The effect of birth timing manipulation around carnival on birth indicators in Brazil.

This paper studies the patterns and consequences of birth timing manipulation around the carnival holiday in Brazil. We document how births are displaced around carnival and estimate the effect of displacement on birth indicators. We show that there is extensive birth timing manipulation in the form of both anticipation and postponement that results in a net increase in gestational length and reductions in neonatal and early neonatal mortality, driven by postponed births that would otherwise happen through scheduled c-sections. We also find a reduction in birthweight for high-risk births at the bottom of the weight distribution, driven by anticipation. Therefore, restrictions on usual delivery procedures due to the carnival holiday can be both beneficial and detrimental, raising a double-sided issue to be addressed by policymakers.

The impacts of COVID-19 hospitalizations on non-COVID-19 deaths and hospitalizations: A panel data analysis using Brazilian municipalities.

The COVID-19 pandemic in Brazil has brought many challenges, particularly regarding the management of hospital capacity, and a new demand for healthcare that added to the preexisting demands, such as neoplasms, cardiovascular diseases and births. In this paper, we estimate the impact of the pandemic on the number of deaths and hospitalizations for other diseases. We construct a monthly panel data of deaths and hospitalizations for various causes by the municipality of residence and relate them to COVID-19 hospitalizations using regression models that control for municipalities fixed-effects and interactions between State and month fixed-effects. The standard errors are clustered at the municipality level. Our estimates imply that 100 more hospitalizations by COVID-19 is associated with a drop of 49 non-COVID-19 hospitalizations and an additional four deaths for other reasons (all measured per 100,000 pop.). The impact of intensive care units COVID-19 hospitalizations on mortality is larger. The groups most affected are the African Brazilians, less-educated and the elderly. Additional deaths occurred both at households and at hospitals. The main causes of additional deaths were diseases related to the circulatory and endocrine system. The decline in hospitalizations for other causes seems to be related to the overcrowding of hospitals in periods of surge in the COVID-19, alongside with the fall in the demand for care by the citizens who were afraid of COVID-19 infection. These mechanisms affected more strongly the vulnerable groups of the population. Our results highlight the importance of promoting the awareness of heightened risk of non-communicable chronic diseases during a health emergency context. This should be done preferably through already established channels with community outreach, such as the Family Health Program in Brazil.

The relationship between staying at home during the pandemic and the number of conceptions: A national panel data analysis.

hether the COVID-19 pandemic has changed fertility patterns is still an open question, as social isolation for long periods can impact the number of conceptions in many ways. We combine administrative data on all recent births in Brazil with daily data on individual location to estimate the relationship between the share of individuals staying close to their homes in each week and the number of conceptions in that same week, comparing municipalities with different social isolation patterns during the first semester of 2020. We find that conceptions unequivocally decline when social isolation increases. The effect is stronger for women who are between 21 and 25 years old and more educated, as well as for richer, larger, and more urban municipalities. COVID-19 is likely to change fertility across countries depending on the behavior of the population and on the lock-down measures implemented to fight the pandemic.

The effects of a national policy to reduce c-sections in Brazil.

In this paper, we assess the effects of a national policy implemented in Brazil to avoid unnecessary cesareans. The policy has a supply-side component that prohibits elective c-sections before the 39th gestational week and a demand-side awareness component. Since the policy is not binding for cases with a strong medical c-section indication, we use births of breech- and transverse-positioned babies as a counterfactual for births of cephalic-positioned babies in a difference-in-differences framework. Our results reveal that the policy decreases the rate of c-sections by 1.6 percentage point, and slightly increases gestational time, birthweight, and first-minute APGAR scores. There is evidence that policy effectiveness is driven by its demand-side component.

Racial social norms among Brazilian students: Academic performance, popularity, and racial identification.

Studies in the United States have shown that minority students might face a trade-off between better academic performance and peer acceptance, which has been termed "acting White." This paper investigates racial differences in the relationship between grades and popularity in five Brazilian schools. Popularity is measured using friendship ties among students, assigning a higher value to students more central in the network. The racial composition of friendship ties is generally diverse, although they tend to favor racial peers, especially among Black students. We find a positive correlation between grades and popularity of non-White students that is driven by their friendships with their White classmates. This contrasts with patterns associated with acting White, where a negative correlation between minorities' grades and their popularity among racial peers is not compensated by their status among White students. We also investigate how academic performance is associated with racial identity choice conditional on skin color, finding a weak negative relationship between higher grades and the odds of classification as mixed race.

