprivation, pointing to social inequalities.

RESUMO Objetivo: Estimar as prevalências de adultos fumante nas 26 capitais e no Distrito Federal segundo o Índice Brasileiro de Privação. Métodos: Os dados sobre tabagismo foram obtidos junto ao sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito (Vigitel) para as 26 capitais e o Distrito Federal, no período de 2010 a 2013. O Índice Brasileiro de Privação classifica os setores censitários segundo indicadores como: renda menor que meio salário mínimo, população não alfabetizada e sem esgotamento sanitário. Nas regiões Norte e Nordeste, os setores censitários foram agrupados em quatro categorias (baixa, média, alta e muito alta privação) e, nas regiões Sul, Sudeste e Centro-Oeste, em três (baixa, média e alta privação). As estimativas de prevalências de adultos fumantes foram obtidas pelo método indireto de estimação em pequenas áreas. Para o cálculo das razões de prevalências, empregram-se modelos de Poisson. Resultados: A associação positiva entre a prevalência e a privação das categorias de setores censitários foi encontrada em 16 (59,3%) das 27 cidades. Em nove (33,3%) cidades, os setores de maior privação apresentaram maior prevalência de fumantes quando comparados aos de menor privação e, em duas (7,4%), não apresentaram diferenças. Em Aracaju, Belém, Fortaleza, João Pessoa, Macapá e Salvador, as prevalências de adultos fumantes foram três vezes maiores no grupo de setores com maior privação em relação aos de menor privação. Conclusão: Setores de maior privação social apresentaram maiores prevalências de tabagismo, comparados com menor privação, apontando desigualdades sociais.

Biases arising from linked administrative data for epidemiological research: a conceptual framework from registration to analyses.

Linked administrative data offer a rich source of information that can be harnessed to describe patterns of disease, understand their causes and evaluate interventions. However, administrative data are primarily collected for operational reasons such as recording vital events for legal purposes, and planning, provision and monitoring of services. The processes involved in generating and linking administrative datasets may generate sources of bias that are often not adequately considered by researchers. We provide a framework describing these biases, drawing on our experiences of using the 100 Million Brazilian Cohort (100MCohort) which contains records of more than 131 million people whose families applied for social assistance between 2001 and 2018. Datasets for epidemiological research were derived by linking the 100MCohort to health-related databases such as the Mortality Information System and the Hospital Information System. Using the framework, we demonstrate how selection and misclassification biases may be introduced in three different stages: registering and recording of people's life events and use of services, linkage across administrative databases, and cleaning and coding of variables from derived datasets. Finally, we suggest eight recommendations which may reduce biases when analysing data from administrative sources.

Differentials in death count records by databases in Brazil in 2010.

OBJECTIVE: To compare the death counts from three sources of information on mortality available in Brazil in 2010, the Mortality Information System (SIM - Sistema de Informações sobre Mortalidade ), Civil Registration Statistic System (RC - Sistema de Estatísticas de Resgistro Civil ), and the 2010 Demographic Census at various geographical levels, and to confirm the association between municipal socioeconomic characteristics and the source which showed the highest death count. METHODS: This is a descriptive and comparative study of raw data on deaths in the SIM, RC and 2010 Census databases, the latter held in Brazilian states and municipalities between August 2009 and July 2010. The percentage of municipalities was confirmed by the database showing the highest death count. The association between the source of the highest death count and socioeconomic indicators - the Índice de Privação Brasileiro (IBP - Brazilian Deprivation Index) and Índice de Desenvolvimento Humano Municipal (IHDM - Municipal Human Development Index) - was performed by bivariate choropleth and Moran Local Index of Spatial Association (LISA) cluster maps. RESULTS: Confirmed that the SIM is the database with the highest number of deaths counted for all Brazilian macroregions, except the North, in which the highest coverage was from the 2010 Census. Based on the indicators proposed, in general, the Census showed a higher coverage of deaths than the SIM and the RC in the most deprived (highest IBP values) and less developed municipalities (lowest IDHM values) in the country. CONCLUSION: The results highlight regional inequalities in how the databases chosen for this study cover death records, and the importance of maintaining the issue of mortality on the basic census questionnaire.

Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review.

OBJECTIVE: Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS: This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS: Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS: Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.

