[COVID-19 and breast cancer screening in Brazil: a comparative analysis of the pre-pandemic and pandemic periods]. / COVID-19 e rastreamento do câncer de mama no Brasil: uma análise comparativa dos períodos pré-pandêmico e pandêmico.

The scope of this study was to evaluate the impacts of COVID-19 on breast cancer screening in Brazil. Data were collected from the Ambulatory Information System relating to "bilateral screening mammography" from January/2015 to December/2021. Analyses were performed by region and for Brazil. The average of exams in each month of the year was calculated based on 2015-2019 data, which was compared, monthly, with the number of exams in 2020 and 2021, obtaining the gross and percentage difference between these values. The same analysis was performed for the total number of exams in 2020 and 2021, individually, and for the two years combined. In 2020 there were reductions in the number of exams, which ranged from 25% (North) to 48% (Northeast), resulting in 1.749 million fewer exams than expected in the country (a drop of 44%). In 2021, the Midwest region presented a number of exams 11% higher than expected, while the other regions presented drops between 17% (North) and 27% (Southeast/South), resulting in 927 thousand exams fewer than expected in Brazil (reduction of 23%). In the joint analysis (2020/2021), reductions varied by region from 11% (Midwest) to 35% (Southeast/South), culminating in 2.676 million exams fewer than expected in Brazil (reduction of 33%).

Objetivou-se avaliar os impactos da COVID-19 no rastreamento do câncer de mama no Brasil. Coletaram-se dados do Sistema de Informações Ambulatoriais referentes a "mamografia bilateral para rastreamento" de janeiro/2015 a dezembro/2021. As análises foram feitas por região e para o Brasil. Calculou-se a média de exames em cada mês do ano com base nos dados de 2015 a 2019, a qual foi comparada, mensalmente, com o quantitativo de exames em 2020 e 2021, obtendo-se a diferença bruta e percentual entre esses valores. A mesma análise foi realizada para o número total de exames em 2020 e 2021, individualmente, e para os dois anos em conjunto. Em 2020 houve quedas no número de exames que variaram de 25% (Norte) a 48% (Nordeste), culminando em 1,749 milhão de exames a menos no país (queda de 44%). Em 2021, a região Centro-Oeste apresentou quantitativo de exames 11% superior ao esperado, enquanto as demais regiões apresentaram quedas entre 17% (Norte) e 27% (Sudeste/Sul), culminando em negativo de 927 mil exames no país (redução de 23%). Na análise conjunta (2020/2021), encontraram-se reduções que variaram de 11% (Centro-Oeste) a 35% (Sudeste/Sul), culminando em negativo de 2,676 milhões de procedimentos no Brasil (queda de 33%).

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.

Estimates of the impact of COVID-19 on mortality of institutionalized elderly in Brazil

Resumo O presente estudo tem como objetivo estimar o impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil. Foram estimados números de óbitos pela doença para o País, Unidades da Federação e Regiões, com base nas estimativas calculadas e efetuadas neste trabalho do percentual de óbitos de idosos que ocorreriam em instituições de longa permanência de acordo com os totais. Essa estimativa foi baseada em informações disponíveis para uma série de países. O percentual ponderado foi de 44,7%. Estimaram-se 107.538 óbitos de idosos nestas instituições no Brasil em 2020, por COVID-19. São previstos maiores números de óbitos na Região Sudeste (48.779 óbitos), seguida da Região Nordeste (28.451 óbitos);São Paulo é a Unidade da Federação que na estimativa será mais afetada (24.500 óbitos). Fica claro o forte impacto da COVID-19 na população idosa residente em instituições de longa permanência para idosos. As estimativas ultrapassam para o país 100 mil idosos, potencialmente os mais frágeis e vulneráveis, e são baseadas em número de óbitos totais conservador, tendo em vista outras estimativas e a situação alarmante de crescimento dos números de óbitos no Brasil. The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths);São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.

