Brazilian Health Care Research Articles

Real world data on cervical cancer treatment patterns, healthcare access and resource utilization in the Brazilian public healthcare system.

The aim of the study is to evaluate the treatment patterns, time to start treatment, and healthcare resources utilization (HCRU) of cervical cancer (CC) patients within the Brazilian public health system (SUS). This is an observational retrospective study using SUS administrative database (DATASUS). Data from January-2014 to December-2020 was gathered from patients with the ICD-10 C53 codes. From 2014 to 2020, 206,861 women were included, among whom 90,073 (43.5%) had stage information. Of staged patients, 60.7% (54,719) had advanced disease (stages III and IV) and the most performed treatments were chemoradiotherapy (CRT) (41.6%), surgery + CRT (19.1%), radiotherapy (RT) only (16.8%) and chemotherapy (CT) only (13.3%). The proportion of patients submitted to CT in advanced stages was higher than in non-advanced stages (I and II), in contrast to RT, which was more frequent in stage I than stage IV. Median time to initiate treatment surpassed two months in approximately 30% of the cases, regardless of stage. Conization was the most performed surgical procedure. The hospitalization rate per patient per month for stage IV was twice as high as stage I (0.05 [95%CI 0.05-0.05] and 0.11 [0.11-0.11], respectively). The same trend was observed for outpatient visits (0.54 [95%CI 0.53-0.55] and 0.96 [0.93-0.98], respectively). This study demonstrated a high proportion of advanced CC at diagnosis in Brazil. The treatment pattern showed that chemoradiotherapy was the most frequent regimen overall and the use of chemotherapy and HCRU increased with staging. These results could provide information to improve public policies towards access to prevention, diagnosis, and treatment of CC in Brazil.

The cost burden of adolescent and young adult pregnancy: real-world evidence from the Brazilian public health care system

Background In low- and middle-income countries, pregnancy in adolescence represents an important public health issue. Rates of early pregnancy have significant social and economic consequences that extend beyond the individual sphere, impacting public/governmental budgets. Aim To estimate the cost implications of early pregnancies from the perspective of the Brazilian Unified Public Health System. Methods This retrospective secondary data analysis focuses on assessing direct hospital costs. The study cohort comprises adolescents and young adults who underwent prenatal care at a reference maternity hospital between January and December 2021. Individual procedure costs were extracted from hospital records and converted into monetary values using the Brazilian Federal Fee. The sample size for each group was determined based on preliminary data collected during a pilot study. Descriptive analyses presented costs stratified by age groups. To estimate budgetary impacts and sensitivity we used national live birth incidence rates. Results The mean cost per case of adolescent pregnancy was US$ 704.92 (SD: 1,707.74) and for adult pregnancy was US$ 592.40 (SD: 941.43). The cost of hospital admission accounted for 61% of the total cost of adolescent pregnancies. The annual budget impact of pregnancies among women under 30 years was estimated at US$ 1 billion, with 239 million coming from women under 20 years old. Conclusion Pregnancy in adolescence may lead to a significant annual budget impact, representing 24% of costs attributed to pregnancies among women under 30 years. Costs related to hospital admissions and complications represent a substantial share of the total costs of adolescent pregnancy.

Cost-effectiveness of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: the brazilian case with bayesian networks and markov influence diagrams

