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1.
Rev. enferm. UERJ ; 28: 49923, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1097213

RESUMEN

Objetivo: refletir sobre as intervenções/ações de cuidado em saúde mental voltados aos profissionais da saúde que prestam assistência ao paciente suspeito ou diagnosticado com COVID-19. Conteúdo: A pandemia de COVID-19 traz o desafio para profissionais da saúde em lidar com sua própria saúde mental e a dos pacientes. É fundamental conhecer e refletir sobre iniciativas que países apresentam para lidar com a manutenção da saúde mental de profissionais da saúde em tempos de pandemia e que contribuem para repensar o planejamento, execução e avaliação de estratégias a serem utilizadas no Brasil. Considerações finais: foi possível elencar ações em saúde mental que têm se mostrado assertivas no cuidado aos trabalhadores de saúde, atuantes na ponta do cuidado, sobretudo as baseadas no esclarecimento da doença, uso adequado de equipamentos de proteção individual, além do mapeamento daqueles profissionais fragilizados emocionalmente e/ou com sofrimento mental anterior à pandemia, além do suporte emocional oferecido por meio de plataformas digitais.


Objective: to reflect on mental health care interventions/actions aimed at health professionals who provide assistance to patients suspected or diagnosed with COVID-19. Content: The COVID-19 pandemic challenges health professionals to lead with their own and patients' mental health. It is essential to know and to reflect about countries' initiatives to deal with health professional's mental health maintenance in times of pandemic, and to help to re-think strategies planning, execution and evaluation to be used in Brazil. Final considerations: it was possible to list actions in mental health that have shown to be assertive in the care of health workers who are in the front line of caring, especially those based on clarifying the disease, appropriate use of individual protective equipment, in addition to mapping those emotionally weakened professionals and or with mental suffering prior to the pandemic, in addition to the emotional support offered through digital platforms.


Objetivo: reflexionar sobre las intervenciones/acciones de atención de salud mental dirigidas a profesionales de la salud que prestan asistencia a pacientes sospechosos o diagnosticados con COVID-19. Contenido: La pandemia COVID-19 desafía a los profesionales de la salud a hacer frente con la salud mental propia y de los pacientes. Es esencial conocer y reflexionar sobre las iniciativas de los países para enfrentar al mantenimiento de la salud mental de los profesionales de la salud en tiempos de pandemia, y para ayudar a repensar la planificación, ejecución y evaluación de estrategias que se utilizarán en Brasil. Consideraciones finales: fue posible enumerar acciones en salud mental que han demostrado ser asertivas en la atención de los trabajadores de salud que trabajan en la primera línea de atención de la salud, especialmente aquellos basados en la aclaración de la enfermedad, el uso apropiado de equipos de protección individual, además de mapear aquellos profesionales debilitados emocionalmente y / o con sufrimiento mental antes de la pandemia, además del apoyo emocional ofrecido a través de plataformas digitales.


Asunto(s)
Humanos , Masculino , Femenino , Salud Mental/normas , Personal de Salud/psicología , Infecciones por Coronavirus , Pandemias , Betacoronavirus , Brasil , Salud Laboral , Difusión de la Información , Equipo de Protección Personal
2.
Rev. enferm. UERJ ; 28: 49570, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1094832

RESUMEN

Objetivo: discutir as experiências e contradições no controle da pandemia de Covid-19 sob a perspectiva da epidemiologia e das políticas públicas brasileiras. Conteúdo: o debate apresentado divide-se em duas seções: a primeira traça a reflexão dos parâmetros epidemiológicos sobre a curva epidêmica do SARS-CoV-2, bem como as experiências internacionais para o controle deste fenômeno. A segunda, ancorada nas políticas públicas brasileiras, apresenta uma análise comparada das experiências nacionais e internacionais, discutindo os potenciais reflexos sobre a pandemia, considerando algumas especificidades sociais. Conclusão: frente à impossibilidade de redução de pessoas susceptíveis por meio de estratégias vacinais, a redução da velocidade da curva epidêmica precisa ocorrer por meio de ações de isolamento físico social. Ademais, a construção de políticas públicas que visem a proteção ao trabalhador e a ampliação do investimento no setor saúde são medidas urgentes.


