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1.
Int J Environ Res Public Health ; 19(1)2021 12 31.
Article in English | MEDLINE | ID: covidwho-1613755

ABSTRACT

This work aimed to apply the ARIMA model to predict the under-reporting of new Hansen's disease cases during the COVID-19 pandemic in Palmas, Tocantins, Brazil. This is an ecological time series study of Hansen's disease indicators in the city of Palmas between 2001 and 2020 using the autoregressive integrated moving averages method. Data from the Notifiable Injuries Information System and population estimates from the Brazilian Institute of Geography and Statistics were collected. A total of 7035 new reported cases of Hansen's disease were analyzed. The ARIMA model (4,0,3) presented the lowest values for the two tested information criteria and was the one that best fit the data, as AIC = 431.30 and BIC = 462.28, using a statistical significance level of 0.05 and showing the differences between the predicted values and those recorded in the notifications, indicating a large number of under-reporting of Hansen's disease new cases during the period from April to December 2020. The ARIMA model reported that 177% of new cases of Hansen's disease were not reported in Palmas during the period of the COVID-19 pandemic in 2020. This study shows the need for the municipal control program to undertake immediate actions in terms of actively searching for cases and reducing their hidden prevalence.


Subject(s)
COVID-19 , Leprosy , Brazil/epidemiology , Humans , Leprosy/epidemiology , Models, Statistical , Pandemics , SARS-CoV-2
2.
Cad. Saúde Pública (Online) ; 37(10): e00119021, 2021. graf
Article in Portuguese | LILACS (Americas) | ID: covidwho-1609136

ABSTRACT

Este ensaio tem como objetivo apresentar e discutir o quadro teórico da sindemia da COVID-19. Na primeira parte, são apresentados os fundamentos e princípios da teoria sindêmica. Adotou-se o conceito de sindemia como processo de interação sinérgica entre duas ou mais doenças, no qual os efeitos se potencializam mutuamente. Foram discutidas as três principais tipologias de interação sindêmica: epidemias mutuamente causais; epidemias interagindo sinergicamente; e epidemias causais em série. Na segunda parte, a COVID-19 é analisada como uma sindemia resultante da interação entre vários grupos de doenças e o contexto socioeconômico. O modelo teórico considerou a interação entre COVID-19 e doenças crônicas não transmissíveis, doenças infecciosas e parasitárias e problemas de saúde mental. Abordou-se como as iniquidades sociais e as condições de vulnerabilidade atuam em diversos níveis e potencializam a atuação da COVID-19 e das demais pandemias. Na última seção, discute-se a necessidade de respostas abrangentes, multisetoriais e integradas ao enfrentamento da COVID-19. Foi apresentado um modelo de intervenção envolvendo as dimensões assistencial e socioeconômica. No âmbito assistencial, defendeu-se a estruturação de sistemas de saúde fortes, responsivos e acessíveis a toda a população. A dimensão econômica e social abordou o resgate dos ideais de solidariedade, da estratégia da promoção da saúde e a ênfase sobre os determinantes sociais. Conclui-se que as lições aprendidas com a abordagem sindêmica da COVID-19 exortam governos e a sociedade para o desenvolvimento de políticas que articulem intervenções clínicas, sanitárias, socioeconômicas e ambientais.


This essay aims to present and discuss the theoretical framework for the COVID-19 syndemic. The first part presents the foundations and principles of syndemic theory. For the purposes of this essay, syndemic was defined as a process of synergic interaction between two or more diseases, in which the effects are mutually enhanced. We discussed the three principal typologies of syndemic interaction: mutually causal epidemics; epidemics interacting synergically; and serial causal epidemics. In the second part, COVID-19 is analyzed as a syndemic resulting from the interaction between various groups of diseases and the socioeconomic context. The theoretical model considered the interaction between COVID-19 and chronic noncommunicable diseases, infectious and parasitic diseases, and mental health problems. The essay addressed how social iniquities and conditions of vulnerability act at various levels to increase the effect of COVID-19 and other pandemics. The last section discusses the need for comprehensive, multisector, and integrated responses to COVID-19. A model for intervention was presented that involves the patient care and socioeconomic dimensions. In the sphere of patient care, the authors defend the structuring of strong and responsive health systems, accessible to the entire population. The economic and social dimension addressed the issue of reclaiming the ideals of solidarity, the health promotion strategy, and emphasis on social determinants of health. In conclusion, the lessons learned from the syndemic approach to COVID-19 call on government and society to develop policies that link clinical, sanitary, socioeconomic, and environmental interventions.


Este ensayo tiene como objetivo presentar y discutir el cuadro teórico de la sindemia de la COVID-19. En la primera parte, se presentan los fundamentos y principios de la teoría sindémica. Se adoptó el concepto de sindemia como un proceso de interacción sinérgica entre dos o más enfermedades, en el que los efectos se potencializan mutuamente. Se discutieron las tres principales tipologías de interacción sindémica: epidemias mutuamente causales; epidemias interactuando sinérgicamente; y epidemias causales en serie. En la segunda parte, la COVID-19 es analizada como una sindemia resultante de la interacción entre varios grupos de enfermedades y el contexto socioeconómico. El modelo teórico consideró la interacción entre COVID-19 y enfermedades crónicas no transmisibles, enfermedades infecciosas y parasitarias, así como problemas de salud mental. Se abordó cómo las inequidades sociales y las condiciones de vulnerabilidad actúan en diversos niveles y potencializan la actuación de la COVID-19 y de las demás pandemias. En la última sección, se discute la necesidad de respuestas integrales, multisectoriales e integradas en el combate a la COVID-19. Se presentó un modelo de intervención implicando las dimensiones asistencial y socioeconómica. En el ámbito asistencial, se defendió la conformación de sistemas de salud fuertes, con capacidad de respuesta y accesibles a toda la población. La dimensión económica y social abordó el rescate de los ideales de solidaridad, de la estrategia de promoción de la salud, así como el énfasis sobre los determinantes sociales. Se concluye que las lecciones aprendidas con el abordaje sindémico de la COVID-19 exhortan a gobiernos y sociedad a que desarrollen políticas que implementen y coordinen intervenciones clínicas, sanitarias, socioeconómicas y ambientales.


