Clinical effectiveness of screening for age-related macular degeneration: A systematic review.

INTRODUCTION: Age-related macular degeneration (AMD) is an eye disease that occurs in patients over 50 years old. Early diagnosis enables timely treatment to stabilize disease progression. However, the fact that the disease is asymptomatic in its early stages can delay treatment until it progresses. As such, screening in specific contexts can be an early detection tool to reduce the clinical and social impact of the disease. OBJECTIVE: Assess the effectiveness of screening methods for early detection of AMD in adults aged 50 years or older. METHODS: A systematic review of comparative observational studies on AMD screening methods in those aged 50 years or older, compared with no screening or any other strategy. A literature search was conducted in the MEDLINE (via PubMed), Embase, Cochrane Library and Lilacs database. RESULTS: A total of 5,290 studies were identified, three of which met the inclusion criteria and were selected for the systematic review. A total of 8,733 individuals (16,780 eyes) were included in the analysis. The screening methods assessed were based on optical coherence tomography (OCT) compared with color fundus photography, and OCT and telemedicine testing compared to a standard eye exam. CONCLUSION: The systematized data are limited and only suggest satisfactory performance in early screening of the population at risk of developing AMD. OCT and the telemedicine technique showed promising results in AMD screening. However, methodological problems were identified in the studies selected and the level of evidence was considered low.

Determining Medication Errors in an Adult Intensive Care Unit.

INTRODUCTION: Research addressing the costs of Medication errors (MEs) is still scarce despite issues related to patient safety having significant economic and health impacts, making it imperative to analyze the costs and adverse events related to MEs for a better patient, professional, and institutional safety. AIM: To identify the number of medication errors and verify whether this number was associated with increased hospitalization costs for patients in an Intensive Care Unit (ICU). METHOD: This retrospective cross-sectional cohort study evaluated secondary data from patients' electronic medical records to compile variables, create a model, and survey hospitalization costs. The statistical analysis included calculating medication error rates, descriptive analysis, and simple and multivariate regression. RESULTS: The omission error rate showed the highest number of errors per drug dose (59.8%) and total errors observed in the sample (55.31%), followed by the time error rate (26.97%; 24.95%). The omission error had the highest average when analyzing the entire hospitalization (170.40) and day of hospitalization (13.79). Hospitalization costs were significantly and positively correlated with scheduling errors, with an increase of BRL 121.92 (about USD $25.00) (95% CI 43.09; 200.74), and to prescription errors, with an increase of BRL 63.51 (about USD $3.00) (95% CI 29.93; 97.09). CONCLUSION: We observed an association between two types of medication errors and increased hospitalization costs in an adult ICU (scheduling and prescription errors).

Financiamento de pesquisas sobre dengue no Brasil, 2004-2020 / Funding for research on dengue in Brazil, 2004-2020

RESUMO A dengue representa um importante problema de saúde pública no Brasil devido às constantes epidemias causadas pela doença no País. Este estudo objetivou analisar o financiamento de pesquisas sobre dengue pelo Departamento de Ciência e Tecnologia do Ministério da Saúde e parceiros no período de 2004 a 2020. Analisou-se a tendência do financiamento por regressão linear generalizada do tipo Prais-Winster e sua distribuição entre as regiões e Unidades Federadas brasileiras, modalidades de contratação das pesquisas, instituições beneficiadas e temas estudados. Entre 2004 e 2020, financiaram-se 232 pesquisas (R$ 164,03 milhões), realizadas, em sua maioria, em instituições da região Sudeste (77,55%), abordando especialmente a temática controle vetorial (37,93%). A tendência de financiamento foi estacionária nos anos estudados. As chamadas estaduais foram a principal forma de modalidade de contratação das pesquisas (65,95%). Houve diferença estatisticamente significante na distribuição do valor financiado entre as modalidades de contratação, bem como no número de pesquisas financiadas e valor financiado entre as regiões brasileiras. Esses achados demonstram a importância de monitorar o financiamento de pesquisas sobre dengue no Brasil e de implementar estratégias de avaliação das pesquisas financiadas, para subsidiar e aprimorar a política de enfrentamento da doença e de seu vetor.

ABSTRACT Dengue represents an important public health problem in Brazil, due to the constant epidemics caused by the disease in the country. This study aimed to analyze the funding of research on dengue by the Department of Science and Technology of the Ministry of Health of Brazil and partners between 2004 to 2020. Was analyzed the trend of the funding by generalized linear regression using Prais-Winster and its distribution between Brazilian regions and Federated Units, research contracting modalities, benefited institutions, and studied themes. Between 2004 and 2020, 232 research studies were funded (R$ 164.03 million), carried out mostly in institutions in the Southeast Region (77.55%), addressing especially the vector control theme (37.93%). The funding trend was stationary in the years studied. The state calls were the main form of contracting modality for the research (65.95%). There was a statistically significant difference in the distribution of the loan amount between the contracting modalities, and in the number of researches funded and loan amount among Brazilian regions. These findings demonstrate the importance of monitoring the research funding on dengue in Brazil and of implementing strategies to evaluate the research funded, to support and improve the policy to combat the disease and its vector.

Consumption of alcoholic beverages in Brazil: estimation of prevalence ratios - 2013 and 2019.