The Civil Registry in the first four months of the Covid-19 pandemic in Brazil: a comparative study between deaths by month of occurrence and by month of registration / O Registro Civil nos quatro primeiros meses da pandemia de Covid-19 no Brasil: estudo comparativo entre óbitos por mês de ocorrência e de registro / El Registro Civil en los primeros cuatro meses de la pandemia de covid-19 en Brasil: un estudio comparativo entre muertes por mes de ocurrencia y por mes de registro

O Registro Civil fornece informações aos estudos demográficos sobre mortalidade, fecundidade e nupcialidade. Questões têm surgido sobre o registro dos óbitos quando as causas de morte decorrem da Covid-19. A notificação pode acontecer com atraso. Com base nas informações disponibilizadas pelo Registro Civil de óbitos pela Covid-19, discriminados por dois grupos - data de registro e data de ocorrência -, o presente estudo compara estes grupos por categoria de município (capital, região metropolitana e interior), no período de março a junho de 2020, que corresponde aos quatro primeiros meses da pandemia no Brasil. Avaliam-se a magnitude e o sentido das diferenças de registros de óbitos entre os dois grupos. Foram utilizados gráficos e análise de regressão linear para comparações. Os achados indicam comportamento diferente de óbitos por mês de registro em comparação àqueles por mês de ocorrência entre março e junho. É importante identificar tal diferença de comportamentos dado que, para o monitoramento em curtíssimo prazo da pandemia, óbitos por data de registro antecipam óbitos cujo registro ainda será corretamente disponibilizado por data de ocorrência. Conclui-se que essa variação deve-

The Civil Registry provides information on demographic studies on mortality, fertility and nuptiality. Questions have been raised about death registration when the causes of death are related to Covid-19. Notification may be delayed. Based on information provided by the Civil Registry of deaths, stratified by two groups - date of registration and date of occurrence - by Covid-19, this study compares these groups by city categories (capital, metropolitan region, interior), over March, April, May and June 2020, occurring in the first four months of the pandemic in Brazil. The magnitude and meaning of the differences in death records between the two groups were assessed. Graphs and linear regression analyses were used for comparisons. The findings indicate a different behavior of deaths per month of registration compared to deaths per month of occurrence between March and June. It is important to identify such a difference in behavior since, for the very short-term monitoring of the pandemic, deaths from registry data anticipate deaths whose records will still be adequately available by occurrence data. Such variation occurs mainly due to the systematic correction and updating of the information. As for the city categories, the biggest difference between deaths by month of occurrence and registration was observed for the municipalities in the interior, in line with the spread of the epidemic towards the interior in the month of May.

El Registro Civil proporciona información sobre estudios demográficos en mortalidad, fecundidad y nupcialidad. Se han planteado preguntas sobre el registro de muertes cuando las causas de muerte son por covid-19, ya que la notificación puede producirse tarde. Con base en la información proporcionada por el Registro Civil de Defunciones, desglosada en dos grupos -fecha de inscripción y fecha de ocurrencia- por covid-19, este estudio los compara por tipo de municipio (capital, región metropolitana, interior), sobre los meses de marzo, abril, mayo y junio de 2020, corresponden a primeros cuatro meses de la pandemia en Brasil. Se evalúa la magnitud y el significado de las diferencias en los registros de defunción entre los dos grupos. Para las comparaciones se utilizaron gráficos y análisis de regresión lineal. Los hallazgos indican un comportamiento diferente de las muertes por mes de registro en comparación con las muertes por mes de ocurrencia entre marzo y junio. Es importante identificar tal diferencia en el comportamiento ya que, para el monitoreo a muy corto plazo de la pandemia, las muertes a partir de los datos del registro anticipan muertes cuyos registros aún estarán disponibles correctamente mediante los datos de ocurrencia. Se concluye que esta variación se produce principalmente por la corrección y actualización sistemática de la información. En cuanto al tipo de municipio, la mayor diferencia entre defunciones por mes de ocurrencia y de registro se registró para los municipios del interior, en línea con la propagación de la epidemia hacia el interior, en mayo.

Estimates of the impact of COVID-19 on mortality of institutionalized elderly in Brazil. / Estimativas de impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil.

The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths); São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.