Social inequalities in the misbelief of chloroquines protective effect against COVID-19: results from the EPICOVID-19 study in Brazil (preprint)

Objectives: The aim of this study was to assess the spread of denialist messages regarding COVID-19 in Brazil, specifically examining how social inequalities contributed to the misconception of chloroquine having a protective effect against the virus. Study design: Three countrywide population-based studies were conducted in 2020 (May 14-21, June 4-7, and June 21-24), including 133 Brazilian cities (n=88,772). Methods: Participants were asked whether they believed in chloroquines protective effect against infection with the SARS-CoV-2 virus (no/yes/dont know). A jeopardy index score to assess cumulative social deprivation was calculated based on gender, racial and socioeconomic variables. Descriptive analysis and inequality measures (Slope Index of Inequality - SII; and Concentration Index - CIX) were used to evaluate the main association under investigation. Multinomial logistic regression was used to evaluate 3-category outcome according to independent variables. Results: Overall, 47.9% of participants either believed that chloroquine prevented against COVID-19 or said, "I dont know". Misbelief and lack of knowledge about chloroquine were greater among the most vulnerable (lowest levels of education and socioeconomic status). Absolute and relative inequalities were observed according to jeopardy index. Lack of knowledge was 2.49 greater among women than among men. Race/ethnicity minorities, those with low education and low socioeconomic status were more likely to erroneously believe that chloroquine prevented against COVID-19. The highest absolute inequality was observed for the category "I dont know" (SII = -14.3). Conclusions: Misbelief of chloroquines protective effect against the SARS-CoV-2 virus was high in Brazil. People with greater social vulnerability were more likely to wrongly believe chloroquine prevented against COVID-19

Hospital characteristics associated with COVID-19 mortality: data from the multicenter cohort Brazilian Registry.

The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (ß = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (ß = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (ß = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (ß = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.

Predictors of quality of life among Brazilian medical students during second coronavirus wave (preprint)

Objective To assess the impact of COVID-19 second wave on quality of life (QoL) of Brazilian medical students. Methods The data from 210 medical students were collected through a web-based survey between February and March 2021. We assessed information about sociodemographic characteristics, health conditions, electronics tools-related to physical activity (PA-eTool), and health-associated QoL. Multiple linear regression was performed to identify the potential QoL predictors. Results The psychological domain was the most affected, showing lower score during COVID-19 second wave. Being male was a positive predictor in the physical health domain. Spending too much time indoors and sexual minority-group membership were associated with lower perception on psychological well-being. Personal benefit from having PA-eTool accessed and higher income were positively associated with psychological and environmental domains, respectively, and in the overall QoL. Conclusions Psychological well-being impairment is a long-term negative impact among Brazilian medical students during COVID-19. By evidencing that students’ QoL has been worsened in this global crisis, supportive interventions provided by community and universities are required to aid those vulnerable students facing mental health or QoL impairment.