OBJECTIVES: To estimate the prevalence of weekly, monthly and abusive alcohol consumption in Brazil in 2013 and 2019, compare the period estimates, and verify the magnitude of the differences. METHODS: Analysis of data on alcohol consumption in the adult population (18 years or older) from the National Health Survey (PNS), 2013 and 2019. The number of interviewees in 2013 was 60,202 and 88,531 in 2019. The samples were characterized according to demographic, socioeconomic, health, and alcohol consumption variables and differences in proportions in the period were compared using Pearson's c2 test, with Rao-Scott approximation and a 5% significance level. Multivariate Poisson regression models were estimated for the outcome variables of monthly, weekly and abusive consumption of alcoholic beverages, in order to estimate the magnitude of the differences between the 2013 and 2019 PNS estimates, using the prevalence ratio (PR). Models were adjusted per sex and age group and stratified per sex and demographic region. RESULTS: There was a difference in the distribution of the population according to race, occupation, income, age group, marital status, and education. There was an increase in alcohol consumption for all outcome variables, with the exception of weekly consumption in males. The PR of weekly consumption was 1.02 (95%CI 1.014-1.026), and in females the PR was 1.05 (95%CI 1.04-1.06). The highest PRs in the general population and per sex occur for abusive consumption. The increase in weekly consumption per region occurred in the South, Southeast, and Central-West regions. CONCLUSIONS: Males are the main alcohol consumers in Brazil; the PRs for both males and females show that there was an increase in monthly, weekly and abusive consumption in the research period; it is noteworthy that females have increased their consumption pattern with greater intensity than males.

Evolution of research funding for neglected tropical diseases in Brazil, 2004-2020.

Neglected tropical diseases are a global public health problem. Although Brazil is largely responsible for their occurrence in Latin America, research funding on the subject does not meet the population's health needs. The present study analyzed the evolution of research funding for neglected tropical diseases by the Ministry of Health and its partners in Brazil, from 2004 to 2020. This is a retrospective study of data from investigations registered on Health Research (Pesquisa Saúde in Portuguese), a public repository for research funded by the Ministry of Health's Department of Science and Technology. The temporal trend of funding and the influence of federal government changes on funding were analyzed using Prais-Winster generalized linear regression. From 2004 to 2020, 1,158 studies were financed (purchasing power parity (PPP$) 230.9 million), with most funding aimed at biomedical research (81.6%) and topics involving dengue, leishmaniasis and tuberculosis (60.2%). Funding was stationary (annual percent change of -5.7%; 95%CI -54.0 to 45.0) and influenced by changes to the federal government. Research funding was lacking for chikungunya, Chagas disease, schistosomiasis, malaria and taeniasis/cysticercosis, diseases with a high prevalence, burden or mortality rates in Brazil. Although the Ministry of Health had several budgetary partners, it was the main funder, with 69.8% of investments. The study revealed that research funding for neglected tropical diseases has stagnated over the years and that diseases with a high prevalence, burden and mortality rate receive little funding. These findings demonstrate the need to strengthen the health research system by providing sustainable funding for research on neglected tropical diseases that is consistent with the population's health needs.

Prevented cases of neural tube defects and cost savings after folic acid fortification of flour in Brazil.

Anencephaly, encephalocele, and spina bifida are congenital neural tube defects and are the main causes of neonatal morbidity and mortality and impose a heavy economic burden on health systems. This study to estimates the direct costs of neural tube defects from the perspective of the Brazilian Ministry of Health, and the prevented cases and cost savings during the period in which mandatory folic acid fortification was in effect in the country (2010-2019). It is a top-down cost-of-illness oriented study based on the prevalence of the disorders in Brazil. Data were collected from the Brazilian Ministry of Health's outpatient and hospital information system databases. The direct cost was estimated from the total patient-years, allocated by age and type of disorder. Prevented cases and cost savings were determined by the difference in the prevalence of the disorders in the pre- and post-fortification periods based on the total number of births and the sum of outpatient and hospital costs during the period. The total cost of outpatient and hospital services for these disorders totaled R$ 92,530,810.63 (Int$ 40,565,896.81) in 10 years; spina bifida accounted for 84.92% of the total cost. Hospital costs were expressive of all three disorders in the first year of the patient's life. Between 2010 and 2019, mandatory folic acid fortification prevented 3,499 live births with neural tube defects and resulted in R$ 20,381,586.40 (Int$ 8,935,373.25) in hospital and outpatient cost savings. Flour fortification has proved to be a valuable strategy in preventing pregnancies with neural tube defects. Since its implementation, there has been a 30% decrease in the prevalence of neural tube defects and a 22.81% decrease associated in hospital and outpatient costs.

Conflito distributivo: análise do Programa de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB) em duas capitais nordestinas / Conflicto distributivo: análisis del Programa de Mejora del Acceso y Calidad de la Atención Básica (PMAQ-AB) en dos capitales del nordeste de Brasil / Distributive conflict: analysis of the Program for Improving Access and Quality of Primary Care (PMAQ-AB) in two Brazilian northeastern capitals

Este artigo analisa a execução do PMAQ-AB a partir de sua contextualização em um cenário político nacional de profundas transformações, desde o reformismo fraco que promoveu lenta extensão de direitos até o contrarreformismo forte da restauração neoliberal. Para debater os elementos relacionados ao trabalho e às disputas pela distribuição dos recursos públicos, foi realizado estudo de caso com trabalhadores, gestores e conselheiros de saúde em duas capitais do nordeste brasileiro. Os resultados evidenciam o acirramento do conflito distributivo e o resultado desfavorável aos trabalhadores no contexto pós-golpe parlamentar de 2016. As dinâmicas locais expõem processos de contração salarial e individualização das relações de trabalho e a reafirmação da meritocracia como justificativa ideológica da precarização. A isso, trabalhadores se contrapõem pela reafirmação de sua condição coletiva de classe, em favor de benefícios derivados do PMAQ, como recomposição salarial para todos.(AU)