Objective: to discuss experiences and contradictions in the control of the Covid-19 pandemic from the perspective of epidemiology and Brazilian public policies. Content: the discussion presented is divided into two sections: the first one present epidemiological parameters on the epidemic curve of SARS-CoV-2, as well as the international experiences for the control of this phenomenon. The second, anchored in the Brazilian public policies, presents a comparative analysis of national and international experiences, discussing the potential impacts on the pandemic, considering some specific social issues. Conclusion: in the face of impossibility of reducing susceptible people through vaccination strategies, the reduction of the speed of the epidemic curve needs to occur through actions of social distance. In addition, the construction of public policies aimed at protecting workers and expanding investment in the health sector are urgent measures.


Objetivo: discutir las experiencias y contradicciones en el control de la pandemia Covid-19 desde la perspectiva de la epidemiología brasileña y las políticas públicas. Contenido: el debate presentado se divide en dos secciones. El primero traza la reflexión de los parámetros epidemiológicos en la curva epidémica del SARS-CoV-2, así como las experiencias internacionales para el control de este fenómeno. El segunda seccione, anclada en las políticas públicas brasileñas, presenta un análisis comparativo de las experiencias nacionales e internacionales, discutiendo los posibles impactos en la pandemia, considerando algunas especificidades sociales brasileñas. Conclusión: dada la imposibilidad de reducir a las personas susceptibles a través de estrategias de vacunación, la reducción de la velocidad de la curva epidémica debe ocurrir a través de acciones de aislamiento social y físico. Además, la construcción de políticas públicas destinadas a proteger a los trabajadores y ampliar la inversión en el sector de la salud son medidas urgentes.


Asunto(s)
Humanos , Neumonía Viral , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Políticas Públicas de Salud , Pandemias , Política Pública , Betacoronavirus
5.
São Paulo; APH; jul. 2020. 34 p.
Monografía en Portugués | LILACS, HomeoIndex - Homeopatia | ID: biblio-1102394

RESUMEN

A infecção humana causada pelo vírus SARS-CoV-2 (COVID-19), diagnosticada como pneumonia de causa desconhecida originalmente na cidade de Wuhan (China), foi considerada como pandemia pela Organização Mundial da Saúde. Sua transmissibilidade parece ser bastante elevada, tendo afetado quase dois milhões de pessoas em todo o mundo e provocado mais de 500 mil mortes. Surgiu no Brasil em fevereiro de 2020, inicialmente na cidade de São Paulo. Afeta de forma mais grave os idosos e portadores de algumas comorbidades (tais como doenças cardiovasculares, hipertensão arterial, diabetes, câncer, DPOC e doenças cerebrovasculares, entre outras), tendo uma sintomatologia variável e tratamentos empíricos que estão sendo testados de forma mais rigorosa desde o seu aparecimento. Na ausência de vacina para proteção dos sadios, tem sido adotada a estratégia de isolamento social e tratamento com medidas de suporte geral e/ou avançado. Neste contexto, cabe investigar a contribuição de intervenções medicamentosas no enfrentamento precoce da doença, notadamente no alívio dos sintomas desconfortáveis por ela provocados em sua fase inicial e eventual interrupção da progressão da doença, com acompanhamento e registro dos resultados obtidos. Com o protocolo se pretende coletar, durante o período em que durar a pandemia da COVID-19 no Brasil, informações de pacientes suspeitos clinicamente ou laboratorialmente diagnosticados com a doença, tratados com medicamentos escolhidos de acordo com protocolos de autoridades locais de saúde ou segundo o tirocínio do médico, Todos os medicamentos deverão estar regularmente registrados na Anvisa, embora sem indicações específicas para a COVID-19. Serão avaliados os efeitos no estado de saúde do paciente, por meio de escores e escalas clínicas, bem como aspectos relacionados à segurança do medicamento, variação na duração da doença e medicamentos mais associados a eventuais sucessos terapêuticos. Questionário padronizado e específico para a COVID-19 foi elaborado e disponibilizado em formulários google para preenchimento dos médicos colaboradores do estudo durante o acompanhamento dos pacientes. Os dados serão armazenados em planilhas eletrônicas e serão analisados com técnicas estatísticas descritivas e inferenciais. Todos os dados dos pacientes serão coletados de forma totalmente anonimizada para proteger a privacidade dos pacientes, que serão identificados no formulário eletrônico, única e exclusivamente, por um código alfanumérico, escolhido pelo seu médico assistente e registrado no seu prontuário médico. Dada a situação pandêmica, nos casos em que não for possível o atendimento presencial será enviado uma folha de informações sobre o estudo e TCLE para preenchimento pelo paciente, bem como feitas as teleconsultas de seguimento para acompanhamento do caso. Além de gerar o desenvolvimento de novas aplicações da telemedicina, o projeto visa também a coleta de informações úteis que poderão ser utilizadas em futuros estudos multicêntricos randomizados e controlados para tratamento medicamentoso de quadros epidêmicos, podendo servir também de modelo para novos estudos clínicos de avaliação dos benefícios de intervenções farmacológicas em outras doenças ou agravos à saúde. (AU)