Subject(s)
Humans , Syndemic , COVID-19 , Brazil , SARS-CoV-2 , Models, Theoretical
4.
Rev Fac Cien Med Univ Nac Cordoba ; 78(4): 437-438, 2021 12 28.
Article in Portuguese | MEDLINE | ID: covidwho-1599939

ABSTRACT

Letter to the editor about the current situation of the COVID-19 pandemic in Brazil.


Cartao ao editor sobre a situação atual da pandemia da COVID-19 no Brasil.


Subject(s)
COVID-19 , Brazil , Humans , Pandemics , SARS-CoV-2
5.
Int J Environ Res Public Health ; 18(24)2021 12 20.
Article in English | MEDLINE | ID: covidwho-1595516

ABSTRACT

The Oral Health Impact Profile-14 (OHIP-14) has been used to assess the impact that oral health problems can have on an individual's life. Different theoretical models were proposed to evaluate the results. The aims of this study were to evaluate the fit of different factorial models of the OHIP-14 to non-dental patients (NDP) and dental patients (DP) samples from Brazil and Finland and to estimate the differential functioning of the items in the OHIP-14 between the samples. Two studies were conducted, one in Brazil and the other in Finland, composed of five samples (Brazil-Sample 1 (S1): DP, n = 434, age: 25.3 [SD = 6.3] years; S2: NDP, n = 1486, age: 24.7 [SD = 5.6] years; S3: DP, n = 439, age: 29.0 [SD = 6.7] years; Finland-S4: DP, n = 482, age: 26.3 [SD = 5.4] years; S5: NDP, n = 2425, age: 26.7 [DP = 5.5] years). The fit of the OHIP-14 models to the data was estimated using a confirmatory strategy (validity based on the internal structure). Differential item functioning (DIF) between samples was estimated. For NDP from both countries, the response pattern severely violated the normality assumption in six items of the OHIP-14, indicating that the instrument does not fit for these samples. For DP, the model with the best fit was unifactorial, which deals with the estimation of the general impact of oral health on an individual's life, without addressing specific dimensions. Configural invariance was refuted between samples. DIF indicated that the characteristic of the sample (NDP and DP) in both countries interfered in the response given to the items, with the response level being more adequate for the latent PD trait. The validity of data related to the impact of oral health problems on an individual's life was confirmed through a unifactorial model. OHIP-14 works properly in DP samples and was limited in NDP samples, being also influenced by cultural context and age.


Subject(s)
Oral Health , Quality of Life , Adult , Brazil , Humans , Psychometrics , Reproducibility of Results , Surveys and Questionnaires , Young Adult
6.
Sci Rep ; 11(1): 24491, 2021 12 29.
Article in English | MEDLINE | ID: covidwho-1591547

ABSTRACT

There is an ongoing need for scientific analysis to help governments and public health authorities make decisions regarding the COVID-19 pandemic. This article presents a methodology based on data mining that can offer support for coping with epidemic diseases. The methodological approach was applied in São Paulo, Rio de Janeiro and Manaus, the cities in Brazil with the most COVID-19 deaths until the first half of 2021. We aimed to predict the evolution of COVID-19 in metropolises and identify air quality and meteorological variables correlated with confirmed cases and deaths. The statistical analyses indicated the most important explanatory environmental variables, while the cluster analyses showed the potential best input variables for the forecasting models. The forecast models were built by two different algorithms and their results have been compared. The relationship between epidemiological and environmental variables was particular to each of the three cities studied. Low solar radiation periods predicted in Manaus can guide managers to likely increase deaths due to COVID-19. In São Paulo, an increase in the mortality rate can be indicated by drought periods. The developed models can predict new cases and deaths by COVID-19 in studied cities. Furthermore, the methodological approach can be applied in other cities and for other epidemic diseases.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Data Mining/methods , Brazil/epidemiology , COVID-19/pathology , Cities/epidemiology , Humans , Models, Theoretical , Morbidity , Pandemics/prevention & control , SARS-CoV-2/pathogenicity
8.
Cad. Saúde Pública (Online) ; 37(3): e00221920, 2021. tab, graf
Article in English | LILACS (Americas) | ID: covidwho-1581648

ABSTRACT

Abstract: This study analyzed changes in the prevalence of physical inactivity and sedentary behaviors according to correlates during the COVID-19 pandemic among Brazilian adults. A national retrospective online survey was conducted with 39,693 Brazilian adults. Physical activity (weekly frequency and daily duration; cut-off point of 150 minutes/week), TV-viewing time and computer/tablet use (daily duration; cut-off point of 4 hours/day) before and during the pandemic period were reported. Sex, age group, schooling level, skin color, per capita income, country region, working status during the quarantine, and adherence to the quarantine were the correlates. Descriptive statistics were used. The prevalence of physical inactivity, high TV-viewing time and computer/tablet use increased, respectively, 26%, 266%, and 38% during the pandemic. While increases in physical inactivity and computer/tablet were more widespread, higher increases in the prevalence of high TV viewing tiem were observed among younger adults (660%), with higher schooling level (437%) and those who were at home office (331%). The prevalence of physical inactivity and sedentary behaviors increased in all population sub-groups during the COVID-19 pandemic in Brazil.


