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.

Adverse drug reactions associated with treatment in patients with chronic rheumatic diseases in childhood: a retrospective real life review of a single center cohort

Abstract Background: Adverse drug reactions (ADRs) are the sixth leading causes of death worldwide; monitoring them is fundamental, especially in patients with disorders like chronic rheumatic diseases (CRDs). The study aimed to describe the ADRs investigating their severity and associated factors and resulting interventions in pediatric patients with CRDs. Methods: A retrospective, descriptive and analytical study was conducted on a cohort of children and adolescents with juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). The study evaluated medical records of the patients to determine the causality and the management of ADRs. In order to investigate the risk factors that would increase the risk of ADRs, a logistic regression model was carried out on a group of patients treated with the main used drug. Results: We observed 949 ADRs in 547 patients studied. Methotrexate (MTX) was the most frequently used medication and also the cause of the most ADRs, which occurred in 63.3% of patients, followed by glucocorticoids (GCs). Comparing synthetic disease-modifying anti-rheumatic drugs (sDMARDs) vs biologic disease-modifying antirheumatic drugs (bDMARDs), the ADRs attributed to the former were by far higher than the latter. In general, the severity of ADRs was moderate and manageable. Drug withdrawal occurred in almost a quarter of the cases. In terms of risk factors, most patients who experienced ADRs due to MTX, were 16 years old or younger and received MTX in doses equal or higher than 0.6 mg/kg/week. Patients with JIA and JDM had a lower risk of ADRs than patients with JSLE. In the multiple regression model, the use of GCs for over 6 months led to an increase of 0.5% in the number of ADRs. Conclusions: Although the ADRs highly likely affect a wide range of children and adolescents with CRDs they were considered moderate and manageable cases mostly. However, triggers of ADRs need further investigations.(AU)

Clinical and socioeconomic characteristics of older adults with COVID-19: A protocol for a rapid systematic review

SUMMARY The aim of this rapid systematic review is to analyze the prevalence of clinical, socioeconomic, and demographic characteristics, laboratory and imaging findings, diagnostic tests, and treatment information of older adults with COVID-19. To conduct this systematic review, the Cochrane Handbook recommendations will be followed. Patients aged 60 years or older with a confirmed diagnosis of SARS-CoV-2 infection will be included. A comprehensive literature search will be performed in the following databases: MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILACS), Spanish Bibliographic Index on Health Sciences (IBECS) and Epistemonikos COVID-19 L·OVE platform. No language restrictions will be applied. To assess the methodological quality of the included studies and the certainty of the evidence, the Newcastle-Ottawa Scale, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used. The meta-analysis will be performed using R software. We believe this rapid systematic review will be able to summarize the currently available evidence on clinical, socioeconomic characteristics, and management of COVID-19 in older adults. Therefore, it will help implement adequate strategies to fight the pandemic and assist in understanding the clinical profile of older patients with COVID-19, providing data with due scientific support upon which to base future choices of procedures and interventions.

RESUMO O objetivo desta rápida revisão sistemática é analisar a prevalência de características clínicas, socioeconômicas e demográficas, achados laboratoriais e de imagem, testes de diagnóstico e informações de tratamento de idosos com COVID-19. Para conduzir esta revisão sistemática, serão seguidas as recomendações do Manual Cochrane. Pacientes com 60 anos ou mais com diagnóstico confirmado de infecção por Sars-CoV-2 serão incluídos. Uma pesquisa bibliográfica abrangente será realizada nas seguintes bases de dados: Medline via PubMed, Embase, Cochrane Central Register of Controlled Trials (Central), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Índice Bibliográfico Espanhol em Ciências da Saúde (Ibecs) e Epistemonikos Plataforma COVID-19 L · OVE. Nenhuma restrição de idioma será aplicada. Para avaliar a qualidade metodológica e a certeza das evidências dos estudos incluídos, serão utilizadas a Escala Newcastle-Ottawa e a abordagem Grading of Recommendations Assessment, Development and Evaluation (Grade). A meta-análise será realizada no software R. Acreditamos que esta revisão sistemática rápida será capaz de resumir as evidências atualmente disponíveis sobre as características clínicas, socioeconômicas e sobre o manejo de idosos com COVID-19. Portanto, ajudará a implementar estratégias adequadas para combater a pandemia e ajudará a entender o perfil clínico de pacientes idosos com COVID-19, fornecendo dados com o devido apoio científico sobre o qual basear futuras escolhas de procedimentos e intervenções.

Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

Abstract Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.