Abstract Background Heart failure (HF) is one of the leading causes of death worldwide, with a significant burden in middle-income countries, such as Brazil. Mineralocorticoid receptor antagonists (MRAs) have been established as a cornerstone in the treatment of HF with reduced ejection fraction (HFrEF), but their adoption has faced obstacles. Until recently, spironolactone was the only MRA available in Brazil, with restricted use due to associated side effects, such as gynecomastia and hyperkalemia. However, the introduction of new MRAs, such as finerenone and eplerenone, has the potential to change the therapeutic landscape. Understanding the cost-effectiveness of these agents in the Brazilian healthcare context is essential to optimize HF management. Methods A Bayesian Network approach complemented by Markov Influence Diagrams was employed to estimate incremental cost-effectiveness ratios (ICERs), presented in international dollars (Int$) gained per quality-adjusted life year (QALYs). Discontinuation rates for MRAs were incorporated into the model, reflecting real-world clinical practice, along with a 5% annual discount rate for both costs and effectiveness. To inform our model, a comprehensive systematic review was conducted, followed by a network meta-analysis (NMA) to assess the comparative effectiveness of ARMs. Data on incident cardiovascular outcomes were derived from a Brazilian real-world cohort of 1,098 patients with HFrEF. All cost assessments were made from the perspective of the Brazilian public health system, with values converted to Int$. Results The NMA highlighted that spironolactone [HR:0.75 (95%CI 0.67-0.84)], eplerenone [HR:0.84 (95%CI 0.77-0.93)] and finerenone [HR:0.90 (95%CI 0.82-0.98)] significantly reduced the relative risk of all-cause mortality compared to no MRA utilization. Notably, eplerenone significantly reduced hospitalizations due to HF [HR:0.60 (95%CI 0.41-0.90)] compared to no MRA therapy, with spironolactone and finerenone showing HRs of 0.68 (95%CI 0.40-1.17) and 0.83 (95%CI 0.59-1.15) . The analysis also revealed a notably higher risk of MRA discontinuation for finerenone (22%) and spironolactone (51%) compared to eplerenone. In cost-effectiveness comparisons, finerenone was dominated by alternatives, while eplerenone exhibited an ICER of Int$2,614 (95%CI 1,851-3,470)/QALY when compared to spironolactone. Both spironolactone and eplerenone emerged as cost-effective options when compared to no MRA therapy, with eplerenone being particularly favorable below the willingness-to-pay threshold of Int$8,900 per QALY. Conclusions In the Brazilian healthcare context, eplerenone will likely be the most cost-effective MRA compared to spironolactone, offering both a reduction in HF-related hospitalizations and a lower discontinuation rate. These findings underscore the value of integrating cost-effectiveness analyzes into healthcare decision-making processes.

Unveiling patterns in pediatric appendectomy: A comparative study on healthcare resource capacity and surgical decisions in Brazil.

Appendicitis is the most prevalent surgical emergency in children. This study examined hospital infrastructure, surgical techniques, patient demographics, and hospitalization parameters to assess the provision of safe and adequate care within the Brazilian public healthcare system. Pediatric hospitalizations for acute appendicitis in 2022 were extracted from the Brazilian national database. We included all hospitalizations for patients aged 0-16years with a primary ICD-10 diagnosis of acute appendicitis who underwent an operation. Parameters of interest were the type of surgical approach, mortality, and total cost of hospitalization. Facilities were defined as basic-facility, full-facility, and pediatric according to the level of pediatric resources available. In 2022, there were 29,983 pediatric appendectomies due to acute appendicitis. Of these, 90.2% were open appendectomies. Most occurred in basic-facility general hospitals (53.0%), followed by full-facility (35.2%) and pediatric hospitals (11.8%). Full-facility hospitals had a higher median cost (USD126.3, IQR 99.5-154.4) compared to basic (USD96.8, IQR 87.6-130.1) and pediatric hospitals (USD103.0, IQR 91.9-117.5), though the cost difference between basic and pediatric was not significant (p=0.367). Death was a rare event across all levels of hospital infrastructure and for all types of procedures performed. The majority of hospitalizations for acute appendicitis occurred in hospitals with minimal pediatric infrastructure. Open appendectomies remain the most predominant procedure across all hospital types.

Barriers to care for dependent older adults: Brazilian Primary Health Care managers' perspective.

This study analyzes the perspective of 16 managers from different Brazilian regions about the barriers to adequate care for dependent older adults in Brazilian PHC. This qualitative approach is anchored in the hermeneutic-dialectic theoretical framework. It builds on the principle that aging has different epidemiological rhythms and multiple specific demands from older adults' biopsychosocial changes. We highlighted several challenges to health services, since family, educational, organizational, and social contexts are fragmented. The 16 managers were selected by convenience from June to September 2019. They interacted individually in a semi-structured interview lasting approximately 30 minutes. The interviews were transcribed in full, and data were organized into four empirically selected themes: barriers due to dependent older adults' family care problems; lack of priority in PHC scheduling; failure in recruiting and training professionals; and lack of a specific public policy. The results indicated weakened families regarding lack of training and overload, especially female caregivers in care routine. Managers recognize the repeated comings and goings and searching for PHC access, highlighting insufficient primary services to organize care. Noteworthy is that high population demand exacerbates inadequate coverage, since lack of professionals with adequate training, priority on the agenda of services, and a public support policy to meet this population's needs fragment healthcare. Thus, it is essential to remedy the barriers recognized by managers by training more experts and qualifying professionals in the service. Society must recognize the stages of aging and support families, especially those most socially needy. The health sector at the Primary Care level has much to contribute to ensuring social protection and healthy longevity for Brazilians.