Resumo: O estudo buscou analisar mudanças na prevalência de inatividade física e comportamento sedentário de acordo com correlatos durante a pandemia da COVID-19 entre adultos brasileiros. Foi realizado um inquérito retrospectivo online, de base nacional, com 39.693 adultos brasileiros. Foram relatadas antes e durante a pandemia: atividade física (frequência semanal e duração diária; ponto de corte de 150 minutos/semana), tempo em TV e computador/tablet (duração diária; ponto de corte de 4 horas/dia). Os correlatos foram sexo, faixa etária, escolaridade, cor da pele, renda per capita, macrorregião, situação de trabalho durante o isolamento social e adesão ao isolamento. Foram utilizadas estatísticas descritivas. A prevalência de inatividade física, tempo de TV e tempo de computador/tablet aumentaram 26%, 266% e 38%, respectivamente, durante a pandemia. Os aumentos na inatividade física e no uso de computador/tablet foram mais prevalentes em geral, mas o aumento na prevalência de tempo elevado na frente da televisão foi maior entre adultos mais jovens (660%), com maior escolaridade (437%) e aqueles que trabalhavam em home office (331%). A prevalência de inatividade física e de comportamento sedentário aumentou em todos os subgrupos da população brasileira durante a pandemia da COVID-19.


Resumen: El objetivo de este estudio fue analizar los cambios en la prevalencia de inactividad física y comportamientos sedentarios, según correlaciones durante la pandemia de COVID-19, entre adultos brasileños. Se realizó una encuesta nacional retrospectiva con 39.693 adultos brasileños. Se informó de actividad física (frecuencia semanal y duración diaria; punto de corte de 150 minutos/semana), ver TV y el uso de computadora/tablet (duración diaria; punto de corte de 4 horas/día) antes y durante el periodo pandémico. Las correlaciones fueron: sexo, grupo de edad, logros académicos más altos, color de piel, ingresos per cápita, macrorregión del país, estatus laboral durante la cuarentena, y adherencia a la cuarentena. Se usaron estadísticas descriptivas. La prevalencia de inactividad física, ver la TV durante mucho tiempo y el uso de computadora/tablet, incrementó, respectivamente, un 26%, 266% y 38% durante la pandemia. Al igual que el incremento en inactividad física, y que el uso de la computadora/tablet era el más extendido, se observaron incrementos más altos en la prevalencia de ver más la TV entre los jóvenes adultos (660%), con un nivel de educación más alto (437%) y entre quienes estaban teletrabajando (331%). La prevalencia de inactividad física y comportamientos sedentarios se incrementaron en todos los subgrupos de población durante la pandemia de COVID-19 en Brasil.


Subject(s)
Humans , Adult , Sedentary Behavior , COVID-19 , Brazil , Prevalence , Cross-Sectional Studies , Retrospective Studies , Pandemics , SARS-CoV-2
9.
BMJ Open ; 11(11): e048073, 2021 11 17.
Article in English | MEDLINE | ID: covidwho-1583118

ABSTRACT

PURPOSE: This population-based open cohort study aims to investigate biological and sociodemographic drivers of malaria transmission in the main urban hotspot of Amazonian Brazil. PARTICIPANTS: Nearly 20% of the households in the northwestern town of Mâncio Lima were randomly selected and 2690 participants were enrolled since April 2018. Sociodemographic, housing quality, occupational, behavioural and morbidity information and travel histories were collected during consecutive study visits. Blood samples from participants>3 months old were used for malaria diagnosis and human genetic studies; samples from participants with laboratory-confirmed malaria have been cryopreserved for genetic and phenotypic characterisation of parasites. Serology was introduced in 2020 to measure the prevalence and longevity of SARS-CoV-2 IgG antibodies. FINDINGS TO DATE: Malaria prevalence rates were low (up to 1.0% for Plasmodium vivax and 0.6% for P. falciparum) during five consecutive cross-sectional surveys between April-May 2018 and October-November 2020; 63% of infections diagnosed by microscopy were asymptomatic. Malaria risk is heterogeneously distributed, with 20% study participants contributing 86% of the overall burden of P. vivax infection. Adult males are at greatest risk of infection and human mobility across the urban-rural interface may contribute to sustained malaria transmission. Local P. vivax parasites are genetically diverse and fragmented into discrete inbred lineages that remain stable across space and time. FUTURE PLANS: Two follow-up visits, with similar study protocols, are planned in 2021. We aim to identify high-risk individuals that fuel onwards malaria transmission and represent a priority target for more intensive and effective control interventions. TRIAL REGISTRATION NUMBER: NCT03689036.