EVOLUTION OF POLICIES RELATED TO CHILD CARE WITHIN THE SCOPE OF PRIMARY HEALTH CARE (PHC) IN BRAZIL / EVOLUÇÃO DAS POLÍTICAS RELACIONADAS À SAÚDE DA CRIANÇA NO ÂMBITO DA ATENÇÃO PRIMÁRIA BRASILEIRA

Introdução: As políticas públicas são essenciais para reduzir a morbimortalidade infantil. Este estudo descreve a evolução das políticas relacionadas à atenção à criança no âmbito da Atenção Primária à Saúde (APS) no Brasil, implementadas desde a criação do Sistema Único de Saúde (SUS). Metodologia: Revisão narrativa da literatura com base nos principais marcos regulatórios com influência direta ou indireta na Atenção à Saúde da Criança (ACS) na APS, publicados entre 1990 e 2017. Resultados: Foram analisados ​​31 documentos oficiais, organizados em uma linha do tempo e classificados em três categorias: I) Normas do SUS e da APS; II) diretrizes para os serviços de saúde materno-infantil no âmbito da APS; e, III) políticas intersetoriais. Conclusão:A evolução das políticas de CSC no Brasil é marcada por uma série de conquistas em prol da ampliação dos direitos sociais e da garantia do direito à saúde que ampliou o acesso aos serviços de saúde e contribuiu para a melhoria das condições de vida e de vida das crianças. No entanto, as desigualdades sociais e os desafios no acesso e qualidade da atenção na APS são persistentes, com retrocessos causados ​​pela implementação de medidas de austeridade desde 2016.

Introdução: Políticas públicas são fundamentais para a redução da morbimortalidade na infância. O presente estudo descreve uma evolução política relacionada à Atenção Primária à Saúde da Criança no âmbito da Atenção Primária Saúde (APS) no Brasil, desde a criação do Sistema Único de Saúde (SUS). Metodologia: Revisão narrativa da literatura com base nos principais marcos normativos com influência na Atenção à Saúde da Criança no âmbito da APS, publicados entre 1990 e 2017. Resultados: Foram analisados 31 documentos oficiais, distribuídos numa linha do tempo, classificados em: I) normatização do SUS e da APS; II) orientação aos serviços de saúde materno-infantil no âmbito da APS e III) políticas intersetoriais. Conclusão: A evolução das políticas pensadas no Brasil está marcada para serviços e como soluções da série de direitos sociais e como possibilidades de vistas da vida. Porém, além das desigualdades sociais, desafios no acesso e na qualidade do cuidado na APS se fazem persistentes, com retrocessos são persistentes agravados com a capacidade de trabalhar1 em medidas de austeridade curso desde 206.

Organization and offer of physical therapy care in response to the COVID-19 pandemic in Brazil. / Organização e oferta da assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil.

The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous physical therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in three dimensions: offering physical therapy assistance in PHC, outpatient care, via telehealth. It is concluded that functional rehabilitation depends on the PHC's response capacity; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; although telehealth is a resource and an opportunity to increase the population's access to functional rehabilitation, its use requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

A recuperação das pessoas acometidas pela COVID-19 é um processo que continua para além do quadro agudo da infecção pelo Sars-CoV-2. O comprometimento de diversos sistemas corporais pode acarretar impactos funcionais e demandar assistência fisioterapêutica contínua tanto na atenção ambulatorial quanto na atenção primária à saúde (APS). Neste ensaio, busca-se discutir os desafios da organização e da oferta de assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil. A análise foi sumarizada em três dimensões: oferta da assistência fisioterapêutica na APS e na atenção ambulatorial, e oferta de atenção fisioterapêutica por telessaúde. Conclui-se que: a reabilitação funcional depende da capacidade de resposta da APS; existe um déficit de serviços de reabilitação que antecede a pandemia, e pode comprometer respostas satisfatórias às demandas do atual contexto epidemiológico; faz-se necessária a articulação entre as equipes de fisioterapia ambulatorial e da APS; embora a telessaúde seja um recurso e uma oportunidade para ampliar o acesso da população à reabilitação funcional, sua utilização exige cautela; o fisioterapeuta possui papel crucial em todo o continuum de cuidados da COVID-19.