Estimating the causal effects of private health insurance in Brazil: Evidence from a regression kink design.

Despite having free access to the public health system, 25% of the Brazilian population have a private insurance plan, which is subsidized by the government by means of an income tax rebate. This paper explores this rebate to tackle the potential endogeneity between private insurance and the demand for health services, using the fiscal incentive as a source of quasi-experimental variation in insurance prices. We estimate the average effect of private insurance for the marginal individuals at the kink points by means of a nonseparable nonparametric regression model. Our data allow us to disentangle moral hazard from adverse selection effects and the results indicate that private insurance has a positive impact on the use of preventive services, health outcomes, physical exercises, and smoke quiting, and does not impact the use of nonpreventive health services, such as inpatient services and surgeries.

Brazilian cohorts with potential for life-course studies: a scoping review.

OBJECTIVE To identify the Brazilian cohorts that started either in the prenatal period or at birth, to describe their characteristics and the explored variables, and to map the cohorts with potential for studies on early determinants on health and the risk of falling ill on later stages of the life cycle. METHODS A scoping review was carried out. The articles were searched in the electronic databases PubMed and Virtual Health Library (VHL). The descriptors used were [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND (Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. The inclusion criteria were Brazilian cohorts that started the baseline in the prenatal period or at birth and with at least two follow-ups with the participants. In order to meet the concept of LCE, we excluded those cohorts whose follow-ups were restricted to the first year of life, as well as those that did not address biological, behavioral and psychosocial aspects, and cohorts with data collection of a single stage of the life cycle. RESULTS The search step identified 5,010 articles. Eighteen cohorts were selected for descriptive synthesis. The median number of baseline participants was 2,000 individuals and the median age at the last follow-up was 9 years. Sample loss at the last follow-up ranged from 9.2 to 87.5%. Most cohorts monitored two phases of the life cycle (the perinatal period and childhood). The Southern region had the highest number of cohorts. The main variables collected were sociodemographic and environmental aspects of the family, morbidity aspects, nutritional practices and lifestyle. CONCLUSIONS We recommend the continuity of these cohorts, the approach to different social contexts and the performance of follow-ups with participants in different phases of the life cycle for the strengthening and expansion of life course epidemiology analyses in Brazil.

Brazilian cohorts with potential for life-course studies: a scoping review / Coortes no Brasil com potencial para estudos do ciclo vital: uma revisão de escopo

ABSTRACT OBJECTIVE To identify the Brazilian cohorts that started either in the prenatal period or at birth, to describe their characteristics and the explored variables, and to map the cohorts with potential for studies on early determinants on health and the risk of falling ill on later stages of the life cycle. METHODS A scoping review was carried out. The articles were searched in the electronic databases PubMed and Virtual Health Library (VHL). The descriptors used were [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND (Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. The inclusion criteria were Brazilian cohorts that started the baseline in the prenatal period or at birth and with at least two follow-ups with the participants. In order to meet the concept of LCE, we excluded those cohorts whose follow-ups were restricted to the first year of life, as well as those that did not address biological, behavioral and psychosocial aspects, and cohorts with data collection of a single stage of the life cycle. RESULTS The search step identified 5,010 articles. Eighteen cohorts were selected for descriptive synthesis. The median number of baseline participants was 2,000 individuals and the median age at the last follow-up was 9 years. Sample loss at the last follow-up ranged from 9.2 to 87.5%. Most cohorts monitored two phases of the life cycle (the perinatal period and childhood). The Southern region had the highest number of cohorts. The main variables collected were sociodemographic and environmental aspects of the family, morbidity aspects, nutritional practices and lifestyle. CONCLUSIONS We recommend the continuity of these cohorts, the approach to different social contexts and the performance of follow-ups with participants in different phases of the life cycle for the strengthening and expansion of life course epidemiology analyses in Brazil.