Subject(s)
COVID-19 , Malaria, Falciparum , Malaria, Vivax , Malaria , Adult , Brazil/epidemiology , Cohort Studies , Cross-Sectional Studies , Humans , Infant , Malaria/epidemiology , Malaria, Vivax/epidemiology , Male , Prevalence , SARS-CoV-2
10.
BMC Infect Dis ; 21(1): 1260, 2021 Dec 18.
Article in English | MEDLINE | ID: covidwho-1582102

ABSTRACT

BACKGROUND: The aim of this study was to describe the temporal trend of tuberculosis cases according to sex and age group and evidence the level of disease before the Covid-19 pandemic in a TB high endemic city. METHODS: This was a time series study carried out in a city in northeast Brazil. The population was composed of cases of tuberculosis, excluding those with HIV-positive status, reported between the years 2002 and 2018. An exploratory analysis of the monthly rates of tuberculosis detection, smoothed according to sex and age group, was performed. Subsequently, the progression of the trend and prediction of the disease were also characterized according to these aspects. For the trends forecast, the seasonal autoregressive linear integrated moving average (ARIMA) model and the usual Box-Jenkins method were used to choose the most appropriate models. RESULTS: A total of 1620 cases of tuberculosis were reported, with an incidence of 49.7 cases per 100,000 inhabitants in men and 34.0 per 100,000 in women. Regarding the incidence for both sexes, there was a decreasing trend, which was similar for age. Evidence resulting from the application of the time series shows a decreasing trend in the years 2002-2018, with a trend of stability. CONCLUSIONS: The study evidenced a decreasing trend in tuberculosis, even before the Covid-19 pandemic, for both sex and age; however, in a step really slow from that recommended by the World Health Organization. According to the results, the disease would have achieved a level of stability in the city next years, however it might have been aggravated by the pandemic. These findings are relevant to evidence the serious behavior and trends of TB in a high endemic scenario considering a context prior to the Covid-19 pandemic.


Subject(s)
COVID-19 , Tuberculosis , Brazil/epidemiology , Humans , Pandemics , SARS-CoV-2 , Tuberculosis/epidemiology
11.
Int J Environ Res Public Health ; 19(1)2021 12 29.
Article in English | MEDLINE | ID: covidwho-1580786

ABSTRACT

OBJECTIVE: To analyze the relationships between sociodemographic variables, intolerance to uncertainty (INT), social support, and psychological distress (i.e., indicators of Common Mental Disorders (CMDs) and perceived stress (PS)) in Brazilian men during the COVID-19 pandemic. METHODS: A cross-sectional study with national coverage, of the web survey type, and conducted with 1006 Brazilian men during the period of social circulation restriction imposed by the health authorities in Brazil for suppression of the coronavirus and control of the pandemic. Structural equation modeling analysis was performed. RESULTS: Statistically significant direct effects of race/skin color (λ = 0.268; p-value < 0.001), socioeconomic status (SES) (λ = 0.306; p-value < 0.001), household composition (λ = 0.281; p-value < 0.001), PS (λ = 0.513; p-value < 0.001), and INT (λ = 0.421; p-value < 0.001) were evidenced in the occurrence of CMDs. Black-skinned men with higher SES, living alone, and with higher PS and INT levels presented higher prevalence values of CMDs. CONCLUSIONS: High levels of PS and INT were the factors that presented the strongest associations with the occurrence of CMDs among the men. It is necessary to implement actions to reduce the stress-generating sources as well as to promote an increase in resilience and the development of intrinsic reinforcements to deal with uncertain threats.


Subject(s)
COVID-19 , Psychological Distress , Brazil/epidemiology , Cross-Sectional Studies , Humans , Male , Pandemics , SARS-CoV-2 , Social Support , Stress, Psychological/epidemiology , Uncertainty
12.
Sci Rep ; 11(1): 24443, 2021 12 27.
Article in English | MEDLINE | ID: covidwho-1585775

ABSTRACT

We investigate, through a data-driven contact tracing model, the transmission of COVID-19 inside buses during distinct phases of the pandemic in a large Brazilian city. From this microscopic approach, we recover the networks of close contacts within consecutive time windows. A longitudinal comparison is then performed by upscaling the traced contacts with the transmission computed from a mean-field compartmental model for the entire city. Our results show that the effective reproduction numbers inside the buses, [Formula: see text], and in the city, [Formula: see text], followed a compatible behavior during the first wave of the local outbreak. Moreover, by distinguishing the close contacts of healthcare workers in the buses, we discovered that their transmission, [Formula: see text], during the same period, was systematically higher than [Formula: see text]. This result reinforces the need for special public transportation policies for highly exposed groups of people.


Subject(s)
COVID-19/transmission , Contact Tracing/methods , Brazil/epidemiology , COVID-19/epidemiology , COVID-19/virology , Disease Outbreaks , Health Personnel/statistics & numerical data , Humans , Models, Theoretical , SARS-CoV-2/isolation & purification , Transportation
13.
Rev Bras Ginecol Obstet ; 43(12): 932-939, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1585681