Infection in humans caused by the SARS-CoV-2 virus (COVID-19), diagnosed as pneumonia of unknown cause originally in the city of Wuhan (China) in December 2019, was considered a pandemic by the World Health Organization. Its transmissibility seems to be quite high, affecting almost two million people worldwide and causing more than 500 thousand deaths. It appeared in Brazil in February 2020, initially in the city of São Paulo. It affects more severely the elderly and people with some comorbidities (such as cardiovascular diseases, high blood pressure, diabetes, malignancy, chronic obstructive pulmonary disease and cerebrovascular disease, among others), with a rich clinical symptomatology. Empirical treatments are being tested in more rigorous clinical trials. In the absence of a vaccine to protect the healthy, the strategy of social isolation and treatment with general and / or advanced support measures has been adopted. In this context, it is worth investigating the potential contribution of some pharmacological interventions for relieving the distressing symptoms caused by coronavirus in its initial phase or stop its progression, together with monitoring and recording outcomes collected by doctors. This protocol intends to collect information from suspected or confirmed cases of COVID-19 patients, during the current pandemic in Brazil. The patients will be attended by doctors that will evaluate their clinical situation and will decide on the appropriate prescription following local clinical protocols or their own clinical expertise. All medicines must be registered in Anvisa (Brazilian regulatory agency for medicines), even if no indication stated for treating COVID-19. The effects on patients' health status will be evaluated by means of scores and clinical scales, together with measures on safety, duration of the disease and medicines better related with good results. A standardized and specific questionnaire for COVID-19 had been designed and will be available on google forms to be filled out by doctors during the study. The data will be stored in electronic spreadsheets and will be analysed using descriptive and inferential statistical techniques. All patient data will be collected in a completely anonymous way to protect patients' privacy. Patients will be identified exclusively by an alphanumeric code, to be registered in doctors' medical records. Given the pandemic situation, in cases in which face-to-face health care is not obligatory, an information sheet about the study will be sent to the patient in order to get the informed consent. Teleconsultations will take place in some cases for follow-up of patients. In addition to enlarge telemedicine applications, this project also aims to collect useful information that could be used in future randomized and controlled multicentre trials to evaluate the role of pharmacological interventions in epidemic or transmissible diseases. It could also be helpful for designing clinical studies using pharmaceutical preparations in other diseases or health problems. (AU)


La infección en humanos causada por el virus SARS-CoV-2 (COVID-19), diagnosticada como neumonía de causa desconocida originalmente en la ciudad de Wuhan (China) en diciembre de 2019, fue considerada una pandemia por la Organización Mundial de la Salud. Su transmisibilidad parece ser bastante alta, afectando a casi dos millones de personas en todo el mundo y causando más de 500 mil muertes. Apareció en Brasil en febrero de 2020, inicialmente en la ciudad de São Paulo. Afecta más severamente a los ancianos y personas con algunas comorbilidades (como enfermedades cardiovasculares, presión arterial alta, diabetes, malignidad, enfermedad pulmonar obstructiva crónica y enfermedad cerebrovascular, entre otros), con una rica sintomatología clínica. Los tratamientos empíricos se están probando en ensayos clínicos más rigurosos. En ausencia de una vacuna para proteger a los sanos, se ha adoptado la estrategia de aislamiento social y tratamiento con medidas de apoyo generales y / o avanzadas. En este contexto, se puede investigar la contribución potencial de preparaciones farmacéuticas para aliviar los síntomas causados por el coronavirus en su fase inicial o interrupción de progresión de la enfermedad, junto con el monitoreo y registro de los resultados recopilados por los médicos. Este protocolo tiene la intención de recopilar información de casos sospechosos o confirmados de pacientes con COVID-19, durante la pandemia actual en Brasil. Los pacientes serán atendidos por médicos que evaluarán su situación clínica y prescribirán medicamentos según protocolos clínicos locales o por decisión propia conforme su expertise clínica. Todos los medicamentos prescritos deberán estar registrados en Anvisa (Agencia Brasileña de regulación de medicamentos), aún sin indicaciones precisas para la COVID-19. Los efectos sobre el estado de salud de los pacientes se evaluarán mediante puntajes de síntomas y escalas clínicas, junto con medidas de seguridad, duración de la enfermedad y revelación de medicamentos más asociados con buenas respuestas clínicas. Se diseñó un cuestionario estandarizado y específico para COVID-19, que estará disponible en los formularios de Google para que los médicos lo completen durante el estudio. Los datos se almacenarán en hojas de cálculo electrónicas y se analizarán mediante técnicas estadísticas descriptivas e inferenciales. Todos los datos del paciente se recopilarán de forma completamente anónima para proteger la privacidad de los pacientes. Los pacientes serán identificados exclusivamente por un código alfanumérico, que se registrará en los registros médicos de los médicos. Dada la situación de pandemia, en los casos en que la atención médica presencial no es obligatoria, se enviará una hoja de información sobre el estudio al paciente para obtener el consentimiento informado. Se realizarán tele consultas en algunos casos para el seguimiento de los pacientes. Además de ampliar las aplicaciones de telemedicina, este protocolo también tiene como objetivo recopilar información útil que podría utilizarse en futuros ensayos multicéntricos controlados y aleatorizados para evaluar el papel de preparaciones farmacéuticas en enfermedades epidémicas o transmisibles. También podría ser útil para diseñar estudios clínicos con medicamentos en otras enfermedades o problemas de salud. (AU)