Este artículo analiza la realización del PMAQ-AB a partir de su contextualización en un escenario político nacional de profundas transformaciones, desde el reformismo débil que promovió una lenta extensión de derechos contra el reformismo fuerte de la restauración neoliberal. Para discutir los elementos relacionados al trabajo y a las disputas por la distribución en los recursos públicos se realizó un estudio de caso con trabajadores, gestores y consejeros de salud en dos capitales del nordeste brasileño. Los resultados ponen en evidencia el recrudecimiento del conflicto distributivo y el resultado desfavorable para los trabajadores en el contexto post-golpe parlamentario de 2016. Las dinámicas locales exponen procesos de contracción salarial e individualización de las relaciones de trabajo y la reafirmación de la meritocracia como justificativa ideológica de la precarización. A eso se contraponen los trabajadores por medio de la reafirmación de su condición colectiva de clase, en favor del beneficio derivado del PMAQ con la recomposición salarial para todos.(AU)

This article analyzes the implementation of the Program for Improving Access and Quality of Primary Care (PMAQ-AB) in the context of a national political scenario of deep transformations, from the weak reformism that promoted slow extension of rights to the strong counter-reformism of neoliberal restoration. It is a case study with health workers, managers, and counselors in two capital cities in northeastern Brazil, discussing matters of work and distributive disputes of public resources. Results show the intensification of these conflicts in health and the unfavorable outcome for workers after the parliamentary coup in 2016 political context. Local dynamics expose the wage contraction and individualization of labor relations and the reassertion of meritocracy as an ideological ground for precariousness. Workers oppose this, reaffirming their collective class condition, favoring the benefit derived from PMAQ for fully regaining their group wages.(AU)

Consumption of alcoholic beverages in Brazil: estimation of prevalence ratios - 2013 and 2019 / Consumo de bebidas alcoólicas no Brasil: estimativa de razões de prevalências - 2013 e 2019

ABSTRACT OBJECTIVES To estimate the prevalence of weekly, monthly and abusive alcohol consumption in Brazil in 2013 and 2019, compare the period estimates, and verify the magnitude of the differences. METHODS Analysis of data on alcohol consumption in the adult population (18 years or older) from the National Health Survey (PNS), 2013 and 2019. The number of interviewees in 2013 was 60,202 and 88,531 in 2019. The samples were characterized according to demographic, socioeconomic, health, and alcohol consumption variables and differences in proportions in the period were compared using Pearson's c2 test, with Rao-Scott approximation and a 5% significance level. Multivariate Poisson regression models were estimated for the outcome variables of monthly, weekly and abusive consumption of alcoholic beverages, in order to estimate the magnitude of the differences between the 2013 and 2019 PNS estimates, using the prevalence ratio (PR). Models were adjusted per sex and age group and stratified per sex and demographic region. RESULTS There was a difference in the distribution of the population according to race, occupation, income, age group, marital status, and education. There was an increase in alcohol consumption for all outcome variables, with the exception of weekly consumption in males. The PR of weekly consumption was 1.02 (95%CI 1.014-1.026), and in females the PR was 1.05 (95%CI 1.04-1.06). The highest PRs in the general population and per sex occur for abusive consumption. The increase in weekly consumption per region occurred in the South, Southeast, and Central-West regions. CONCLUSIONS Males are the main alcohol consumers in Brazil; the PRs for both males and females show that there was an increase in monthly, weekly and abusive consumption in the research period; it is noteworthy that females have increased their consumption pattern with greater intensity than males.

RESUMO OBJETIVOS Estimar as prevalências de consumo de bebidas alcoólicas semanal, mensal e abusivo no Brasil em 2013 e 2019, comparar as estimativas do período e estimar a magnitude das diferenças. MÉTODOS Análise dos dados do consumo de bebidas alcoólicas na população adulta (18 anos ou mais) da Pesquisa Nacional de Saúde (PNS), 2013 e 2019. O número de entrevistados em 2013 foi de 60.202 e, em 2019, de 88.531. As amostras foram caracterizadas segundo variáveis demográficas, socioeconômicas, de saúde e de consumo de bebidas alcoólicas; e foram comparadas as diferenças de proporções no período, por meio do teste do c2 de Pearson, com aproximação de Rao-Scott e nível de significância de 5%. Foram estimados modelos multivariados de regressão de Poisson para as variáveis de desfecho de consumo mensal, semanal e abusivo de bebidas alcoólicas, com o intuito de estimar a magnitude das diferenças entre as estimativas da PNS 2013 e 2019, por meio da razão de prevalência (RP). Os modelos foram ajustados por sexo e faixa etária e estratificados por sexo e região demográfica. RESULTADOS Houve diferença da distribuição da população segundo raça, ocupação, renda, faixa etária, estado civil e escolaridade. Houve aumento do consumo de álcool para todas as variáveis desfecho, com exceção do consumo semanal em homens. A razão de prevalência do consumo semanal foi de 1,02 (IC95% 1,014-1,026), nas mulheres a RP foi de 1,05 (IC95% 1,04-1,06). As maiores razões de prevalência na população geral e por sexo ocorrem para o consumo abusivo. O aumento do consumo semanal por região ocorreu no Sul, Sudeste e Centro-Oeste. CONCLUSÕES O homem é o principal consumidor de álcool no Brasil, as razões de prevalência tanto em homens quanto em mulheres demonstram que houve aumento do consumo mensal, semanal e abusivo no período pesquisado, destaca-se que as mulheres têm aumentado o padrão de consumo com maior intensidade do que os homens.