ABSTRACT

OBJECTIVE: To study maternal anxiety in pregnant women without comorbidities in the context of the COVID-19 outbreak in Brazil and to study maternal knowledge and concerns about the pandemic. METHODS: This is a secondary analysis from a national multicenter cross-sectional study performed in 10 cities, from June to August, 2020, in Brazil. Interviewed postpartum women, without medical or obstetrical comorbidities, were included in the present subanalysis. A structured questionnaire and the Beck Anxiety Inventory (BAI) were applied. RESULTS: Out of the 1,662 women, 763 (45.9%) met the criteria for the current analysis and 16.1% presented with moderate and 11.5% with severe maternal anxiety. Moderate or severe maternal anxiety was associated with high school education (odds ratio [OR]:1.58; 95% confidence interval [CI]:1.04-2.40). The protective factor was cohabiting with a partner (OR: 0.46; 95%CI: 0.29-0.73). There was a positive correlation between the total BAI score and receiving information about care in the pandemic (rpartial 0.15; p < 0.001); concern about vertical transmission of COVID-19 (rpartial 0.10; p = 0.01); receiving information about breastfeeding (rpartial 0.08; p = 0.03); concerns about prenatal care (rpartial 0.10; p = 0.01), and concerns about the baby contracting COVID-19 (rpartial 0.11; p = 0.004). The correlation was negative in the following aspects: self-confidence in protecting from COVID-19 (rpartial 0.08; p = 0.04), having learned (rpartial 0.09; p = 0.01) and self-confidence in breastfeeding (rpartial 0.22; p < 0.001) in the context of the pandemic. CONCLUSION: The anxiety of pregnant women without medical or obstetrical comorbidities was associated to high school educational level and not living with a partner during the COVID-19 pandemic. Self-confidence in protecting against COVID-19 and knowledge about breastfeeding care during the pandemic reduced maternal anxiety.


OBJETIVO: Estudar a ansiedade materna em gestantes sem comorbidades no contexto do surto de COVID-19 no Brasil e estudar o conhecimento e as preocupações maternas sobre a pandemia. MéTODOS: Trata-se de análise secundária de um estudo transversal multicêntrico nacional realizado em 10 cidades, de junho a agosto de 2020, no Brasil. Mulheres no pós-parto entrevistadas, sem comorbidades médicas ou obstétricas, foram incluídas nesta subanálise. Foram aplicados um questionário estruturado e o Inventário de Ansiedade de Beck (BAI, na sigla em inglês). RESULTADOS: Das 1.662 mulheres, 763 (45,9%) atenderam aos critérios da análise atual e 16,1% apresentaram ansiedade materna moderada e 11,5% ansiedade materna grave. A ansiedade materna moderada ou grave foi associada à escolaridade no ensino médio (odds ratio [OR]: 1,58; intervalo de confiança [IC] 95%: 1,04­2,40). O fator protetor foi coabitar com companheiro (OR: 0,46; IC95%: 0,29­0,73). Houve correlação positiva entre a pontuação total do BAI e o recebimento de informações sobre cuidados na pandemia (rparcial 0,15; p < 0,001); preocupação com a transmissão vertical de COVID-19 (rparcial 0,10; p = 0,01); receber informações sobre amamentação (rparcial 0,08; p = 0,03); preocupações sobre cuidados pré-natais (rparcial 0,10; p = 0,01) e preocupações sobre o bebê contrair COVID-19 (rparcial 0,11; p = 0,004). A correlação foi negativa com os seguintes aspectos: ter autoconfiança para se proteger (rparcial 0,08; p = 0,04), aprender (rparcial 0,09; p = 0,01) e ter autoconfiança para amamentar (rparcial 0,22; p < 0,001) no contexto da pandemia. CONCLUSãO: A ansiedade de gestantes sem comorbidades médicas ou obstétricas esteve associada à escolaridade no ensino médio e não morar com companheiro durante a pandemia de COVID-19. A autoconfiança na proteção contra COVID-19 e o conhecimento sobre os cuidados com a amamentação durante a pandemia reduziram a ansiedade materna.


Subject(s)
COVID-19 , Pregnant Women , Anxiety/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Depression , Female , Humans , Pandemics , Pregnancy , SARS-CoV-2
15.
Cad. Saúde Pública (Online) ; 37(9): e00028321, 2021. tab, graf
Article in English | LILACS (Americas) | ID: covidwho-1574301

ABSTRACT

Abstract: We aim to examine the effect of the COVID-19 pandemic on the ethnoracial disparities in hospitalizations due to dementia and its related outcomes, in Brazil. A longitudinal panel study was carried out with data extracted from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS). We assessed the number of hospital admission per 100,000 inhabitants, mean inpatient spending, and inpatient mortality rate due to dementia during the first semester of 2019 and 2020. Data were stratified by geographic region and ethnoracial groups (black, mixed, and white) based on skin color. We observed an overall reduction in hospital admissions, mean inpatient spending, and mortality rate between the first semester of 2019 and 2020. However, the reduction of hospitalization rates among black and mixed people was 105.3% and 121.1% greater than in whites, respectively. Mortality rate was decreased by 9% in whites and was increased by 65% and 43% in the black and mixed population, respectively. In the first semester of 2020, black and mixed patients had a higher risk of losing their lives due to dementia than white people. This disparity was not observed in the same period of 2019. In 2020, the inpatient mortality ratio reached the highest values among black individuals in all regions but the North (no data available). Since the beginning of the COVID-19 epidemic in Brazil, ethnoracial disparity in hospital admissions and mortality rates due to dementia has been heightened. Governmental actions and policies to mitigate this indirect effect of the pandemic on the Brazilian population are urgent.