Organização e oferta da assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil / Organization and offer of physical therapy care in response to the COVID-19 pandemic in Brazil

Resumo A recuperação das pessoas acometidas pela COVID-19 é um processo que continua para além do quadro agudo da infecção pelo Sars-CoV-2. O comprometimento de diversos sistemas corporais pode acarretar impactos funcionais e demandar assistência fisioterapêutica contínua tanto na atenção ambulatorial quanto na atenção primária à saúde (APS). Neste ensaio, busca-se discutir os desafios da organização e da oferta de assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil. A análise foi sumarizada em três dimensões: oferta da assistência fisioterapêutica na APS e na atenção ambulatorial, e oferta de atenção fisioterapêutica por telessaúde. Conclui-se que: a reabilitação funcional depende da capacidade de resposta da APS; existe um déficit de serviços de reabilitação que antecede a pandemia, e pode comprometer respostas satisfatórias às demandas do atual contexto epidemiológico; faz-se necessária a articulação entre as equipes de fisioterapia ambulatorial e da APS; embora a telessaúde seja um recurso e uma oportunidade para ampliar o acesso da população à reabilitação funcional, sua utilização exige cautela; o fisioterapeuta possui papel crucial em todo o continuum de cuidados da COVID-19.

Abstract The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous physical therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in three dimensions: offering physical therapy assistance in PHC, outpatient care, via telehealth. It is concluded that functional rehabilitation depends on the PHC's response capacity; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; although telehealth is a resource and an opportunity to increase the population's access to functional rehabilitation, its use requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review

ABSTRACT OBJECTIVE Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.

Differentials in death count records by databases in Brazil in 2010

ABSTRACT OBJECTIVE To compare the death counts from three sources of information on mortality available in Brazil in 2010, the Mortality Information System (SIM - Sistema de Informações sobre Mortalidade ), Civil Registration Statistic System (RC - Sistema de Estatísticas de Resgistro Civil ), and the 2010 Demographic Census at various geographical levels, and to confirm the association between municipal socioeconomic characteristics and the source which showed the highest death count. METHODS This is a descriptive and comparative study of raw data on deaths in the SIM, RC and 2010 Census databases, the latter held in Brazilian states and municipalities between August 2009 and July 2010. The percentage of municipalities was confirmed by the database showing the highest death count. The association between the source of the highest death count and socioeconomic indicators - the Índice de Privação Brasileiro (IBP - Brazilian Deprivation Index) and Índice de Desenvolvimento Humano Municipal (IHDM - Municipal Human Development Index) - was performed by bivariate choropleth and Moran Local Index of Spatial Association (LISA) cluster maps. RESULTS Confirmed that the SIM is the database with the highest number of deaths counted for all Brazilian macroregions, except the North, in which the highest coverage was from the 2010 Census. Based on the indicators proposed, in general, the Census showed a higher coverage of deaths than the SIM and the RC in the most deprived (highest IBP values) and less developed municipalities (lowest IDHM values) in the country. CONCLUSION The results highlight regional inequalities in how the databases chosen for this study cover death records, and the importance of maintaining the issue of mortality on the basic census questionnaire.

Methods to evaluate COVID-19 vaccine effectiveness, with an emphasis on quasi-experimental approaches. / Métodos para avaliação da efetividade de vacinas para COVID-19 com ênfase em abordagens quase-experimentais.

The evaluation of vaccine effectiveness is conducted with real-world data. They are essential to monitor the performance of vaccination programmes over time, and in the context of the emergence of new variants. Until now, the effectiveness of COVID-19 vaccines has been assessed based on classic methods, such as cohort and test-negative case-control studies, which may often not allow for adequate control of inherent biases in the assignment of vaccination campaigns. The aim of this review was to discuss the study designs available to evaluate vaccine effectiveness, highlighting quasi-experimental studies, which seek to mimic randomized trials, by introducing an exogenous component to allocate to treatment, in addition to the advantages, limitations, and applicability in the context of Brazilian data. The use of quasi-experimental approaches, such as interrupted time series, difference-in-differences, propensity scores, instrumental variables, and regression discontinuity design, are relevant due to the possibility of providing more accurate estimates of COVID-19 vaccine effectiveness. This is especially important in scenarios such as the Brazilian, which characterized by the use of various vaccines, with the respective numbers and intervals between doses, applied to different age groups, and introduced at different times during the pandemic.