Big Data e Inteligência Artificial para pesquisa translacional na Covid-19: revisão rápida / Big Data and artificial intelligence for translational research in COVID-19: a rapid review

RESUMO O objetivo deste estudo foi identificar como a Inteligência Artificial (IA) vem sendo utilizada para a pesquisa translacional no contexto da Covid-19. Foi realizada uma revisão rápida para identificar o uso de técnicas de IA na translação de tecnologias para o enfrentamento da Covid-19. Empregou-se estratégia de busca com base em termos MeSH e seus respectivos sinônimos em sete bases de dados. Dos 59 artigos identificados, oito foram incluídos. Foram identificadas 11 experiências que usaram IA para a pesquisa translacional em Covid-19: predição de eficácia medicamentosa; predição de patogenicidade do Sars-CoV-2; diagnóstico de imagem para Covid-19; predição de incidência de Covid-19; estimativas de impacto da Covid-19 na sociedade; automatização de sanitização de ambientes hospitalares e clínicos; rastreio de pessoas infectadas e possivelmente infectadas; monitoramento do uso de máscaras; predição de gravidade de pacientes; estratificação de risco do paciente; e predição de recursos hospitalares. A pesquisa translacional pode ajudar no desenvolvimento produtivo e industrial em saúde, especialmente quando apoiada em métodos de IA, uma ferramenta cada vez mais importante, sobretudo quando se discute a Quarta Revolução Industrial e suas aplicações na saúde.

ABSTRACT The objective of this study was to identify how Artificial Intelligence (AI) has been used for translational research in the context of COVID-19. A rapid review was carried out to identify the use of AI techniques in the translation of technologies to face COVID-19. A search strategy was used based on MeSH terms and their respective synonyms in seven databases. Of the 59 articles identified, eight were included. We identified 11 experiments that used AI for translational research in Covid-19: prediction of drug efficacy; predicting the pathogenicity of SARS-CoV-2; imaging diagnosis for COVID-19; predicting the incidence of COVID-19; estimates of the impact of COVID-19 on society; automation of sanitizing hospital and clinical environments; screening of infected and possibly infected people; monitoring the use of masks; prediction of patient severity; patient risk stratification; and prediction of hospital resources. Translational research can help in productive and industrial development in health, especially when supported by AI methods, an increasingly important tool, especially when discussing the Fourth Industrial Revolution and its applications in health.

Direct and indirect costs attributed to alcohol consumption in Brazil, 2010 to 2018.

INTRODUCTION: Alcohol consumption is the main risk factor for death and disability in the world population between 15 to 49 years old, is related to more than 200 causes of death, and has an important economic impact on the health and social security systems. In 2016, three million deaths were attributable to alcohol worldwide and 131.4 million DALYs. In Brazil, alcohol consumption per inhabitant was 7.8 liters in 2016; and the prevalence of abusive consumption was 17.1% in 2019. OBJECTIVE: Estimate the costs attributable of alcohol consumption in the Brazilian population 18 years-old and over, in the period 2010 to 2018. METHODS: This is a prevalence-based cost-of-illness study, with a top-down and retrospective approach, including direct costs (hospital and outpatient) and indirect costs (absenteeism from work) related to alcohol consumption. A list of diseases and conditions for which alcohol is a risk factor was used, and the Population Attributable Risk (PAR) was calculated to estimate what portion of the cost of these diseases is attributable to alcohol consumption. Prevalence was calculated by sex and level of alcohol consumption, based on data from the 2019 National Health Survey. Relative risk data were identified by disease/injury and level of daily consumption obtained from the Global Burden Disease study in 2017. The cost data used are from the Brazilian Unified Health System and social security system. All costs were adjusted for inflation for the period and converted to purchasing power parity. RESULTS: Prevalence data revealed that 73.6% of the Brazilian population reported not consuming alcoholic beverages, which included 62.9% of men and 83.0% of women. The lowest values for the PAR were found at the consumption range of 60 grams per day. Although the 12 grams per day consumption category is the least in terms of the quantity of alcohol consumed, it is one of the main ones in terms of PAR, given the higher prevalence of consumption. The total cost attributable to alcohol between 2010 and 2018 was Int$ 1,487,417,115.43, of which Int$ 737,834,696.89 was for hospital expenses, Int$ 416,052,029.75 for outpatient care, and Int$ 333,530,388.79 due to absenteeism from work. CONCLUSION: Few comprehensive studies of alcohol-related costs have been developed, which suggests a knowledge gap in Brazil and worldwide and indicates the need for more research in this area. Understanding the economic impact of alcohol consumption is essential to help measure this public health problem in all its aspects and encourage implementation of public policies.

Development of an Index to Assess COVID-19 Hospital Care Installed Capacity in the 450 Brazilian Health Regions.