Resumo: O estudo teve como objetivo examinar o efeito da pandemia da COVID-19 sobre disparidades étnico-raciais nas hospitalizações e desfechos relacionados à demência no Brasil. Foi realizado um estudo de painel longitudinal com dados extraídos do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Avaliamos o número de internações hospitalares por 100 mil habitantes, média de gastos hospitalares e taxa de mortalidade por demência durante o primeiro semestre de 2019 e de 2020. Os dados foram estratificados por região geográfica e grupo étnico-racial (preto, pardo e branco) com base na cor da pele. Observamos uma redução geral nas internações, média de gastos hospitalares e taxa de mortalidade entre o primeiro semestre de 2019 e o mesmo período em 2020. Entretanto, as reduções nas taxas de hospitalização entre pretos e pardos foram 105,3% e 121,1% maiores que em brancos, respectivamente. A taxa de mortalidade diminuiu em 9% entre brancos e aumentou em 65% e 43% entre pretos e pardos, respectivamente. No primeiro semestre de 2020, pacientes pretos e pardos tiveram um risco mais alto de perder a vida por demência quando comparados aos brancos, disparidade essa não havia sido observada no mesmo período de 2019. Em 2020, a razão de mortalidade hospitalar atingiu os níveis mais altos em indivíduos pretos em todas as regiões exceto a Norte (dados não publicados). Desde o início da epidemia de COVID-19 no Brasil, aumentou a disparidade étnico-racial nas internações e taxas de mortalidade por demência. São necessárias medidas e políticas governamentais para mitigar esse efeito indireto da pandemia sobre a população brasileira.


Resumen: El objetivo fue examinar el efecto de la pandemia de COVID-19 respecto a las disparidades étnico-raciales en hospitalizaciones, así como los resultados informados de las mismas, debido a la demencia en Brasil. Se trata de un estudio longitudinal en panel, realizado con datos extraídos del Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS). Evaluamos el número de admisiones hospitalarias por 100.000 habitantes, la media del gasto hospitalario, además de la tasa de mortalidad hospitalaria, debido a la demencia, durante el primer semestre de 2019 y 2020. Los datos fueron estratificados por región geográfica y grupos étnico-raciales (negros, mestizos, y blancos), basados en su color de piel. Observamos en general una reducción en las admisiones hospitalarias, media del gasto hospitalario, y tasa de mortalidad entre el primer semestre de 2019 y 2020. No obstante, la reducción de las tasas de hospitalización entre negros y mestizos fue 105.3% y 121.1% superior, respecto a la de los blancos, respectivamente. La tasa de mortalidad decreció un 9% en blancos y aumentó en un 65% y un 43% en la población negra y mestiza, comparativamente. En el primer semestre de 2020, los pacientes negros y mestizos tenían un riesgo más alto de fallecer, debido a la demencia que la gente blanca, esta disparidad no se observó en el mismo periodo de 2019. En 2020, la ratio de mortalidad hospitalaria alcanzó los valores más altos entre individuos negros en todas las regiones, salvo en el Norte (no había datos disponibles). Desde el principio de la epidemia de COVID-19 en Brasil, la disparidad étnico-racial en las admisiones hospitalarias y tasas de mortalidad, debido a la demencia, se ha incrementado. Son urgentes acciones gubernamentales y políticas para mitigar este efecto indirecto de la pandemia en la población brasileña.


Subject(s)
Humans , Dementia/epidemiology , COVID-19 , Brazil/epidemiology , Pandemics , SARS-CoV-2 , Hospitalization
16.
Cad. Saúde Pública (Online) ; 37(9): e00242320, 2021. tab, graf
Article in English | LILACS (Americas) | ID: covidwho-1573779

ABSTRACT

On March 24, 2020, a partial lockdown was decreed in the state of São Paulo, Brazil, as a measure to hinder the spread of COVID-19, which consisted in prohibiting crowding and advising people to stay home, except for urgent or extremely necessary matters. Based on studies performed in other countries, this study aims to assess the impacts of the lockdown on the air quality of five cities in the state of São Paulo. Our study was conducted by using particulate matter and nitrogen dioxide as air quality indicators, and by correlating the contaminants concentrations with weather data. The results showed an increase in these contaminants in all cities within the first weeks after the lockdown compared with the weeks before the decree and with the same period in previous years. This result is inconsistent with the literature. Therefore, a secondary goal was set to investigate the possible cause (or causes) of such deterioration in air quality, which led to the increased number of wildfires. The anomalous dry weather favored the burning of vegetation in agricultural rural areas and in small, vegetated areas near the municipalities, and limited pollution scavenging by rainfall, both of which contributed to higher pollution concentration. We hypothesize the possible effects of worse air quality on the aggravation of COVID-19, but further research is necessary to obtain a complete assessment.


Em 24 de março de 2020, foi decretado confinamento parcial no Estado de São Paulo, Brasil, como medida para desacelerar a disseminação da COVID-19. O decreto consistia na proibição de aglomerações e na recomendação para as pessoas permanecerem em casa, exceto em situações urgentes ou de extrema necessidade. Na esteira de estudos realizados em outros países, o artigo busca avaliar os impactos do confinamento na qualidade do ar em cinco cidades no Estado de São Paulo. Nosso estudo foi realizado com o material particulado e dióxido de nitrogênio enquanto indicadores da qualidade do ar e pela correlação das concentrações dos contaminantes com dados meteorológicos. Os resultados mostraram um aumento desses contaminantes em todas as cinco cidades dentro das primeiras semanas depois do confinamento, comparado às semanas que antecederam o decreto e com o mesmo período em anos anteriores. O resultado é inconsistente com os achados usualmente relatados em outros estudos. Portanto, foi definido um objetivo secundário a fim de investigar a possível causa (ou causas) da piora na qualidade do ar, o que revelou um aumento no número de incêndios. O tempo anormalmente seco favoreceu a queima de vegetação nas áreas agrícolas rurais e em pequenas áreas de vegetação próximas às cidades, além do limitado escoamento da poluição pela chuva, o que contribuiu à maior concentração de poluentes. Os achados sugerem hipóteses sobre os possíveis efeitos dessa situação de pior qualidade do ar sobre o agravamento de casos de COVID-19, porém são necessários mais estudos para uma avaliação completa.