Caracterização de indivíduos acometidos por sífilis adquirida e congênita em um município do oeste do Paraná / Characterization of affected individuals for acquired and congenital syphilis in a municipality of the west of Paraná

Objetivo: Geral conhecer o número de indivíduos notificados com sífilis adquirida e congênita em um município localizado na região oeste do Paraná, nos anos de 2014 e 2015 e como objetivos específicos traçar o perfil socioeconômico e demográfico dos indivíduos notificados com sífilis adquirida e congênita e verificar o tratamento utilizado. Método: Estudo descritivo, retrospectivo com análise quantitativa. Resultado: No período do estudo foram notificados 39 casos de sífilis adquirida e sete de sífilis congênita. Quanto ao tratamento, o esquema predominante foi com Penicilina G. benzatina. Apenas 13 indivíduos adultos notificados receberam o tratamento. Todas as crianças receberam tratamento inadequado. A maioria dos indivíduos notificados era do gênero feminino com predominância da raça branca, quanto as notificações de sífilis congênita, houve maior concentração no gênero masculino e raça branca. Conclusão: É fundamental conhecer os casos de sífilis, para planejar ações de controle e prevenção.

Objective: general objective to find out the number of individuals notified with acquired and congenital syphilis in a town located in the Western region of Parana, between 2014 and 2015. As the specific objectives, it tried to outline the socio-economic and demographic profile of thenotified individuals with acquired and congenital syphilis, as well as to verify the used treatment. Method: Descriptive, retrospective with quantitative analysis study. Results: In the period of the study, 39 acquired syphilis and seven congenital syphilis cases were notified. With the respect to the treatment, the predominant scheme was with Benzathine Penicillin G. Only 13 notified adult individuals have received the treatment. All the children have received inappropriate treatment. The majority of the notified individuals was from the female gender with the predominance of the white race. With the respect to the notifications of congenital syphilis, there was a bigger concentration in the male gender and the white race. Conclusion: It is basic to know the cases in of syphilis, to plan actions to control the prevention.

Objetivo: Tuvo como objetivo general conocer el número de individuos notificados con sífilis adquirida y congénita en un municipio ubicado en la región oeste de Paraná, en los años de 2014 y 2015 y como objetivos específicos trazar el perfil socioeconómico y demográfico de los individuos notificados con sífilis adquirida y congénita y verificar el tratamiento utilizado. Método: Estudio descriptivo, retrospectivo con análisis cuantitativo. Resultados: En el periodo del estudio fueron notificados 39 (treinta y nueve) casos de sífilis adquiridas y 7 (siete) de sífilis congénita. Cuanto al tratamiento, el esquema predominante fue con Penicilina G Benzatínica. Solo 13 individuos adultos notificados recibieron el tratamiento. Todos los niños recibieron tratamiento inadecuado. La mayoría de los individuos notificados era del género femenino con predominancia de la raza blanca. Cuanto a las notificaciones de sífilis congénita, hubo mayor concentración en el género masculino y raza blanca. Conclusión: Es elemental conhecer los casos de sífilis, para planejar ações de control e prevención.

Vivenciando problemas de saúde em família: a implementação de uma proposta teórico-metodológica de cuidado / Experiencing problems of the health in family: the implementation of the theoretical-methodological proposal of care

Esta pesquisa teve por objetivo implementar parte da proposta teórico-metodológica de cuidado à família do portador de doença crônica descrita por Waidman e avaliar seus resultados. Trata-se de uma pesquisa qualitativa convergente-assistencial realizada no período de agosto de 2005 a junho de 2006. A população foi composta de 5 famílias de portadores de doenças crônicas vinculadas ao serviço público de saúde de Maringá-Paraná. Utilizou-se como estratégia de abordagem à família a visita domiciliar e o grupo terapêutico. A análise de conteúdo foi a técnica escolhida para analisar os dados. Os achados estão apresentados em duas categorias: "caracterização das famílias" e "vivenciando os problemas de saúde em família". Observamos que, apesar das dificuldades enfrentadas, o cuidador consegue cuidar de seu familiar e tem um laço afetivo forte com ele, laço que é fundamental para a manutenção da vida em família.

The aim of this research was implement in part the theoretical-methodological proposal of care in the family of chronic diseases bearer, described by Waidman, and evaluate the obtained results. This assistance and convergent qualitative research was carried out between August of 2005 and June of 2006. Five families with a chronic disease bearer, assisted by the Public Health Service of Maringá city, in Paraná ­ Brazil, was studied. The approach strategies to the studied families were the home visits and the therapeutic groups. The analysis of the obtained data was carried out by contents analyses technique. The obtained results were presented in two categories, family characterization and experiencing the family health troubles. In spite of difficult, was observed that the family caregivers are willing to care of the ill, having affection with them. These facts are fundamental to keep family coexistence.

Espaço físico do centro cirúrgico: situação ideal versus realidade / Physical Space of Operating Room: ideal situation versus reality

Centro Cirúrgico é o local onde são realizadas intervenções cirúrgicas, com suporte da ação de uma equipe profissional. É considerada área crítica de um Hospital. Visto que em muitas Instituições, esta unidade não se enquadra aos padrões pré-estabelecidos pelo Ministério da Saúde, avaliou-se a estrutura física do Centro Cirúrgico, de um Hospital de médio porte e comparou-se com o preconizado pelo Ministério. Para tanto, entrevistou-se o Técnico de Segurança do Trabalho. Pôde-se notar que muitas das normas exigidas pelo Ministério da Saúde não são cumpridas, o que pode interferir diretamente na assistência prestada.