Protocol of Randomized Controlled Community Trial (RCCT) for obesity management in Brazilian primary health care.

Obesity is a chronic disease characterized by excess body fat and is a risk factor for other chronic non-communicable diseases. Its multifactorial and complex nature makes its management a challenge for health services. This manuscript presents an investigation protocol that aims to analyze the effectiveness of collective nutritional interventions for obesity management applicable to primary health care. Randomized Controlled Community Trial (RCCT) in a representative sample of users of the Programa Academia de Saúde (PAS), in Belo Horizonte, Minas Gerais, Brazil, with obesity. The research consists of four phases: (1) Screening to identify the participants eligible for the nutritional interventions (individuals with obesity, readiness for change to lose body weight, and willingness and interest to participate in a group activity for six months or more); (2) Baseline to characterize the participants; (3) Implementation of collective nutritional interventions; (4) Reassessment of the participants. Participants in the control group (CG) will receive the usual health service care, and participants in the intervention group (IG) will participate in collective nutritional interventions based on Therapeutic Group 1 (TG1) or Therapeutic Group 2 (TG2) of the "Instructive of Collective Approach for the obesity management in SUS". The strengths of the study include its robust RCCT design, which allows for longitudinal analyses and is suitable for investigating causal hypotheses and applying strategies to improve adherence to interventions. Furthermore, the study included a representative sample of a public health service and aims to evaluate therapeutic proposals from the Brazilian Ministry of Health, which can contribute to implementation and extension in the national territory. RBR-3vzsyqq and RBR-6pg682m.

Adherence to optimal delirium management practices in intensive care units in Brazil: a nationwide survey.

Effective delirium management is crucial, considering its association with adverse outcomes. Adherence to best practices has the potential to reduce the incidence and prevalence of delirium and improve health outcomes. The objectives of this project were to describe self-assessed adherence to best practices in delirium management by health care professionals in intensive care units (ICUs) in Brazil, assess the health care professionals' perception of the importance of adequate delirium prevention and treatment in ICUs, and compare the compliance rates with best practices between public and private ICUs. A cross-sectional study was conducted in Brazil using an online questionnaire consisting of three parts, namely, data about the health care professionals and the ICU in which they worked; statements about the 17 best practices; and questions related to perceptions of delirium prevention and management by ICU physicians and nurses. The survey was sent to email addresses registered with the Brazilian Association of Intensive Care Medicine. The compliance rate exceeded 50% for only eight best practices. These included the identification and management of pressure sores and falls in delirium patients, with compliance rates of 77.8% and 74.1%, respectively. Among ICU professionals in Brazil, adherence to best practices in delirium management is low, particularly for practices involving patient education and involvement of their relatives in their care. These results emphasize the importance of enhancing delirium management in Brazilian health care institutions, regardless of hospital classification. http://links.lww.com/IJEBH/A274.

Matrix Support: interface between Specialty Dental Centers and primary oral health care in Brazil