El 24 de marzo de 2020 se decretó un confinamiento parcial en el estado de São Paulo, Brasil, como medida para evitar la propagación de la COVID-19, que consistió en prohibir aglomeraciones de personas y avisar a la gente que permaneciera en casa, salvo para asuntos urgentes o extremadamente necesarios. Siguiendo algunos estudios realizados en otros países, el objetivo de este trabajo es evaluar los impactos del confinamiento en la calidad del aire de ciudades en el estado de São Paulo. Nuestro estudio fue realizado usando material particulado y dióxido de nitrógeno, como indicadores de la calidad del aire, y mediante la correlación de las concentraciones de contaminantes con los datos meteorológicos. Los resultados mostraron un incremento en estos contaminantes en todas las ciudades dentro de las primeras semanas tras el confinamiento, comparando las semanas antes del decreto y dentro del mismo periodo en los años previos. Este resultado es inconsistente con aquellos que han sido informados en otros estudios. Por ello, un objetivo secundario fue investigar la posible causa (o causas) de tal deterioro en la calidad del aire, que conduce a un incremento en el número de incendios. La climatología seca anómala favoreció la quema de vegetación en las áreas rurales agrícolas, y en áreas con poca vegetación cerca de las ciudades, y la eliminación limitada de la contaminación gracias a la lluvia, ambos contribuyeron a una mayor concentración de contaminación. Se especula que los posibles efectos de esta situación de una peor calidad del aire podrían afectar en el agravamiento de los casos de COVID-19, pero son quizás necesarias más investigaciones para conseguir una evaluación completa.


Subject(s)
Humans , Air Pollutants/analysis , Air Pollutants/adverse effects , Air Pollution/analysis , Air Pollution/adverse effects , COVID-19 , Brazil/epidemiology , Communicable Disease Control , Environmental Monitoring , Pandemics , SARS-CoV-2
17.
PLoS One ; 16(3): e0248580, 2021.
Article in English | MEDLINE | ID: covidwho-1575655

ABSTRACT

BACKGROUND: Brazil became the epicenter of the COVID-19 epidemic in a brief period of a few months after the first officially registered case. The knowledge of the epidemiological/clinical profile and the risk factors of Brazilian COVID-19 patients can assist in the decision making of physicians in the implementation of early and most appropriate measures for poor prognosis patients. However, these reports are missing. Here we present a comprehensive study that addresses this demand. METHODS: This data-driven study was based on the Brazilian Ministry of Health Database (SIVEP-Gripe) regarding notified cases of hospitalized COVID-19 patients during the period from February 26th to August 10th, 2020. Demographic data, clinical symptoms, comorbidities and other additional information of patients were analyzed. RESULTS: The hospitalization rate was higher for male gender (56.56%) and for older age patients of both sexes. Overall, the lethality rate was quite high (41.28%) among hospitalized patients, especially those over 60 years of age. Most prevalent symptoms were cough, dyspnoea, fever, low oxygen saturation and respiratory distress. Cardiac disease, diabetes, obesity, kidney disease, neurological disease, and pneumopathy were the most prevalent comorbidities. A high prevalence of hospitalized COVID-19 patients with cardiac disease (65.7%) and diabetes (53.55%) and with a high lethality rate of around 50% was observed. The intensive care unit (ICU) admission rate was 39.37% and of these 62.4% died. 24.4% of patients required invasive mechanical ventilation (IMV), with high mortality among them (82.98%). The main mortality risk predictors were older age and IMV requirement. In addition, socioeconomic conditions have been shown to significantly influence the disease outcome, regardless of age and comorbidities. CONCLUSION: Our study provides a comprehensive overview of the hospitalized Brazilian COVID-19 patients profile and the mortality risk factors. The analysis also evidenced that the disease outcome is influenced by multiple factors, as unequally affects different segments of population.


Subject(s)
COVID-19/mortality , Adolescent , Adult , Aged , Brazil/epidemiology , COVID-19/epidemiology , Child , Child, Preschool , Databases, Factual , Female , Hospitalization , Humans , Infant , Intensive Care Units , Male , Middle Aged , Risk Factors , SARS-CoV-2/isolation & purification , Young Adult
18.
PLoS One ; 16(3): e0247794, 2021.
Article in English | MEDLINE | ID: covidwho-1575402