RESUMO OBJETIVO Identificar as coortes brasileiras iniciadas no período pré-natal ou no nascimento, descrever suas características e as variáveis exploradas, além de mapear as coortes com potencial para se estudar os determinantes precoces de saúde e doença e o risco de adoecer em etapas posteriores do ciclo vital. MÉTODOS Realizou-se uma revisão de escopo. A busca dos artigos foi realizada nas bases de dados PubMed e Biblioteca Virtual em Saúde em 16 de junho de 2018. Os descritores utilizados foram [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND ("Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. Os critérios de inclusão foram coortes brasileiras que iniciaram a linha de base no período pré-natal ou no nascimento e com pelo menos dois acompanhamentos com os participantes. Foram excluídas as coortes cujos acompanhamentos foram restritos ao primeiro ano de vida, as que não abordaram aspectos biológicos, comportamentais e psicossociais e também aquelas com coleta de informações em um único estágio do ciclo vital. RESULTADOS A etapa de busca identificou 5.010 artigos. Foram selecionadas 18 coortes para a síntese descritiva. A mediana do número de participantes na linha de base foi 2.000 indivíduos e a mediana de idade no último acompanhamento foi 9 anos. A perda amostral no último acompanhamento variou de 9,2 a 87,5%. A maioria das coortes realizou acompanhamentos em duas fases do ciclo vital (período perinatal e infância). A região Sul contemplou o maior número de coortes. As principais variáveis coletadas foram sociodemográficas e ambientais da família, aspectos de morbidade, práticas alimentares e estilo de vida dos participantes. CONCLUSÕES Recomenda-se a continuidade dessas coortes, a abordagem de diferentes contextos sociais e a realização de acompanhamentos com os participantes em diferentes fases do ciclo vital para o fortalecimento e ampliação das análises de epidemiologia do ciclo vital no Brasil.

Brazil's unified health system: the first 30 years and prospects for the future.

In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.

Os efeitos do Programa Bolsa Família sobre a duração do emprego formal dos indivíduos de baixa renda / Los efectos del Programa Bolsa Familia sobre la duración del empleo formal de los individuos de bajos ingresos / The impact of the Bolsa Família Program on the duration of formal employment for low income individuals

Resumo Neste artigo utilizamos microdados do Cadastro Único combinados com dados da Relação Anual de Informações Sociais (Rais) para examinar a duração do emprego entre indivíduos de famílias beneficiárias do Programa Bolsa Família. Para tanto, estimamos modelos de riscos proporcionais de Cox para comparar a duração no emprego entre beneficiários e não beneficiários do programa utilizando uma base de dados com mais de três milhões de indivíduos pertencentes a famílias de baixa renda. Os resultados sugerem que o risco de desligamento do emprego para os beneficiários do Programa Bolsa Família é entre 7% e 10% menor do que para os não beneficiários. Modelos paramétricos também foram ajustados para verificação de robustez, produzindo resultados equivalentes aos do modelo de Cox. Em todos os casos, a participação no programa foi observada por meio de uma covariável variando no tempo, extraída diretamente das folhas de pagamento do programa.

Resumen En este artículo utilizamos microdatos del registro nacional de personas pobres (Cadastro Único) combinados con datos de la Relación Anual de Informaciones Sociales (Rais) para examinar la duración del empleo entre individuos de familias beneficiadas por el Programa Bolsa Família. Por lo tanto, se estima un modelo de riesgos proporcionales de Cox para comparar la duración del empleo entre beneficiarios y no beneficiarios del programa, utilizando una base de datos con más de tres millones de individuos pertenecientes a familias de bajos recursos. Los resultados sugieren que el riesgo de extinción de empleo para los beneficiarios del Programa Bolsa Família es entre un 7% y un 10% inferior a la de los no usuarios. Modelos paramétricos también fueron ajustados para verificación de robustez, produciendo resultados equivalentes a los del modelo de Cox. En todos los casos, la participación en el programa fue observada a través de una covariable variando en el tiempo, extraída directamente de la nómina del programa.

Abstract This article uses microdata from the Unified Registry of Social Programs (CadUnico) and the Annual Social Information Report (Rais) to examine the duration of employment for families receiving benefits from the Bolsa Família Program. To achieve this goal, Cox proportional hazard models were used to estimate the job duration for beneficiaries and non-beneficiaries of the program using a database of more than three million people. The findings indicate that the risk of leaving work among beneficiaries of the Bolsa Família Program is 7% to 10% lower than the risk for non-beneficiaries. Parametric models were also adjusted to verify robustness, producing results equivalent to those of the Cox model. In all cases, participation in the program was observed through a covariate that varies over time, extracted directly from the program's payment records.