Asunto(s)
Preparaciones Farmacéuticas , Recolección de Datos , Evaluación de Resultado en la Atención de Salud , Infecciones por Coronavirus , Homeopatía
6.
Artículo en Inglés | MEDLINE | ID: mdl-32644220

RESUMEN

Initial reports at the onset of the COVID-19 pandemic indicated that the obstetric population did not appear to be at higher risk of developing severe symptoms of COVID-19 than the general population.[1] However, following recent publications showing that pregnancy and the postpartum period might indeed pose additional risks for both women and babies, these preliminary observations urgently require review.[2] Explanations for heightened risk may include relative immunodeficiency associated with maternal physiological adaptations, as well as organic response to virus infections.

8.
Artículo en Inglés | MEDLINE | ID: mdl-32609257

RESUMEN

Age, sex and presence of comorbidities are risk factors associated with COVID-19. Hypertension, diabetes and heart disease are the most common comorbidities in patients with COVID-19. The objective of this study was to estimate the prevalence of patients with comorbidities who died of COVID-19 in Brazil. Searches of data were carried out on the official pages of the 26 State health departments and the federal district. The random-effect method was used to calculate the prevalence of patients with comorbidities who died. From the beginning of the pandemic in Brazil until May 20, 2020, 276,703 cases of COVID-19 were notified in Brazil, 6.4% died, 58.6% of whom were male. The prevalence of comorbidities among deaths was 83% (95% CI: 79 - 87), with heart disease and diabetes being the most prevalent. To our knowledge, this study represents the first large analysis of cases of patients with confirmed COVID-19 in Brazil. There is a high prevalence of comorbidities (83%) among patients who died from COVID-19 in Brazil, with heart disease being the most prevalent. This is important considering the possible secondary effects produced by drugs such as hydroxychloroquine.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Cardiopatías/mortalidad , Pandemias/estadística & datos numéricos , Neumonía Viral/mortalidad , Brasil/epidemiología , Enfermedad Crónica , Comorbilidad , Diabetes Mellitus/mortalidad , Femenino , Humanos , Hipertensión/mortalidad , Enfermedades del Sistema Inmune/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Enfermedades Renales/mortalidad , Enfermedades Pulmonares/mortalidad , Masculino , Obesidad/mortalidad , Neumonía/mortalidad , Prevalencia , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Accidente Cerebrovascular/mortalidad
9.
Rev Lat Am Enfermagem ; 28: e3344, 2020.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-32609281