ABSTRACT

BACKGROUND: Identified in December 2019 in the city of Wuhan, China, the outbreak of COVID-19 spread throughout the world and its impacts affect different populations differently, where countries with high levels of social and economic inequality such as Brazil gain prominence, for understanding of the vulnerability factors associated with the disease. Given this scenario, in the absence of a vaccine or safe and effective antiviral treatment for COVID-19, nonpharmacological measures are essential for prevention and control of the disease. However, many of these measures are not feasible for millions of individuals who live in territories with increased social vulnerability. The study aims to analyze the spatial distribution of COVID-19 incidence in Brazil's municipalities (counties) and investigate its association with sociodemographic determinants to better understand the social context and the epidemic's spread in the country. METHODS: This is an analytical ecological study using data from various sources. The study period was February 25 to September 26, 2020. Data analysis used global regression models: ordinary least squares (OLS), spatial autoregressive model (SAR), and conditional autoregressive model (CAR) and the local regression model called multiscale geographically weighted regression (MGWR). FINDINGS: The higher the GINI index, the higher the incidence of the disease at the municipal level. Likewise, the higher the nurse ratio per 1,000 inhabitants in the municipalities, the higher the COVID-19 incidence. Meanwhile, the proportional mortality ratio was inversely associated with incidence of the disease. DISCUSSION: Social inequality increased the risk of COVID-19 in the municipalities. Better social development of the municipalities was associated with lower risk of the disease. Greater access to health services improved the diagnosis and notification of the disease and was associated with more cases in the municipalities. Despite universal susceptibility to COVID-19, populations with increased social vulnerability were more exposed to risk of the illness.


Subject(s)
COVID-19/epidemiology , Nurses/statistics & numerical data , Brazil/epidemiology , COVID-19/diagnosis , COVID-19/mortality , Cities/epidemiology , Demography , Female , Humans , Incidence , Male , Risk Factors , Socioeconomic Factors , Spatial Analysis , Spatial Regression
19.
Rev Med Virol ; 31(6): e2231, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574317

ABSTRACT

The Spike protein is the target of both antibody-based therapeutics (convalescent plasma, polyclonal serum, monoclonal antibodies) and vaccines. Mutations in Spike could affect efficacy of those treatments. Hence, monitoring of mutations is necessary to forecast and readapt the inventory of therapeutics. Different phylogenetic nomenclatures have been used for the currently circulating SARS-CoV-2 clades. The Spike protein has different hotspots of mutation and deletion, the most dangerous for immune escape being the ones within the receptor binding domain (RBD), such as K417N/T, N439K, L452R, Y453F, S477N, E484K, and N501Y. Convergent evolution has led to different combinations of mutations among different clades. In this review we focus on the main variants of concern, that is, the so-called UK (B.1.1.7), South African (B.1.351) and Brazilian (P.1) strains.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Antibodies, Neutralizing/therapeutic use , COVID-19/therapy , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics , Antibodies, Monoclonal/chemistry , Antibodies, Monoclonal/metabolism , Antibodies, Neutralizing/chemistry , Antibodies, Neutralizing/metabolism , Antibodies, Viral/chemistry , Antibodies, Viral/metabolism , Antibodies, Viral/therapeutic use , Brazil/epidemiology , COVID-19/epidemiology , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Gene Expression , Humans , Immune Evasion , Immunization, Passive/methods , Mutation , Phylogeny , Protein Binding , Risk Assessment , SARS-CoV-2/classification , SARS-CoV-2/drug effects , SARS-CoV-2/immunology , South Africa/epidemiology , Spike Glycoprotein, Coronavirus/immunology , United Kingdom/epidemiology
20.
Environ Res ; 204(Pt D): 112369, 2022 03.
Article in English | MEDLINE | ID: covidwho-1574591

ABSTRACT

Brazil, the country most impacted by the coronavirus disease 2019 (COVID-19) on the southern hemisphere, use intensive care admissions per day, mobility and other indices to monitor quarantines and prevent the transmissions of SARS-CoV-2. In this study we quantified the associations between residential mobility index (RMI), air pollution, meteorology, and daily cases and deaths of COVID-19 in São Paulo, Brazil. We applied a semiparametric generalized additive model (GAM) to estimate: 1) the association between RMI and COVID-19, accounting for ambient particulate matter (PM2.5), ozone (O3), relative humidity, temperature and delayed exposure between 4 and 21 days, and 2) the association between COVID-19 and exposure to for ambient particulate matter (PM2.5), ozone (O3), accounting for relative humidity, temperature and mobility. We found that an RMI of 45.28% results in 1212 cases (95% CI: 1189 to 1235) and 44 deaths (95% CI: 40 to 47). Increasing the isolation from 45.28% to 50% would avoid 438 cases and 21 deaths. Also, we found that an increment of 10 µg⋅m-³ of PM2.5 results in a risk of 1.140 (95% CI: 1.021 to 1.274) for cases and 1.086 (95% CI: 1.008 to 1.170) for deaths, while O3 produces a relative risk of 1.075 (95% CI: 1.006 to 1.150) for cases and 1.063 (95% CI: 1.006 to 1.124) for deaths, respectively. We compared our results with observations and literature review, finding well agreement. Policymakers can use such mobility indices as tools to control social distance activities. Spatial distancing is an important factor to control COVID-19, however, measuring face-mask usage would enhance the understanding the pandemic dynamic. Small increments of air pollution result in an increased number of COVID-19 cases and deaths.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Air Pollutants/analysis , Air Pollutants/toxicity , Air Pollution/analysis , Air Pollution/statistics & numerical data , Brazil/epidemiology , Humans , Particulate Matter/analysis , Particulate Matter/toxicity , SARS-CoV-2
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