BackgroundMatrix Support (MS) is a strategy that can be used to improve integration between Primary Health Care (PHC) and other levels of care.ObjectiveThe aim of this study was to investigate the association between MS carried out in Brazilian Dental Specialty Centers (CEOs) (secondary level of oral health care) and aspects of the integrated work process with PHC, as well as contextual variables.MethodsA quantitative cross-sectional study was conducted using data from the Program for Quality Improvement and Access to CEOs (PMAQ-CEO). Secondary data from the External Evaluation of the second cycle of PMAQ-CEO were analyzed, including contextual variables obtained from sources such as the Unified Health System (SUS) and official research institutions. Descriptive analyses were performed, and four multiple models were adjusted to investigate the association between the variables.ResultsThe results showed that about half of the CEOs did not carry out therapeutic projects developed with the oral health teams of PHC. It was found that the lack of therapeutic projects developed with the teams was associated with the lack of discussion of complex cases by the team, lack of discussion of individual therapeutic project, absence of joint continuing education activities, lack of construction and discussion of clinical protocols, and lack of belief in the importance of planning and periodic evaluation. The results suggest that the articulation between PHC and secondary oral health care still presents weaknesses within the scope of SUS. Comprehensive care needs to be strengthened, requiring greater intervention from management.ConclusionIt was concluded that the individual factors of CEOs, related to the work process, have a greater influence on the lack of integration with oral health teams of PHC, compared to the contextual variables of municipalities.

Screening, diagnosis, treatment and outcomes of developmental dysplasia of the hip in Brazilian population: a scoping review protocol

IntroductionDevelopmental dysplasia of the hip (DDH) includes a spectrum of clinical and imaging findings at birth or early infancy. The circumstances in which this condition is detected and managed may...

Formal Institution Networks and Coopetition: Insights from the Brazilian Private Healthcare Industry

This study demonstrates that formal institution networks are antecedent to firms adopting coopetition to improve performance. The influence of formal institution agents to foster coopetition within an industry is driven by fragilities in the institutions of emerging economies. We studied the Brazilian healthcare sector, which is characterized by strong regulation and government support. We analyzed how and to what extent coopetition relates to formal institution agents and the performance of private healthcare operators. The study employs a quantitative methodology with a sample of 149 firms from the Brazilian private healthcare system through partial least squares structural equation modelling (PLS-SEM). Our findings highlight that networks facilitated by formal institution agents precede firms’ adoption of coopetition to enhance performance. They also underscore the impact of regulatory policy on firms’ strategies and behaviors in the healthcare sector. Our findings emphasize that formal institution networks alone do not guarantee performance improvement. Healthcare firms must develop coopetitive strategies to create and capture value within these relationships. Our study sheds light on the organizational dynamics within the Brazilian private healthcare sector and provides insights for managers and policymakers. For policymakers, it highlights opportunities and challenges in enhancing healthcare sector competitiveness, emphasizing the importance of considering the institutional environment. For healthcare firm managers, it details opportunities for developing coopetitive strategies. Finally, the study is subject to boundary conditions potentially limiting the generalizability of its findings to a broader global context. Additionally, it is also limited by the cross-sectional design since respondents’ replies are specific to the current scenario in the healthcare sector.

Obesity is one of most expensive disease of Brazilian's public healthcare

Obesity is one of most expensive disease of Brazilian's public healthcare

Analysis and forecast of emissions associated with electricity consumption in hospitals: Encouraging a net zero healthcare roadmap in Brazil

In several countries, the concept of Net Zero Healthcare (NZH) has gained prominence within the healthcare domain as a response to national commitments on climate change. NZH plays a crucial role in advocating for customized commitments and objectives to reduce greenhouse gas (GHG) emissions across diverse healthcare units, serving as a catalyst for decarbonization strategies in both the public and private sectors. This paper addresses the absence of primary research on NZH in Brazil while asserting its substantial potential to support GHG-curbing initiatives. This is the first study to establish a foundational knowledge base for decarbonization initiatives in Brazilian healthcare sector, focused on assisting in the sustainability roadmap of a University Hospital situated in Northeast Brazil. The major contribution of this study is the quantification of the GHG emissions associated with the electricity consumption at the hospital, which serves as a gateway to a comprehensive GHG inventory of the entire unit. The hospital's GHG emissions are then registered for 2017-2023. Methodologically, this study employs a comprehensive framework encompassing data processing of the electric mix, calculation of emission factors via life cycle assessment, forecasting algorithms, and data visualization. GHG emissions from electricity consumption at the hospital amounted to approximately 230 t CO2e annually (2017-2023 average value). Short-term forecasts supported by SARIMA models projected emissions of 271.9 t CO2e in 2024, with 92% originating from off-peak consumption. The significance of this research is the potential to provide new insights into shaping strategies for a viable NZH roadmap in Brazil.