OBJECTIVE: The article seeks to assess the Brazilian health system ability to respond to the challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic by measuring the capacity of Brazilian hospitals to care for COVID-19 cases in the 450 Health Regions of the country during the year 2020. Hospital capacity refers to the availability of hospital beds, equipment, and human resources. METHODS: We used longitudinal data from the National Register of Health Facilities (CNES) regarding the availability of resources necessary to care for patients with COVID-19 in inpatient facilities (public or private) from January to December 2020. Among the assessed resources are health professionals (certified nursing assistants, nurses, physical therapists, and doctors), hospital beds (clinical, intermediate care, and intensive care units), and medical equipment (computed tomography scanners, defibrillators, electrocardiograph monitors, ventilators, and resuscitators). In addition to conducting a descriptive analysis of absolute and relative data (per 10,000 users), a synthetic indicator named Installed Capacity Index (ICI) was calculated using the multivariate principal component analysis technique to assess hospital capacity. The indicator was further stratified into value ranges to understand its evolution. RESULTS: There was an increase in all selected indicators between January and December 2020. It was possible to observe differences between the Northeast and North regions and the other regions of the country; most Health Regions presented low ICI. The ICI increased between the beginning and the end of 2020, but this evolution differed among Health Regions. The average increase in the ICI was more evident in the groups that already had considerably high baseline capacity in January 2020. CONCLUSIONS: It was possible to identify inequalities in the hospital capacity to care for patients affected by COVID -19 in the Health Regions of Brazil, with a concentration of low index values in the Northeast and North of the country. As the indicator increased throughout the year 2020, inequalities were also observed. The information here provided may be used by health authorities, providers, and managers in planning and adjusting for future COVID-19 care and in dimensioning the adequate supply of hospital beds, health-care professionals, and devices in Health Regions to reduce associated morbidity and mortality. We recommend that the ICI continue to be calculated in the coming months of the pandemic to monitor the capacity in the country's Health Regions.

Direct costs of prematurity and factors associated with birth and maternal conditions.

OBJECTIVE: To estimate the direct costs due to hospital care for extremely, moderate, and late preterm newborns, from the perspective of a public hospital in 2018. The second objective was to investigate whether factors associated with birth and maternal conditions explain the costs and length of hospital stay. METHODS: This is a cost-of-illness study, with data extracted from hospital admission authorization forms and medical records of a large public hospital in the Federal District, Brazil. The association of characteristics of preterm newborns and mothers with costs was estimated by linear regression with gamma distribution. In the analysis, the calculation of the parameters of the estimates (B), with a confidence interval of 95% (95%CI), was adopted. The uncertainty parameters were estimated by the 95% confidence interval and standard error using the Bootstrapping method, with 1,000 samples. Deterministic sensitivity analysis was performed, considering lower and upper limits of 95%CI in the variation of each cost component. RESULTS: A total of 147 preterm newborns were included. We verified an average cost of BRL 1,120 for late preterm infants, BRL 6,688 for moderate preterm infants, and BRL 17,395 for extremely preterm infants. We also observed that factors associated with the cost were gestational age (B = -123.00; 95%CI: -241.60 to -4.50); hospitalization in neonatal ICU (B = 6,932.70; 95%CI: 5,309.40-8,556.00), and number of prenatal consultations (B = -227.70; 95%CI: -403.30 to -52.00). CONCLUSIONS: We found a considerable direct cost resulting from the care of preterm newborns. Extreme prematurity showed a cost 15.5 times higher than late prematurity. We also verified that a greater number of prenatal consultations and gestational age were associated with a reduction in the costs of prematurity.

Implementation of the e-SUS Primary Care Strategy: an analysis based on official data.

OBJETIVE: Analyze the implementation of the strategy e-SUS Atenção Básica (e-SUS AB - e-SUS Primary Care) in Brazil between the first years of the system, from 2013 to 2019. METHODS: This is a quantitative, descriptive, and exploratory study. We considered official data from the Ministry of Health, submitted by Brazilian municipalities, in the period from April 2013 to December 2019. We categorized the municipalities as 'not implemented', 'initial implementation', 'partial implementation' and 'implemented' according to the criteria defined in this study. We also verified whether the type of municipality, according to the IBGE classification, influenced the degree of implementation of the e-SUS AB strategy. We performed descriptive analyses and investigated the association between the degrees of implementation of e-SUS AB and the typology of the IBGE classification and characterization of rural and urban spaces. RESULTS: The implementation increased in the analyzed period. The implementation status of the e-SUS AB strategy in 2019 was 'implemented' in 20.2% (1,117) of the municipalities, 'partial implementation' in 32.9% (1,819), 'initial implementation' in 39.1% (2,159) and 'not implemented' in 7.8% (432). The South and Southeast regions presented the best implementation situation in all years, and the states of Rio Grande do Sul, São Paulo and Santa Catarina reached a higher percentage of municipalities with 'implemented' status in 2019. CONCLUSIONS: We confirmed the progress in the implementation of the e-SUS AB strategy over the years. Most of the municipalities are between the status 'initial implementation' and 'partial implementation'. Therefore, we conclude that investments in technological resources, training of professionals, and support are necessary to qualify the implementation and use of information systems in the country, especially for the e-SUS AB strategy.

Direct costs of prematurity and factors associated with birth and maternal conditions / Custos diretos da prematuridade e fatores associados ao nascimento e condições maternas