A avalição da efetividade de vacinas é feita com dados do mundo real e é essencial para monitorar o desempenho dos programas de vacinação ao longo do tempo bem como frente a novas variantes. Até o momento, a avaliação da efetividade das vacinas para COVID-19 tem sido baseada em métodos clássicos como estudos de coorte e caso controle teste-negativo, que muitas vezes podem não permitir o adequado controle dos vieses intrínsecos da alocação das campanhas de vacinação. O objetivo dessa revisão foi discutir os desenhos de estudo disponíveis para avaliação de efetividade das vacinas, enfatizando os estudos quase-experimentais, que buscam mimetizar os estudos aleatorizados ao introduzir um componente exógeno para atribuição ao tratamento, bem como suas vantagens, limitações e aplicabilidade no contexto dos dados brasileiros. O emprego de métodos quase-experimentais, incluindo as séries temporais interrompidas, o método de diferença em diferenças, escore de propensão, variáveis instrumentais e regressão descontínua, são relevantes pela possibilidade de gerar estimativas mais acuradas da efetividade de vacinas para COVID-19 em cenários como o brasileiro, que se caracteriza pelo uso de várias vacinas, com respectivos número e intervalos entre doses, aplicadas em diferentes faixas etárias e em diferentes momentos da pandemia.

Métodos para avaliação da efetividade de vacinas para COVID-19 com ênfase em abordagens quase-experimentais / Methods to evaluate COVID-19 vaccine effectiveness, with an emphasis on quasi-experimental approaches

Resumo A avalição da efetividade de vacinas é feita com dados do mundo real e é essencial para monitorar o desempenho dos programas de vacinação ao longo do tempo bem como frente a novas variantes. Até o momento, a avaliação da efetividade das vacinas para COVID-19 tem sido baseada em métodos clássicos como estudos de coorte e caso controle teste-negativo, que muitas vezes podem não permitir o adequado controle dos vieses intrínsecos da alocação das campanhas de vacinação. O objetivo dessa revisão foi discutir os desenhos de estudo disponíveis para avaliação de efetividade das vacinas, enfatizando os estudos quase-experimentais, que buscam mimetizar os estudos aleatorizados ao introduzir um componente exógeno para atribuição ao tratamento, bem como suas vantagens, limitações e aplicabilidade no contexto dos dados brasileiros. O emprego de métodos quase-experimentais, incluindo as séries temporais interrompidas, o método de diferença em diferenças, escore de propensão, variáveis instrumentais e regressão descontínua, são relevantes pela possibilidade de gerar estimativas mais acuradas da efetividade de vacinas para COVID-19 em cenários como o brasileiro, que se caracteriza pelo uso de várias vacinas, com respectivos número e intervalos entre doses, aplicadas em diferentes faixas etárias e em diferentes momentos da pandemia.

Abstract The evaluation of vaccine effectiveness is conducted with real-world data. They are essential to monitor the performance of vaccination programmes over time, and in the context of the emergence of new variants. Until now, the effectiveness of COVID-19 vaccines has been assessed based on classic methods, such as cohort and test-negative case-control studies, which may often not allow for adequate control of inherent biases in the assignment of vaccination campaigns. The aim of this review was to discuss the study designs available to evaluate vaccine effectiveness, highlighting quasi-experimental studies, which seek to mimic randomized trials, by introducing an exogenous component to allocate to treatment, in addition to the advantages, limitations, and applicability in the context of Brazilian data. The use of quasi-experimental approaches, such as interrupted time series, difference-in-differences, propensity scores, instrumental variables, and regression discontinuity design, are relevant due to the possibility of providing more accurate estimates of COVID-19 vaccine effectiveness. This is especially important in scenarios such as the Brazilian, which characterized by the use of various vaccines, with the respective numbers and intervals between doses, applied to different age groups, and introduced at different times during the pandemic.

Primary care-based health surveillance actions in response to the COVID-19 pandemic: contributions to the debate. / Ações de vigilância à saúde integradas à Atenção Primária à Saúde diante da pandemia da COVID-19: contribuições para o debate.

