Brazilian Unified Health System Research Articles

Disability and costs of ischemic heart disease attributable to the consumption of trans fatty acids in Brazil.

To estimate the disability and costs of the Brazilian Unified Health System (SUS) for ischemic heart disease (IHD) attributable to trans fatty acid (TFA) consumption in 2019. This ecological study used secondary data from the Global Burden of Disease (GBD) Study 2019 to estimate the years lived with disability (YLDs) from IHD attributable to TFA in Brazil in 2019. Data on direct costs (purchasing power parity: 1 Int$ = R$ 2.280) were obtained from the Hospital and Ambulatory Information Systems of the SUS. Moreover, the total costs in each state were divided by the resident population in 2019 and multiplied by 10,000 inhabitants. The relationship between the socio-demographic index (SDI), disease, and economic burden was investigated. Brazil and its 27 states. Adults aged ≥ 25 years of both sexes. IHD attributable to TFA consumption resulted in 11,165 YLDs (95% uncertainty interval [UI]: 932-18,462) in 2019 in Brazil. A total of Int$ 54,546,227 (95% UI: 4,505,792-85,561,810) was spent in the SUS in 2019 due to IHD attributable to TFA, with the highest costs of hospitalizations, for males and individuals aged ≥ 50 years or over. The highest costs were observed in Sergipe (Int$ 6,508/10,000; 95% UI: 576-10,265), followed by the two states from the South. Overall, as the SDI increases, expenditures increase. TFA consumption results in a high disease and economic IHD burden in Brazil, reinforcing the need for more effective health policies, such as industrial TFA elimination, following the international agenda.

SOCIODEMOGRAPHIC AND CLINICAL PROFILE OF FAMILIES AND INDIVIDUALS WITH AUTISM SPECTRUM DISORDER

Autism Spectrum Disorder (ASD) imposes limitations on individuals and their families, making it necessary to understand these realities to design effective interventions. Therefore, this study aimed to survey the sociodemographic and clinical data of families and individuals with ASD in Mossoró-RN. It is characterized as a descriptive, cross-sectional, and quantitative study, through an active search on social networks and using Google Forms. After the participants had given their consent, a form was used to gather data on the socio-economic and clinical situation of the families. The target population was families with individuals diagnosed with ASD and living in Mossoró - RN.  The sample was by convenience, totaling 35 individuals with ASD. Among these, 80% were male, aged between 2 and 19, and the predominant races were white and brown (45.7% each). The most common professional at the time of diagnosis was the neuropediatrician (71.4%), and the most common feeling at this time was fear (34.3%). The diagnosis was received at a late stage by the majority (42.9%), and 25.7% felt satisfied with having received it. About being monitored by health professionals, the majority reported having been (97.1%); however, this monitoring is minimally provided by the Brazilian Unified Health System (SUS) (20%). The most frequently cited day-to-day difficulties were food restrictions (65.7%) and communication (62.9%). Concerning the caregivers' data, there was a prevalence of females (97.1%), with an age range from 23 to 53 years, married (65.7%), with a high school education (40%), and who did not work (54.3%), with a monthly income of one minimum wage (40%). The urban area prevailed as their home (97.1%). Based on these results, it was possible to identify a profile of individuals and families with ASD in the city of Mossoró, highlighting the need for more targeted public policies and assistance.

Rising rates of paracoccidioidomycosis-related hospitalizations and in-hospital deaths, Rio de Janeiro, Brazil (2010-2019).

The epidemiological dynamics of paracoccidioidomycosis (PCM) has been changing over the years. We analyzed secondary public data from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), focusing on PCM-related hospitalizations and in-hospital deaths. In the period between 2010 and 2019, 396 hospitalizations and 30 deaths were related to PCM among 7073334 hospitalizations registered in Rio de Janeiro. We highlight the rising rates, reflecting the increase in the number of acute forms previously reported. Urgent public health policies are essential to prevent poor outcomes related to this neglected mycosis.

Factors for Implementing Medical Cannabis Cultivation in Brazil

Abstract: The medicinal properties of the Cannabis genus are evident and many studies indicate its usefulness to treat many diseases. However, the production of Cannabis-based products has been hampered by its criminalization. Currently its cultivation is not allowed in Brazil, except in specific situations. It increases the price of Cannabis-based products, as it requires the importation of inputs, making it difficult for most of the population to access such medicines. In this context, this review presents an overview of Brazilian legislation on medical Cannabis and the current market for Cannabis products in Brazil. The main goal is to encourage the cultivation of medical Cannabis and the distribution of its products by the Brazilian Unified Health System. In addition, it presents recommendations to implement cultivation based on a bibliographic survey carried out in scientific databases and clinical evidence of the effectiveness of Cannabis in treating patients suffering from several diseases and conditions, although more complete studies are needed to confirm both risk-benefit relationship and dose to be administered. After searching for legislation and bills on government websites, it became evident that there was a need for changes in Brazilian legislation to enable cultivation in Brazil. However, there are several proposals for legislation in progress, and Brazil can significantly benefit from this therapeutic option.