Supporting evidence-based judicial decisions on health care in Brazil: an experience report

Objective: The main objective of this study is to report on the implementation and results of the “Supporting Health-Related Judicial Decisions in Brazil” project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês through the “Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde”, in Brazil. Methods: This study is an experience report of a project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês. Results: The activities of the project occurred in 2023 and included two online training courses on primary studies and systematic reviews, 11 one-day workshops with technical-scientific content for members of the Technical Support Centers for the Judiciary (NATJus), 40 online technical-scientific consultations for magistrates on a digital platform, 11 technical-scientific reports addressing the most legally claimed technologies in Brazil; two methodological tools, a national forum (hybrid event), 10 chat-based mentorships for NATJus members; and the maintenance of an open-access blog, by publishing news on relevant topics on law and health. Discussion and conclusion: This project has contributed to the improvement of the judicial decision-making process by providing a range of activities aimed at aiding the prioritization of health technologies that are clearly effective and safe over those that are ineffective, harmful, or have uncertain effects. Submission: 04/09/24| Review: 06/29/24| Approval: 08/18/24

External validation of the parsimonious EuroLung risk models: analysis of the Brazilian Lung Cancer Registry.

The purpose of this study was to assess performance in the Brazilian Lung Cancer Registry Database by using the parsimonious EuroLung risk models for morbidity and mortality. The EuroLung1 and EuroLung2 models were tested and evaluated through calibration (calibration plot, Brier score, and the Hosmer-Lemeshow test) and discrimination (ROC AUCs), in a national multicenter registry of 1,031 patients undergoing anatomic lung resection. The evaluation of performance in Brazilian health care facilities utilizing risk-adjustment models, specifically EuroLung1 and EuroLung2, revealed substantial miscalibration, as evidenced by calibration plots and Hosmer-Lemeshow tests in both models. In terms of calibration, EuroLung1 exhibited a calibration plot with overlapping points, characterized by a slope of 1.11 and a Brier score of 0.15; the Hosmer-Lemeshow test yielded a statistically significant p-value of 0.015; and the corresponding ROC AUC was 0.678 (95% CI: 0.636-0.721). The EuroLung2 model displayed better calibration, featuring fewer overlapping points in the calibration plot, with a slope of 1.22, with acceptable discrimination, as indicated by a ROC AUC of 0.756 (95% CI: 0.670-0.842). Both models failed to accurately predict morbidity and mortality outcomes in this specific health care context. Discrepancies between the EuroLung model predictions and outcomes in Brazil underscore the need for model refinement and for a probe into inefficiencies in the Brazilian health care system.

Inclusion of disability in primary healthcare facilities and socioeconomic inequity in Brazil.

To describe disability-related performance and inequality nationwide in Brazil, and the changes that took place between 2012 and 2019 after the introduction of Programme for Improving Primary Care Access and Quality (PMAQ). We derived scores for disability-related care and accessibility of primary healthcare facilities from PMAQ indicators collected in round 1 (2011-2013), and round 3 (2015-2019). We assessed how scores changed after the introduction of PMAQ. We used census data on per capita income of local areas to examine the disability-specific care and accessibility scores by income group. We undertook ordinary least squares regressions to examine the association between PMAQ scores and per capita income of each local area across implementation rounds. Disability-related care scores were low in round 1 (18.8, 95%CI 18.3-19.3, out of a possible 100) and improved slightly by round 3 (22.5, 95%CI 22.0-23.1). Accessibility of primary healthcare facilities was also poor in round 1 (30.3, 95%CI 29.8-30.8) but doubled by round 3 (60.8, 95%CI 60.3-61.3). There were large socioeconomic inequalities in round 1, with both scores approximately twice as high in the richest compared to the poorest group. Inequalities weakened somewhat for accessibility scores by round 3. These trends were confirmed through regression analyses, controlling for other area characteristics. Disability-related and accessibility scores also varied strongly between states in both rounds. People with disabilities are being left behind by the Brazilian healthcare system, particularly in poor areas, which will challenge the achievement of universal health coverage.