We conducted an integrated literature review aimed at reflecting on the challenges related to primary care-based health surveillance actions in response to the COVID-19 pandemic in selected countries. The study included countries with different PHC models that adopted surveillance as an approach to control the transmission of COVID-19. We performed a search in October 2020 for relevant literature and norms and guidelines related to the organization of primary health care (PHC) in response to the pandemic on official government websites and the databases Web of Science and Science Direct. The integrated health surveillance actions demonstrated that efforts were more focused on risks, with some countries adopting innovative and effective measures to respond to COVID-19, considering emerging needs within PHC. However, in addition to ethical controversies and operational difficulties, access to technology was a challenge in actions developed by some countries due to social inequalities.

Trata-se de uma revisão de síntese integrativa com objetivo de refletir sobre os desafios atinentes às ações de vigilância em saúde no enfrentamento da COVID-19, no âmbito da Atenção Primária à Saúde (APS), em sistemas de saúde de países selecionados. Foram incluídos, no estudo, países com modelos de APS distintos, mas que adotaram a vigilância nos territórios como premissa para o controle da transmissão da COVID-19. Houve a revisão bibliográfica da literatura científica e a análise documental de normas e diretrizes relacionadas à organização da APS para enfrentamento da pandemia. A produção dos dados ocorreu no período entre abril e julho de 2020 e envolveu a busca de documentos sobre o enfrentamento da COVID-19, no que se refere à APS, nos sites oficiais governamentais de cada país e nas bases de dados científicas Web of Science e Science Direct. Ações integradas de vigilância em saúde demonstraram atuação mais direcionada sobre riscos, sendo possível respostas inovadoras e mais efetivas para enfrentamento da COVID-19, considerando necessidades emergentes no âmbito da APS. Contudo, experiências desenvolvidas por alguns países apresentaram controvérsias éticas e operacionais além dos desafios de acesso às tecnologias decorrente das desigualdades sociais.

Organization and offer of physiotherapeutic assistance in response to the COVID-19 pandemic in Brazil / Organização e oferta da assistência fisioterapêutica em resposta a pandemia da COVID-19 no Brasil

The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous Physical Therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in four dimensions: distribution of physical therapists in the country; offering physical therapy assistance in PHC and outpatient care; and provision of physical therapy care via telehealth. It is concluded that there is inequity in the regional distribution of physical therapists in Brazil; functional rehabilitation depends on the PHC's response capacity, which is threatened by the ongoing disruption process; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; telehealth, although a resource and an opportunity to increase the population's access to functional rehabilitation, requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

A recuperação das pessoas acometidas pela COVID-19 é um processo que continua para além do quadro agudo da infecção pelo Sars-CoV-2. O comprometimento de diversos sistemas corporais pode acarretar impactos funcionais e demandar assistência fisioterapêutica contínua tanto na atenção ambulatorial quanto na Atenção Primária à Saúde (APS). Neste ensaio, busca-se discutir os desafios da organização e da oferta de assistência fisioterapêutica em resposta a pandemia da COVID-19 no Brasil. A análise foi sumarizada em quatro dimensões: distribuição de fisioterapeutas no país; oferta da assistência fisioterapêutica na APS e na atenção ambulatorial; e oferta de atenção fisioterapêutica por Telessaúde. Conclui-se haver iniquidade na distribuição regional de fisioterapeutas no Brasil; a reabilitação funcional depende da capacidade de resposta da APS, a qual se encontra ameaçada pelo processo de desestruturação em curso; existe um déficit de serviços de reabilitação que antecede a pandemia, e pode não responder satisfatoriamente às demandas do atual contexto epidemiológico; faz-se necessária a articulação entre as equipes de fisioterapia ambulatorial e da APS; a telessaúde embora seja um recurso e uma oportunidade para ampliar o acesso da população à reabilitação funcional exige cautela; o fisioterapeuta possui papel crucial em todo o continuum de cuidados da COVID-19.

Methodological proposal for the redistribution of deaths due to garbage codes in mortality estimates for Noncommunicable Chronic Diseases.