ABSTRACT OBJECTIVE To estimate the direct costs due to hospital care for extremely, moderate, and late preterm newborns, from the perspective of a public hospital in 2018. The second objective was to investigate whether factors associated with birth and maternal conditions explain the costs and length of hospital stay. METHODS This is a cost-of-illness study, with data extracted from hospital admission authorization forms and medical records of a large public hospital in the Federal District, Brazil. The association of characteristics of preterm newborns and mothers with costs was estimated by linear regression with gamma distribution. In the analysis, the calculation of the parameters of the estimates (B), with a confidence interval of 95% (95%CI), was adopted. The uncertainty parameters were estimated by the 95% confidence interval and standard error using the Bootstrapping method, with 1,000 samples. Deterministic sensitivity analysis was performed, considering lower and upper limits of 95%CI in the variation of each cost component. RESULTS A total of 147 preterm newborns were included. We verified an average cost of BRL 1,120 for late preterm infants, BRL 6,688 for moderate preterm infants, and BRL 17,395 for extremely preterm infants. We also observed that factors associated with the cost were gestational age (B = -123.00; 95%CI: -241.60 to -4.50); hospitalization in neonatal ICU (B = 6,932.70; 95%CI: 5,309.40-8,556.00), and number of prenatal consultations (B = -227.70; 95%CI: -403.30 to -52.00). CONCLUSIONS We found a considerable direct cost resulting from the care of preterm newborns. Extreme prematurity showed a cost 15.5 times higher than late prematurity. We also verified that a greater number of prenatal consultations and gestational age were associated with a reduction in the costs of prematurity.

RESUMO OBJETIVOS Estimar os custos diretos advindos com a assistência hospitalar a recém-nascidos prematuros extremos, moderados e tardios, sob a perspectiva de um hospital público em 2018. O segundo objetivo foi investigar se fatores associados ao nascimento e às condições maternas explicam os custos e o tempo de permanência hospitalar. MÉTODOS Estudo de custo da doença, com extração de dados a partir das autorizações de internação hospitalares e prontuários de um hospital público de grande porte do Distrito Federal. Estimou-se a associação de características dos recém-nascidos prematuros e das genitoras nos custos por meio de regressão linear com distribuição gamma. Na análise, adotou-se o cálculo dos parâmetros das estimativas (B), com intervalo de confiança de 95% (IC95%). Os parâmetros de incerteza foram estimados pelo intervalo de confiança de 95% e erro padrão por meio do método de Bootstrapping, com 1.000 amostragens. Realizou-se análise de sensibilidade determinística, considerando limites inferiores e superiores do IC95% na variação de cada componente de custo. RESULTADOS Foram incluídos 147 recém-nascidos prematuros. Verificamos um custo médio de R$ 1.120 para prematuros tardios, R$ 6.688 para prematuros moderados e R$ 17.395 para prematuros extremos. Verificamos também que os fatores associados ao custo foram idade gestacional (B = -123,00; IC95% -241,60 a -4,50); internação em UTI neonatal (B = 6.932,70; IC95% 5.309,40-8.556,00) e número de consultas pré-natal (B = -227,70; IC95% -403,30 a -52,00). CONCLUSÕES Verificamos um custo direto considerável advindo da assistência a recém-nascidos prematuros. A prematuridade extrema demonstrou um custo 15,5 vezes maior comparado à tardia. Verificamos ainda que uma maior quantidade de consultas pré-natal e a idade gestacional foram associadas a uma redução dos custos da prematuridade.

Implementation of the e-SUS Primary Care Strategy: an analysis based on official data / Implantação da Estratégia e-SUS Atenção Básica: uma análise fundamentada em dados oficiais

ABSTRACT OBJETIVE Analyze the implementation of the strategy e-SUS Atenção Básica (e-SUS AB - e-SUS Primary Care) in Brazil between the first years of the system, from 2013 to 2019. METHODS This is a quantitative, descriptive, and exploratory study. We considered official data from the Ministry of Health, submitted by Brazilian municipalities, in the period from April 2013 to December 2019. We categorized the municipalities as 'not implemented', 'initial implementation', 'partial implementation' and 'implemented' according to the criteria defined in this study. We also verified whether the type of municipality, according to the IBGE classification, influenced the degree of implementation of the e-SUS AB strategy. We performed descriptive analyses and investigated the association between the degrees of implementation of e-SUS AB and the typology of the IBGE classification and characterization of rural and urban spaces. RESULTS The implementation increased in the analyzed period. The implementation status of the e-SUS AB strategy in 2019 was 'implemented' in 20.2% (1,117) of the municipalities, 'partial implementation' in 32.9% (1,819), 'initial implementation' in 39.1% (2,159) and 'not implemented' in 7.8% (432). The South and Southeast regions presented the best implementation situation in all years, and the states of Rio Grande do Sul, São Paulo and Santa Catarina reached a higher percentage of municipalities with 'implemented' status in 2019. CONCLUSIONS We confirmed the progress in the implementation of the e-SUS AB strategy over the years. Most of the municipalities are between the status 'initial implementation' and 'partial implementation'. Therefore, we conclude that investments in technological resources, training of professionals, and support are necessary to qualify the implementation and use of information systems in the country, especially for the e-SUS AB strategy.

RESUMO OBJETIVO Analisar a implantação da estratégia e-SUS Atenção Básica (e-SUS AB) no Brasil entre os anos iniciais do sistema, de 2013 até 2019. MÉTODOS Trata-se de um estudo quantitativo, descritivo e exploratório. Foram considerados os dados oficiais do Ministério da Saúde, enviados pelos municípios brasileiros, no período de abril de 2013 a dezembro de 2019. Os municípios foram categorizados como 'não implantado', 'implantação inicial', 'implantação parcial' e 'implantado', de acordo com os critérios definidos neste estudo. Verificou-se também se o tipo de município, segundo a classificação do IBGE, influenciou no grau de implantação da estratégia e-SUS AB. Foram realizadas análises descritivas e investigada a associação entre os graus de implantação do e-SUS AB e a tipologia da classificação e caracterização dos espaços rurais e urbanos do IBGE. RESULTADOS O grau de implantação aumentou no período analisado. A situação de implantação da estratégia e-SUS AB, em 2019, foi 'implantado' em 20,2% (1.117) dos municípios, 'implantação parcial' em 32,9% (1.819), 'implantação inicial' 39,1% (2.159) e a situação 'não implantado' foi atribuída em 7,8% (432). As regiões Sul e Sudeste apresentaram a melhor situação de implantação em todos os anos e os estados do Rio Grande do Sul, São Paulo e Santa Catarina alcançaram um maior percentual de municípios com a situação 'implantado' em 2019. CONCLUSÕES Houve avanço na implantação da estratégia e-SUS AB ao longo dos anos. A maior parte dos municípios encontra-se entre o status 'implantação inicial' e 'implantação parcial'. Com isso, conclui-se que ainda são necessários investimentos em recursos tecnológicos, treinamento de profissionais e suporte para qualificar a implantação e uso de sistemas de informação no país, especialmente para a estratégia e-SUS AB.