RESUMEN

OBJECTIVE: to analyze the relationship between per capita income and the cumulative incidence of COVID-19 in the neighborhoods of the city of Rio de Janeiro, RJ, Brazil. METHOD: an ecological study using neighborhoods as units of analysis. The cumulative incidence rate per 100,000 inhabitants and the median of potential confounding variables (sex, race, and age) were calculated. Multiple analysis included quantile regression, estimating the regression coefficients of the variable income for every five percentiles from the 10th to 90th percentiles to verify the relationship between income and incidence. RESULTS: the city's rate was 36.58 new cases per 100,000 inhabitants. In general, the highest rates were observed in the wealthiest regions. Multiple analysis was consistent with this observation since the per capita income affected all percentiles analyzed, with a median regression coefficient of 0.02 (p-value <0.001; R2 32.93). That is, there is an increase of R$ 0.02 in the neighborhood's per capita income for every unit of incidence. CONCLUSION: cumulative incident rates of COVID-19 are influenced by one's neighborhood of residency, suggesting that access to testing is uneven.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Renta , Pandemias , Neumonía Viral/epidemiología , Características de la Residencia/estadística & datos numéricos , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Distribución por Edad , Brasil/epidemiología , Ciudades/epidemiología , Infecciones por Coronavirus/economía , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pandemias/economía , Pandemias/estadística & datos numéricos , Neumonía Viral/economía , Distribución por Sexo , Factores Socioeconómicos
10.
Rev Lat Am Enfermagem ; 28: e3345, 2020.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-32609282

RESUMEN

OBJECTIVE: to estimate the transmission rate, the epidemiological peak, and the number of deaths by the new coronavirus. METHOD: a mathematical and epidemiological model of susceptible, infected, and recovered cases was applied to the nine Brazilian capitals with the highest number of cases of the infection. The number of cases for the 80 days following the first case was estimated by solving the differential equations. The results were logarithmized and compared with the actual values to observe the model fit. In all scenarios, it was considered that no preventive measures had been taken. RESULTS: the nine metropolises studied showed an upward curve of confirmed cases of COVID-19. The prediction data point to the peak of the infection between late April and early May. Fortaleza and Manaus had the highest transmission rates (≥2·0 and ≥1·8, respectively). Rio de Janeiro may have the largest number of infected people (692,957) and Florianópolis the smallest (24,750). CONCLUSION: the estimates of the transmission rate, epidemiological peak, and number of deaths from coronavirus in Brazilian metropolises presented expressive and important numbers the Brazilian Ministry of Health needs to consider. The results confirm the rapid spread of the virus and its high mortality in the country.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Algoritmos , Brasil/epidemiología , Ciudades/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Humanos , Modelos Estadísticos , Modelos Teóricos , Pandemias/estadística & datos numéricos , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Factores de Tiempo
11.
Rev Lat Am Enfermagem ; 28: e3348, 2020.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-32609284

RESUMEN

OBJECTIVE: to map the production of knowledge regarding recommendations for providing care to pregnant women dealing with the novel coronavirus. METHOD: scoping review, using a broadened strategy to search databases and repositories, as well as the reference lists in the sources used. Data were collected and analyzed by two independent reviewers. Data were analyzed and synthesized in the form of a narrative. RESULTS: the final sample was composed of 24 records, the content of which was synthesized in these conceptual categories: clinical manifestations, diagnosis, treatment, working pregnant women, vaccine development, complications, prenatal care, vertical transmission, and placental transmissibility. It is recommended to confirm pregnancy and disease early on, to use technological resources for screening and providing guidance and support to pregnant women. CONCLUSION: recommendations emphasize isolation, proper rest, sleep, nutrition, hydration, medications, and in the more severe cases, oxygen support, monitoring of vital signs, emotional support, and multiprofessional and individualized care. Medications should be used with caution due to a lack of evidence. Future research is needed to analyze the impact of the infection at the beginning of pregnancy and the psychological aspects of pregnant women infected with the virus.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Pandemias , Neumonía Viral/terapia , Guías de Práctica Clínica como Asunto , Complicaciones Infecciosas del Embarazo/terapia , Atención Prenatal/métodos , Brasil/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Conocimiento , Pandemias/estadística & datos numéricos , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología
16.
Preprint en Portugués | SciELO Preprints | ID: pps-901

RESUMEN

The Covid-19 pandemic announces something that has never been experienced by contemporary people. A virus that chronifies a series of inequalities and processes that affect subjects differently. In view of the statistical data on deaths, we actuate historical processes that are updated in the present, questioning who is dying and who was already marked to die, under the logic of state racism and necro-politics. We seek to reflect on whether the pandemic produces the new infamous and intensifies the production of bodies not subject to mourning, which implies a non-trivialization, a concern about not getting used to death that doesn't reach all in the same way, in the direction of an ethics that focuses on the struggle for life.