OBJECTIVE: To propose a method for improving mortality estimates from noncommunicable diseases (NCD), including the redistribution of garbage codes in Brazilian municipalities. METHODS: Brazilian Mortality Information System (MIS) was used as a data source to estimate age standardized mortality rates, before and after correction, for NCD (cardiovascular, chronic respiratory, diabetes, and neoplasms). The treatment for the correction of data addressed missing data, under-registration, and redistribution of garbage codes (GCs). Three-year periods 2010-2012 and 2015-2017, and the Bayesian method were used to estimate mortality rates, reducing the effect of fluctuation caused by small numbers at the municipal level. RESULTS: GCs redistribution step showed greater weight in corrections, about 40% in 2000 and roughly 20% as from 2007, with stabilization starting in this year. Throughout the historical series, the quality of information on causes of death has improved in Brazil, with heterogeneous results being observed among municipalities. CONCLUSION: Methodological studies that propose correction and improvement of the MIS are essential for monitoring mortality rates due to NCD at regional levels. The methodological proposal applied, for the first time in real data from Brazilian municipalities, is challenging and deserves further improvements. Improving the quality of the data is essential in order to build more accurate estimates based on the raw data from the SIM.

Retração de cintura escapular em recémnascidos internados em uma Unidade de Cuidados Intermediários / Scapular waist retraction in newborns admitted to an Intermediate Care Unit

INTRODUÇÃO: As unidades de cuidados neonatais dispõem de altos recursos tecnológicos que, aliados ao avanço da ciência, visam garantir a sobrevida de recém-nascidos (RNs). Entretanto, o internamento expõe os RNs a variados estímulos que, associados a assistência inadequada, podem favorecer o surgimento de alterações posturais. OBJETIVO: Investigar a frequência dos sinais sugestivos de retração de cintura escapular em RNs que necessitaram de internamento. MATERIAIS E MÉTODOS: Estudo observacional, quantitativo e longitudinal, realizado com 16 RNs, internados na Unidade de Cuidados Intermediários (UCI) de um hospital estadual, localizado na cidade de cidade de Salvador, Bahia, no ano de 2019. Os dados foram coletados por meio de medidas das escápulas, sinal do cachecol, protocolo de inspeção biomecânica e prontuários. RESULTADOS: Sete (43,7%) RNs apresentaram sinais sugestivos de retração de cintura escapular. Seis (37,5%) apresentaram sinal do cachecol positivo e apenas um (6,3%) apresentou simultaneamente os sinais de abdução de membros superiores, adução escapular, sinal do cachecol positivo e redução das medidas das escápulas em relação à coluna ao longo do internamento. A comparação entre a diferença do maior e do menor valor das medidas das escápulas, com o sinal do cachecol, não foi estatisticamente significante. Porém, aqueles que apresentaram sinal do cachecol positivo e/ou diminuição das medidas atingiram valores máximos de dias de internamento. CONCLUSÃO: Os sinais sugestivos de retração de cintura escapular estiveram presentes em quase metade da amostra. Importante salientar que esses achados traduzem as características específicas da população do estudo, considerando suas limitações.

INTRODUCTION: Neonatal care units have high technological resources that, together with the advancement of science, aim to ensure the survival of newborns (NBs). However, hospitalization exposes newborns to various stimuli that, associated with inadequate care, can favor the appearance of postural changes. OBJECTIVE: To investigate the frequency of signs suggestive of scapular waist retraction in newborns who required hospitalization. Materials and METHODS: Observational, quantitative, and longitudinal study, carried out with 16 newborns, admitted to the Intermediate Care Unit (ICU) of a state hospital, located in the city of Salvador, Bahia, in the year 2019. Data were collected through scapula measurements, scarf signs, biomechanical inspection protocol, and medical records. RESULTS: Seven (43.7%) of the newborns showed signs suggestive of scapular waist retraction. Six (37.5%) showed a positive scarf sign and only one (6.3%) simultaneously showed signs of the abduction of the upper limbs, scapular adduction, positive scarf sign, and reduced scapular measurements in relation to the spine along with hospitalization. The comparison between the difference between the highest and lowest scapular measurements, with the scarf sign, was not statistically significant. However, those who showed a positive scarf sign and/or reduced measurements reached maximum values for days of hospitalization. CONCLUSION: Signs suggestive of scapular waist retraction were present in almost half of the sample. It is important to note that these findings reflect the characteristics of the study population, considering their limitations.