Cost-effectiveness of mandatory folic acid fortification of flours in prevention of neural tube defects: A systematic review.

BACKGROUND: Neural tube defects (NTDs) constitute the most frequent group among congenital malformations and are the main cause of neonatal morbimortality. Folic acid (FA) can reduce the risk of pregnancies affected by NTDs. OBJECTIVE: We aimed to investigate whether mandatory folic acid (FA) fortification of flours is cost-effective as compared to non-mandatory fortification, and to verify whether FA dosage, cost composition, and the quality of economic studies influence the cost-effectiveness of outcomes. METHODS: We conducted a systematic review. The protocol was registered on PROSPERO (CRD 42018115682). A search was conducted using the electronic databases MEDLINE/PubMed, Web of Science, Embase, Scopus, and EBSCO/CINAHL between January 2019 and October 2020 and updated in February 2021. Eligible studies comprised original economic analyses of mandatory FA fortification of wheat and corn flours (maize flours) compared to strategies of non-mandatory fortification in flours and/or use of FA supplements for NTD prevention. The Drummond verification list was used for quality analysis. RESULTS: A total of 7,859 studies were identified, of which 13 were selected. Most (77%; n = 10) studies originated from high-income countries, while three (23%) were from upper-middle-income countries. Results of a cost-effectiveness analysis showed that fortification is cost-effective for NTD prevention, except for in one study in New Zealand. The cost-benefit analysis yielded a median ratio of 17.5:1 (0.98:1 to 417.1:1), meaning that for each monetary unit spent in the program, there would be a return of 17.5 monetary units. Even in the most unfavorable case of mandatory fortification, the investment in the program would virtually payoff at a ratio of 1:0.98. All FA dosages were cost-effective and offered positive health gains, except in one study. The outcomes of two studies showed that FA dosages above 300 µg/100 g have a higher CBA ratio. The studies with the inclusion of "loss of consumer choice" in the analysis may alter the fortification cost-efficacy ratio. CONCLUSION: We expect the findings to be useful for public agencies in different countries in decision-making on the implementation and/or continuity of FA fortification as a public policy in NTD prevention.

Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020.

BACKGROUND: Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. METHODS: A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10-40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. RESULTS: With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40-50% in people who needed an ICU admission. CONCLUSIONS: The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.

Timely availability of public data for health management: COVID-19 wave´s analysis / Disponibilidade de dados públicos em tempo oportuno para a gestão: análise das ondas da COVID-19

The aim of this study is to support health management, with recent and reliable information, during the COVID-19 pandemic.  Notified and confirmed cases and deaths by COVID-19 were evaluated from three public databases. 1)  Data from the Coronavirus Panel of the Ministry of Health, updated daily, show the existence of two epidemic waves. 2)  The Civil Registry Transparency Portal, also with recent data, points to high mortality rates of COVID-19, especially in older age groups. 3)  The cases, reported by the Information System of the Epidemiological Surveillance of Influenza (Sivep-gripe), confirmed mainly by laboratory test, show predominance of men, high age groups, white race/color, residence in urban areas, presence of comorbidities, higher occurrence of hospitalization and lower use of intensive care unit. This last database, in addition to the first wave, records only the first eight epidemiological weeks of the second wave.  The vertiginous rate of increase in cases and deaths in the second wave points to the need for more drastic measures of social distancing, in addition to the expansion of vaccination against COVID-19. The combination of the three banks expands information that can support timely decision-making.

O objetivo deste estudo é apoiar a gestão em saúde, com informações recentes e confiáveis, durante a pandemia de COVID-19. Casos notificados e confirmados e óbitos por COVID-19 foram avaliados a partir de três bancos de dados públicos.1) Dados do Painel Coronavírus do Ministério da Saúde, atualizados diariamente, mostram a existência de duas ondas epidêmicas. 2) O Portal da Transparência do Registro Civil, também com dados recentes, aponta altas taxas de mortalidade do COVID-19, especialmente nas faixas etárias mais velhas. 3) Os casos notificados pelo Sistema de Informação da Vigilância Epidemiológica da Influenza (Sivep-gripe), confirmados principalmente por exame laboratorial, mostram predominância de homens, faixas etárias elevadas, raça/cor branca, residência em áreas urbanas, presença de comorbidades, maior ocorrência de internação e menor uso de unidade de terapia intensiva. Esta última base de dados, além da primeira onda, registra apenas as primeiras oito semanas epidemiológicas da segunda onda. A vertiginosa taxa de aumento de casos e óbitos na segunda onda aponta para a necessidade de medidas mais drásticas de distanciamento social, além da expansão da vacinação contra o COVID-19. A combinação dos três bancos expande as informações, que podem apoiar a tomada de decisões em tempo oportuno.