Cost-Utility Analysis of Deep Brain Stimulation for Generalized and Cervical Dystonia: A Perspective from Brazilian Healthcare

ObjectiveIn the Brazilian public national healthcare system, botulinum toxin type A has traditionally been the sole treatment option for patients with dystonia. However, as of October 2022, Deep Brain Stimulation (DBS) garnered positive recommendations for the condition. This study aims to assess the cost-effectiveness of DBS in treating adults with generalized and cervical dystonia within the Brazilian healthcare context, considering its recent inclusion. MethodsA systematic review identified randomized controlled trials (RCTs) assessing DBS efficacy in treating adults with generalized and cervical dystonia. Two cost-utility analyses compared the cost-effectiveness of DBS plus the Best Clinical Practice (BCP) to BCP alone. Markov models, which included three health states (no clinical improvement, clinical improvement, and death), employed a one-year cycle and a lifetime horizon. The study utilized both one-way and probabilistic sensitivity analyses. ResultsTwo RCTs, one for each condition, revealed superior clinical improvement with DBS when compared to sham simulation. The Incremental Cost-Utility Ratio (ICUR) was $ 1,121.66 for generalized dystonia and $4,556.50 for cervical dystonia. Effectiveness discount rates and age at surgery were identified as influential parameters. In 1,000 Monte Carlo simulations, 99.9% of the ICUR values for generalized dystonia and 74.2 % for cervical dystonia fell below the cost-effectiveness threshold in Brazil ($8,146.64 per QALY). ConclusionsFrom the perspective of the Brazilian public health system, the combination of DBS and BCP appears to be cost-effective for the treatment of both generalized and cervical dystonia when compared to BCP alone.

Decreasing Productivity in the Primary Healthcare: A Study of the Brazilian Case

ABSTRACT: In 2015, the United Nations (UN) proposed the 2030 Agenda, a resolution that outlines the global goals for sustainable development. This report focuses on promoting health and well-being, emphasizing the importance of primary healthcare (PHC). However, Brazil faces challenges in managing its healthcare system, exacerbated by fiscal policy changes that have reduced public sector expenditures after 2015. This study was motivated by these recent changes in Brazil’s fiscal policy. We evaluated potential fluctuations in total factor productivity (TFP) in 5,524 Brazilian municipalities’ primary healthcare from 2015 to 2019. TFP, a measure of efficiency and production technology in PHC, was computed using the bootstrapping Malmquist productivity index (MPI) derived from the Data Envelopment Analysis (DEA) algorithm. This study focused on the economic recession and austerity measures initiated in 2015. Moreover, it’s essential to highlight that the SARS-CoV-2 pandemic in Brazil in 2020 brought significant changes to the country’s economic, social, and health dynamics. Therefore, this research intentionally concentrated on the pre-pandemic period. Our results revealed that TFP in the PHC sector in Brazil decreased between 2015 and 2019. It was possible to note that three out of every four Brazilian municipalities experienced either stagnation or a decline in the TFP of primary healthcare, with more pronounced challenges in the Midwest and Northeast regions. Looking at the TFP elements, we could see a continuous drop in technical efficiency everywhere in the country, markedly in the Midwest and Northeast. Conversely, there was a considerable uptick in Brazil’s technological component. These results implied that there might have been advancements in PHC’s technological infrastructure, preventing even less favorable outcomes in the TFP indicator. We concluded that the productivity of primary healthcare in Brazil declined when the 2015 fiscal ceiling was implemented. This decrease in performance was evident in the sluggish growth rate of primary healthcare inputs, a diminution in vaccination coverage indicators, and an increase in hospitalizations for preventable causes. Given that health is a crucial component of social well-being, it is vital to highlight the need for comprehensive efforts to guarantee the effective operation and advancement of primary healthcare services, even during economic downturns.