The weight of obesity: a retrospective analysis of the direct costs of hospitalizations due to obesity between 2011 and 2020 for the unified health system in Brazil

Aim: This study aimed to analyze the evolution of obesity-related costs over the past 10 years for Brazil's Unified Health System (SUS) and provide insights for guiding and expanding health management and promotion measures. Methods: An observational and retrospective study was conducted using secondary data from 2011 to 2020, extracted from DataSUS with the ICD-10 code for obesity. Statistical analysis was performed to assess trends in hospitalizations and costs related to obesity. Results: During the analyzed period, there was a substantial increase of 110% in hospitalizations and 167% in obesity-related costs for SUS. Female patients (86%) accounted for the majority of hospitalizations, while males (14%) had lower representation. Predominantly, white individuals (62%) were admitted, whereas indigenous individuals had the lowest representation (0,007%). The Southern region contributed to 46% of total cases, in contrast to the Northern region, which accounted for only 0,9%. Conclusion: The findings of this study indicate a significant rise in hospitalizations and associated costs related to obesity for Brazil's Unified Health System. These results underscore the urgency of implementing health promotion and prevention measures, both in the public and private sectors. There is a need for optimized allocation of human resources, including trained professionals for obesity treatment, to mitigate the burden of obesity-related morbidity and mortality and alleviate the strain on the healthcare system.

[The territorial nature of the Primary Health Care of Brazil's Unified Health System (SUS): the proliferation of community medical clinics in the Metropolitan Region of Belém, State of Pará, Brazil].

The scope of this article is an analysis of the proliferation of community medical clinics in the municipalities that comprise the Metropolitan Region of Belem. An investigation was conducted into the performance of the primary health care network of Brazil's Unified Health System, with a view to getting a better understanding of the reasons for, and origins of, the proactive stance of the community health sector. The discussion is based on the review of primary and secondary data, obtained via fieldwork in 119 community clinics in the Metropolitan Region of Belem, and information from Brazil's Unified Health System data center. It was revealed that the community health clinic sector has benefited extensively in recent years from the intensification of underfunding of Brazil's Unified Health System, especially the primary health care network, which is undergoing a process of fragmentation. This is directly responsible for the reduction and disruption of multiprofessional primary health care teams, in addition to the losses suffered in the supplementary health sector. The community clinics adopt an spontaneous and contradictory care model created by the private sector to meet the repressed demand of Brazil's Unified Health System.

Costs of hospital admissions due to COVID-19 in the federal capital of Brazil: a study based on hospital admission authorizations

This is a cost analysis study based on hospital admissions, conducted from the perspective of the Brazilian Unified Health System (SUS), carried out in a cohort of patients hospitalized at the University Hospital of Brasília (UHB) due to Severe Acute Respiratory Infections (SARI) caused by COVID-19, from April 1, 2020, to March 31, 2022. An approach based on macro-costing was used, considering the costs per patient identified in the Hospital Admission Authorizations (HAA). Were identified 1,015 HAA from 622 patients. The total cost of hospitalizations was R$ 2,875,867.18 for 2020 and 2021. Of this total, 86.41 % referred to hospital services and 13.59 % to professional services. The highest median cost per patient identified was for May 2020 (R$ 19,677.81 IQR [3,334.81–33,041.43]), while the lowest was in January 2021 (R$ 1,698.50 IQR [1,602.70–2,224.11]). The high cost of treating patients with COVID-19 resulted in a high economic burden of SARI due to COVID-19 for UHB and, consequently, for SUS.

Resumption of brazilian oral medicine health care during the second period of the COVID-19 pandemic

Aim: This present study aims to compare the data from the Brazilian Unified Health System on the number of clinical consultations of Oral Medicine from the first 6 months (March-August 2020) of the COVID-19 pandemic in Brazil with the last 6 months (September-February 2020/2021) to update the data, verify the measures’ effectiveness to return clinical activities in the following months. Methods: perform a literature review of recent articles that report the impact of the COVID-19 pandemic on Oral Medicine. Results: There was an increase in the number of Oral Medicine clinical consultations in the second half of the pandemic throughout Brazil (+64.2%), representing over 9,235 appointments in this period. Conclusion: measures for the return of health assistance and the practice of Telemedicine proved to be effective after the second period of the pandemic. Even so, strengthening security measures against the coronavirus is essential to ward off a new wave since the Omicron variant emerged in the country and, consequently, possible new lockdowns that might affect healthcare in Brazil.