Inpatient flow for COVID-19 in the Brazilian health regions / Fluxo de internação por COVID-19 nas regiões de saúde do Brasil

Objective: To investigate the flows of hospitalizations for COVID-19 in the 450 regions and 117 Brazilian health macro-regions between March and October 2020. Method: Descriptive study, comprising all hospitalizations due to COVID-19 registered in the Flu Epidemiological Surveillance Information System (SIVEP-Gripe) between the 8th and 44th epidemiological weeks of 2020. The proportion of hospitalizations for COVID-19 occurred within same health region of residency was calculated, stratified according to periods of greater and lesser demand for health care, according to the population size of health regions. The indicator of migratory efficacy was calculated, which takes into account the evasion and invasion of patients, by crossing the data of origin of the patients (health region of residence) with the data of the place of hospitalization (health region of attendance). Results: 397,830 admissions were identified for COVID-19 in the period. Evasion was 11.9% of residents in health regions and 6.8% in macro-regions, pattern that was maintained during the peak period of hospitalizations for COVID-19. There was an average of 17.6% of evasion of residents of health regions in the Northeast and of 8.8% in health regions of the South. Evasion was more accentuated in health regions with up to 100 thousand / inhabitants (36.9%), which was 7 times greater than that observed in health regions with more than 2 million / inhabitants (5.2%). The negative migratory efficacy indicator (-0.39) indicated a predominance of evasion. Of the 450 Brazilian health regions, 117 (39.3%) had a coefficient of migratory efficacy between -1 and -0.75 and 113 (25.1%) between -0.75 and -0.25. Conclusion: The results indicate that the regionalization of the health system proved to be adequate in the organization of care in the territory, however the long distances traveled are still worrying.

Objetivo: Investigar os fluxos de internações por COVID-19 nas 450 regiões e 117 macrorregiões de saúde brasileiras no período de março a outubro de 2020. Método: Estudo descritivo, compreendendo todas as internações por COVID-19 registradas no Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) entre a 8ª e a 44ª semanas epidemiológicas de 2020. Foi calculada a proporção das internações por COVID-19 realizadas pelos residentes que ocorreram dentro da sua respectiva região de saúde, estratificado segundo períodos de maior e menor demanda de internações e segundo o porte populacional das regiões de saúde. Foi calculado o indicador de eficácia migratória, que leva em consideração a evasão e invasão de pacientes, por meio do cruzamento dos dados de origem dos pacientes (região de saúde de residência) com os dados do local da realização das internações (região de saúde de atendimento). Resultados: Foram identificadas 397.830 internações por COVID-19 no Brasil. A evasão foi de 11,9% dos residentes nas regiões de saúde e de 6,8% nas macrorregiões; o padrão que se manteve também no período de pico das internações por COVID-19. Houve em média 17,6% de evasão dos residentes das regiões de saúde do Nordeste e de 8,8% nas regiões de saúde do Sul. A evasão foi mais acentuada nas regiões de saúde com até 100 mil/hab. (36,9%), a qual foi 7 vezes maior que a verificada nas regiões de saúde com mais de 2 milhões/habitantes (5,2%). O indicador de eficácia migratória negativo (-0,39) indicou predomínio da evasão. Das 450 regiões de saúde brasileiras, 117 (39,3%) apresentaram coeficiente de eficácia migratória entre -1 e -0,75 e 113 (25,1%) entre -0,75 e -0,25. Conclusão: Os resultados indicam que a regionalização do sistema de saúde mostrou-se adequada na organização do atendimento no território, porém as longas distâncias percorridas ainda são preocupantes

Fluxo de internação por COVID-19 nas regiões de saúde do Brasil

Objetivo: Investigar os fluxos de internações por COVID-19 nas 450 regiões e 117 macrorregiões de saúde brasileiras no período de março a outubro de 2020. Método: Estudo descritivo, compreendendo todas as internações por COVID-19 registradas no Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) entre a 8ª e a 44ª semanas epidemiológicas de 2020. Foi calculada a proporção das internações por COVID-19 realizadas pelos residentes que ocorreram dentro da sua respectiva região de saúde, estratificado segundo períodos de maior e menor demanda de internações e segundo o porte populacional das regiões de saúde. Foi calculado o indicador de eficácia migratória, que leva em consideração a evasão e invasão de pacientes, por meio do cruzamento dos dados de origem dos pacientes (região de saúde de residência) com os dados do local da realização das internações (região de saúde de atendimento). Resultados: Foram identificadas 397.830 internações por COVID-19 no período. A evasão foi de 11,9% dos residentes nas regiões de saúde e de 6,8% nas macrorregiões; o padrão que se manteve também no período de pico das internações por COVID-19. Houve em média 17,6% de evasão dos residentes das regiões de saúde do Nordeste e de 8,8% nas regiões de saúde do Sul. A evasão foi mais acentuada nas regiões de saúde com até 100 mil/hab. (36,9%), a qual foi 7 vezes maior que a verificada nas regiões de saúde com mais de 2 milhões/habitantes (5,2%). O indicador de eficácia migratória negativo (-0,39) indicou predomínio da evasão. Das 450 regiões de saúde brasileiras, 117 (39,3%) apresentaram coeficiente de eficácia migratória entre -1 e -0,75 e 113 (25,1%) entre -0,75 e -0,25. Conclusão: Os resultados indicam que a regionalização do sistema de saúde mostrou-se adequada na organização do atendimento no território, porém as longas distâncias percorridas ainda são preocupantes.