A pandemia da Covid-19 anuncia algo nunca vivido na contemporaneidade. Um vírus que cronifica uma série de desigualdades e processos que incidem diferentemente sobre os sujeitos. Diante dos dados estatísticos de mortes, acionamos processos históricos que se atualizam no presente, questionando quem está morrendo e quem já estava marcado para morrer, sob a lógica do racismo de estado e da necropolítica. Buscamos refletir se a pandemia produz os novos infames e intensifica a produção de corpos não passíveis de luto, o que implica em uma não banalização, uma inquietação em não nos acostumarmos com a morte que não atinge a todos de maneira igual, na direção de uma ética que aposte na luta pela vida.

17.
Preprint en Portugués | SciELO Preprints | ID: pps-881

RESUMEN

This article analyses the international performance of Brazil related to the new coronavirus pandemic, taking into consideration the strategic role of foreign policy and the historic Brazilian diplomatic participation in multilateral forums, including global health. It analyzes how Brazilian foreign policy is responding to the main domestic and international challenges related to fighting the pandemic and the country's economic recovery, highlighting its social consequences. We start from the hypothesis that Brazil is acting far below the requirements and far below the country's prohibitions and diplomatic tradition. We conclude that beyond the detrimental effect on the international scene of global health governance, when denying science through systematic action and policies, the Brazilian government is responsible for exposing the population to avoidable deaths.


Este artículo analiza el desempeño internacional de Brasil  la pandemia debido al nuevo coronavirus, teniendo en cuenta el papel estratégico de la política exterior; las relaciones internacionales de Brasil y la tradición diplomática brasileña en foros multilaterales e en la salud mundial. Analiza se cómo la política exterior brasileña está respondiendo a los principales desafíos nacionales e internacionales relacionados a la pandemia y los resultados de esta acción. Comienza con la hipótesis de que Brasil está actuando abajo de las necesidades y por debajo de las capacidades y la tradición diplomática del país. Concluimos que el efecto nocivo en el escenario internacional de la gobernanza mundial de la salud, al negar la ciencia a través de acciones y políticas sistemáticas, el gobierno brasileño es responsable de exponer a la población a muertes prevenibles.


O artigo analisa a atuação internacional do Brasil durante uma pandemia por novo coronavírus, considerando o papel estratégico da política externa, uma tradição diplomática brasileira nos fóruns multilaterais e na área da saúde global. Analise como a política externa brasileira está respondendo aos principais desafios domésticos e internacionais relacionados ao combate à pandemia e quais são os resultados práticos dessa atuação. Parte-se da hipótese de que o Brasil está atuando abaixo das exigências e das habilidades e tradição diplomática do país. Conclui que, para além do efeito prejudicial no cenário de governança global da saúde, para negar uma ciência por meio de ações e políticas sistemáticas, o governo brasileiro é responsável por exportar uma população a mortes evitáveis.

18.
Lancet Glob Health ; 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32622400

RESUMEN

BACKGROUND: Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms. METHODS: We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics: Branco (White), Preto (Black), Amarelo (East Asian), Indígeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation. FINDINGS: Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82·0%) of these patients were from the central-south region, and 2043 (18·0%) were from the north region. Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1·45, 95% CI 1·33-1·58 for Pardo Brazilians; 1·32, 1·15-1·52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states. INTERPRETATION: We found evidence of two distinct but associated effects: increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19. FUNDING: None.

20.
Diabetes Res Clin Pract ; : 108304, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32623040

RESUMEN

The present study aims atidentifying main barriers faced by people living with diabetes in Brazil during the COVID-19 pandemic. METHODS: In a convenience sampling study, data were collected from 1701 individuals, aged 18 or above; 75.54% female participants; 60.73% T1D and 30.75% T2D, between April 22nd and May 4th, using an anonymous and untraceable survey containing 20 multiple choice questions (socio-demographic; health status and habits of life during COVID-19 pandemic). Relationship between variables was established using the multiple correspondence analysis technique. RESULTS: 95.1% of respondents reduced their frequency of going outside of their homes; among those who monitored blood glucose at home during the pandemic (91.5%), the majority (59.4%) experienced an increase, a decrease or a higher variability in glucose levels; 38.4% postponed their medical appointments and/or routine examinations; and 59.5% reduced their physical activity. T1D, the youngest group, was more susceptible to presenting COVID-19 symptoms despite not being testing; whilst the TD2 group had higher frequency of comorbidities that are additional risk factors for COVID-19 severity. CONCLUSIONS: This study provides a firsthand revelation of the severity of COVID-19 on individuals with diabetes in Brazil, altering their habits, which impacted their glycemia, potentially increasing their risk of poor outcomes if infected by SARS-CoV-2.

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