Life expectancy and death pattern associated with systemic lupus erythematosus diagnosis in Brazil between 2000 and 2019.

to evaluate the main factors associated with mortality and determine the life expectancy of SLE patients between 2000 and 2019 years in Brazil. death data related to SLE available in the Brazilian Unified Health System (SUS) (DATASUS) were evaluated in all Brazilian states. Three groups of death causes potentially associated from SLE were evaluated: cardiovascular and kidney diseases and infections. The main causes of death associated with SLE were infection and kidney disease. Most SLE patients died between 19 and 50 years of age. Deaths associated with kidney disease were proportionally higher than in the general population with progressive decrease during the period. Instead, there have been an increase in the proportion of deaths due to infections both in SLE and in the general population. SLE patients presented higher mortality compared to the general population matched for sex and age and the main causes associated with death were infection and kidney disease. Public health policies that promote early diagnosis, treatment and prevention of damage are necessary to reduce morbidity and mortality in SLE patients.

Pharmacological potential of Fridericia Chica: traditional knowledge and chemical composition

The Fridericia chica is a shrub widely distributed throughout the Brazilian territory. In traditional knowledge, it is used for various pathologies. It is a plant of interest in phytotherapy as it is part of the National List of Medicinal Plants of Interest to the Brazilian Unified Health System – RENISUS. Among the scientific studies conducted, the potential antioxidant, analgesic, anti-inflammatory, immunomodulatory, healing, gastroprotective, antibacterial, antifungal, antiprotozoal, antiviral, antitumor, antiangiogenic, photoprotective, diuretic, and hepatoprotective properties have been demonstrated. Furthermore, the assays report the low toxicity of the extracts. Therefore, Fridericia chica is a plant with pharmacological potential for the development of new medications. This article contributes to the dissemination of the species' pharmacological potential and the imminent observation of traditional knowledge.

On-Demand PrEP: Clinical Report of Pharmaceutical Care in HIV Pre-Exposure Prophylaxis

Introduction: Pre-Exposure Prophylaxis (PrEP) for HIV involves the combined use of antiretrovirals for individuals frequently exposed to HIV. Initially implemented in Brazil in 2018 with a daily dosing regimen of one pill, on-demand usage was recently (2022) incorporated into routine practice. Aim: To report the experience of providing pharmaceutical care to an on-demand PrEP patient in an outpatient pharmacy within Brazil's Unified Health System. Outlining: This experience report details of pharmaceutical care that included reception of the patient, conducting anamnesis, legally and technically prescription evaluation, dispensing PrEP with verbal guidance on potential adverse events related to pharmacotherapy, and scheduling a return visit to the service. Results: The patient was initially prescribed a daily regimen of PrEP. During the first return consultation, 30 days after starting PrEP, the patient reported adverse effects related to the gastrointestinal tract, leading to the recommendation of an on-demand PrEP regimen. Implications: As of the last pharmaceutical consultation (June 21, 2022), the patient maintained a negative HIV serology, was accustomed to the newly prescribed dosage, and reported reduced gastric discomfort associated with the use of on-demand PrEP. This facilitated adherence to pharmacotherapy and improved the preventive efficacy against HIV infection.

Hospitalisations and fatality due to respiratory diseases according to a national database in Brazil: a longitudinal study

BackgroundRespiratory diseases (RDs) cause millions of hospitalisations and deaths worldwide, resulting in economic and social impacts. Strategies for health promotion and disease prevention based on the epidemiological profile of the...

Epidemiology of Supracondylar Fractures of the Humerus in Children

Background: Supracondylar fracture of the humerus are the second most common fracture in pediatric patients. There are few studies concerning their epidemiology in Brazil. This study aims to assess the clinical and epidemiological characteristics of supracondylar fractures of the humerus in children managed at a tertiary-level hospital within the Brazilian Unified Health System (translation for SUS - Sistema Público de Saúde). Methods: This retrospective study included patients younger than 13 years diagnosed with supracondylar fracture of the humerus assisted at an urgent and emergency referral unit of the Unified Health System from June 2022 to July 2023. The statistical analysis used R software version 4.0.4 with a significance level set at 0.05 using descriptive and inferential statistics. Results: 197 children with mean age of 5.4 years (2.4) were diagnosed with a supracondylar fracture of the humerus. The highest temporal incidence occurred in December, being 56.9% male patients, 81.3% identified as African American, and 51.8% had a fracture on the left side. The most prevalent cause for the fracture was a fall from standing height on the outstretched hand. At least 95% of the patients had extension fractures, and the distribution by Gartland classification was: I, 36.7%; II, 26.2%; III, 30.9%; and IV, 6.3%. Three patients had a neurological injury. All patients with III and IV fractures, as well as those with flexion fractures, underwent surgery. However, of the 50 patients with grade II fractures, 11 underwent surgery, and 39 managed with nonoperative methods. We observed an association between the fracture severity, and fall height, neurological impairment, and management received. Conclusion: Targeted education efforts and interventions can prevent the occurrence of supracondylar fractures in our region at the northeast side of the country.