Head and neck squamous cell carcinoma epidemiology at diagnosis: A description of public and private health care systems in Brazil regarding tumor location, staging and risk factors

ObjectivesThere is a limited number of updated epidemiological Brazilian data on head and neck squamous cell carcinoma (HNSCC). This study aimed to describe demographic and clinical characteristics of HNSCC patients from Brazilian public and private systems. MethodsThis is a retrospective observational study that included patients diagnosed with HNSCC from Brazilian public and private settings from 2016 to 2018. As for the public scenario, data were drawn from the public hospital national cancer registry database. As for the private sector, the data were extracted from medical records of patients from Oncoclinicas, a large Brazilian oncology group. ResultsA total of 37,121 patients were included in the study, with 36,914 from the public and 207 from the private system. Patients in the public sector were younger than those in the private sector, with medians ages of 61.2 and 66.9 years, respectively. In both cohorts, a predominance of men with a history of tobacco and alcohol consumption and an advanced locoregional stage at diagnosis was observed. The main site of the primary tumor was the oropharynx in the private sector and oral cavity in the public sector. Among patients with oropharyngeal cancer, only those in the private sector were tested for HPV, with the majority being positive. ConclusionsThis real-world data study provides epidemiologic characteristics of patients with HNSCC in two different Brazilian healthcare settings, presenting relevant insights into possible opportunities for improvements in the patient's journey with HNSCC.

Overview of Endovascular Treatment of Infra Renal Abdominal Aortic Aneurysms Over the Last 21 Years in Brazil

Introduction: Endovascular treatment of abdominal aortic aneurysms (EVAR) has emerged as an innovative therapeutic alternative with significant growth potential. Despite its advantages, factors such as costs, short- and long-term benefits and patient characteristics are still being analyzed and make it difficult to increase the number of these procedures when compared to the traditional open technique. Objectives: To describe the statistical behavior of endovascular treatment for AAA repair over the last 21 years in Brazil. Materials and Methods: Retrospective and descriptive study of data available in the DataSUS database, where variables relating to the number of hospitalizations, number of deaths, average length of stay and hospital and professional costs were analyzed. Results: Among the 1,618 hospitalizations for endovascular treatment of abdominal aortic aneurysms in Brazil between 2002 and 2023, 680 occurred in the South region, followed by the Southeast region with 674 hospitalizations. The mortality rate was 7.94% in this period and the number of deaths was 130. The highest number of deaths was recorded in the Southeast, while the highest mortality rates were in the North and Midwest, 66.67 and 47, respectively. Discussion: The results showed regional inequalities and the influence of socio-economic indices on access to healthcare in Brazil, so that the more economically developed regions showed better results in terms of hospitalizations and mortality. Conclusion: Although the study has limitations, it showed a growing trend in the use of EVAR in Brazil, with the South and Southeast regions having better results in terms of hospitalizations and mortality, while the North and Midwest regions had lower hospitalization rates and higher mortality rates, pointing to underreporting and limited access to advanced treatments.

The role of primary healthcare amid the COVID-19 pandemic: Evidence from the Family Health Strategy in Brazil

This paper investigates the role of primary healthcare in mitigating the consequences of the COVID-19 pandemic, focusing on the Brazilian Family Health Strategy (ESF) as a case study. ESF is Brazil’s major primary care initiative, with prior evidence indicating its effectiveness in improving various health outcomes. The COVID-19 pandemic submitted the Brazilian healthcare system to a rigorous and unprecedented stress test, whose repercussions are still under study. Using comprehensive administrative microdata from 2016 to 2022 encompassing dimensions related to mortality, healthcare service, supply of family health teams, and vaccination coverage, our empirical strategy accounts for heterogeneous effects based on program intensity and pandemic evolution of the 5570 Brazilian municipalities. Our findings reveal that municipalities with high-intensity of ESF coverage (i.e. stronger primary care) experienced 347.93 (95% CI: 289.04, 406.81) fewer COVID-19 and cardiorespiratory deaths per million inhabitants throughout the pandemic period, compared to those in low-intensity ESF areas, despite sharing similar profiles of deaths from respiratory and cardiovascular causes. Among the channels contributing to this relative performance, high-intensity ESF municipalities were found to engage in more home-based primary care visits and health promotion activities while maintaining a similar supply of community health workers. Additionally, they achieved higher vaccination coverage, and these effects were more pronounced in areas with greater ESF presence, emphasising the importance of primary care coverage. In conclusion, our findings underscore the relevance of strong primary care in mitigating the consequences of the pandemic and addressing post-pandemic health challenges.