Pediatric chronic kidney disease mortality in Brazil-A time trend analysis.

Chronic kidney disease (CKD) is defined based on structural or functional abnormalities of the kidneys, or a glomerular filtration rate (GFR) below the threshold of 60 ml/min per 1.73 m2 for more than 3 months. It is an important noncommunicable disease with a rising worldwide, becoming a global public health problem. There are few studies about this problem, especially in low- and middle-income countries (LMIC), including Brazil, an upper-middle-income country. The objective of the study was to determine the cause-specific mortality rates for pediatric CKD patients (CKDMR) from 0 to 19 years old, based on the 10th revision of the International Classification of Diseases (ICD-10) and the Global Burden of Diseases Injuries and Risk Factors Study's (GBD) list. We calculated the impact of the annual human development indexes (HDI) in CKDMR in Brazil and its regions at two different times and compared it with the literature results. We obtained data from the Department of Informatics of the Brazilian Unified Health System (DATASUS) from 1996 to 2017. The Joinpoint regression analyses estimated the average annual percentage changes (AAPCs). The correlation between the HDI values and the number of deaths from each age group in Brazil and its different regions were assessed using the time series autoregressive integrated moving average (ARIMA) models. There were 8838 deaths in a pediatric and adolescent population of about 1.485 x 109 person-years observed in Brazil from 1996 to 2017. Our results demonstrated a significant increase in the AAPC in Brazil's less than 1-year-old age group and a decrease in children from 5 to 19 years old. We observed a positive correlation between CKDMR and HDI among children under 1 year of age. Conversely, there is a negative association in the age groups ranging from 5 to 19 years, indicating an inverse relationship between CKDMR and HDI.

Use of a Modelling Tool to Optimise the Organisation of the Demand for Primary Oral Health Care in the Brazilian Unified Health System.

To describe the use of work process modelling to optimise the organisation of the demand for oral health treatment in primary care units in Brazil. The oral health care routine was at first described as the "AS IS" model, which was evaluated by the oral team professionals, rearranged, and further described as the "TO BE" model described using a business process management modelling tool. The significant increase in the demand of patients due to restrictions offered by the dental service in addition to non-urgent treatments being avoided by patients during COVID-19 pandemic was also considered. Structuring the work processes in a visual way using modelling tools was useful to picture the entire treatment process and adjust when needed. The use of the managerial tool was useful to understand and reorganise the workflow of organising the demand and ultimately improve the efficiency of the resources. The use of such managerial tools helped oral health professionals to efficiently rearrange their tasks and set priorities to meet their needs. With the use of management tools, each unit can readjust its structures and ways of working, aiming to improve the quality of public health care services provided to patients.

The incorporation of the 3HP regimen for tuberculosis preventive treatment in the Brazilian health system: a secondary-database nationwide analysis.

The recommendation of rifampin-based shorter - and safer - regimens for tuberculosis preventive treatment (TPT) is progressively replacing monotherapy with isoniazid by different countries. The Brazilian Ministry of Health (MoH) approved the incorporation of the Rifapentine + isoniazid regimen (3HP) at the end of 2020, with free distribution in the Brazilian Unified Health System (SUS) started from the last quarter of 2021. The objectives were to describe the implementation of the IL-TB System (Information System of TPT Notification) and uptake of Rifapentine + isoniazid (3HP) and Isoniazid (6H or 9H) in Brazil. A quantitative observational and descriptive was performed using the IL-TB National System as the main data source, from January 2018 to December 2022. There was a steady increase of the number of TPT prescription quarterly throughout the period, which reflects the implementation of the system itself and the progressive adherence of the health system to the non-compulsory notification of new TPT. The substitution of isoniazid (6H or 9H) by 3HP is progressing. The 3HP regimen represented less than 4% of the total administered by the end of 2021, reaching around 30% in the second half of 2022 and 40% in the last quarters of 2022. The study points not only to the need to expand TPT in the country, but also to accelerate 3HP uptake and to encourage the municipalities to notify to the IL-TB system, since there is still a high level of underreporting.

Cost-Effectiveness of Onasemnogene Abeparvovec Compared With Nusinersen and Risdiplam in Patients With Spinal Muscular Atrophy Type 1 in Brazil: Custo-Efetividade do Onasemnogeno Abeparvoveque (AVXS-101) em Comparação ao Nusinersena e Risdiplam em Pacientes com Atrofia Muscular Espinhal Tipo 1 no Brasil

ObjectivesThis study aimed to evaluate the cost-effectiveness of the onasemnogene abeparvovec in relation to nusinersen and risdiplam in the treatment of spinal muscular atrophy type 1 from the perspective of the Brazilian Unified Health System. MethodsA Markov model was built on a lifetime horizon. Short-term data were obtained from clinical trials of the technologies and from published cohort survival curves (long term). Costs were measured in current 2022 local currency (R$) values and benefits in quality-adjusted life-years (QALYs). Utility values were derived from type 1 spinal muscular atrophy literature, whereas costs related to technologies and maintenance care in each health state were obtained from official sources of reimbursement in Brazil. Deterministic and probabilistic, as well as scenario, sensitivity analyses were performed. ResultsCompared with the less costly strategy (nusinersen), the use of onasemnogene abeparvovec resulted in an incremental cost of R$2.468.448,06 ($975 671.169 – purchasing power parity [PPP]) and a 3-QALY increment and incremental cost-effectiveness ratio of R$742.890,92 ($293 632.774 – PPP)/QALY. Risdiplam had an extended dominance from other strategies, resulting in an incremental cost-effectiveness ratio of R$926.586,22 ($366 239.612 – PPP)/QALY compared with nusinersen. Sensitivity analysis showed a significant impact of the follow-up time of the cohort and the cost of acquiring onasemnogene abeparvovec. ConclusionsOver a lifetime horizon, onasemnogene abeparvovec seems to be a potentially more effective option than nusinersen and risdiplam, albeit with an incremental cost. Such a trade-off should be weighed in efficiency criteria during decision making and outcome monitoring from the perspective of the Brazilian Unified Health System.

Inequalities in the access to diagnosis and treatment of obstructive sleep apnea in Brazil: a cross-sectional study.

Obstructive sleep apnea (OSA) is highly prevalent, and positive airway pressure (PAP) therapy is the primary treatment. The study aimed to assess the diagnostic and PAP treatment resources for OSA within Brazil's Unified Health System (SUS) and to identify potential inequalities and gaps. A structured survey was sent to members of the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine to identify sleep laboratories providing OSA diagnosis and/or treatment within the SUS. The number of centers, care team structure, sleep studies availability, PAP accessibility, and follow-up services were characterized in all five Brazilian regions using a structured survey. Forty-seven centers were identified: Midwest (n=4), Northeast (n=10), North (n=3), Southeast (n=22), South (n=8). Most centers (70%) provided both OSA diagnosis and treatment, mainly in capitals and/or metropolises (87%). Ten out of 27 Brazilian Federal Units lacked sleep services for OSA management, with the North having the highest proportion of states without a sleep service (71%). Annual number of diagnostic exams for OSA was 14,932 with significant heterogeneity across regions (Midwest: 240; North: 400, Northeast: 35,64; South: 4,380; Southeast: 6,348. Mean waiting times for diagnosis and treatment were 11 and 8 months, respectively. Only 56% of PAP treatments were publicly funded, making legal injunctions and out-of-pocket expenditure common practices. This study revealed significant disparities in OSA diagnosis and treatment resources across Brazil, with the North region being particularly underserved. The findings underscore an urgent need for strategies to improve sleep care nationwide.

Como a judicialização da cirurgia de implante coclear impacta o Sistema Único de Saúde

ABSTRACT Purpose To describe the impact of Judicialization on the performance of Cochlear Implant (CI) surgery in the Brazilian Unified Health System (SUS), including the public service and supplementary health. Methods A documentary survey of judgments of all National Courts and the Dominant Jurisprudence focused on CI surgery in the SUS from 2007 to 2019 was carried out through the Jusbrasil Platform using the term “cochlear implant” to carry out the search. A survey was also carried out on the DATASUS platform on how many uni and bilateral CI procedures were performed in the same period. Results According to DATASUS, from 2008 to 2019, 8,857 CI surgery procedures were performed by Public Entities or Health Plan Operators in the country. With regard to Judicialization, for requesting unilateral or bilateral CI surgery, a total of 216 processes were found, representing a total of 2.43% of Judicialization of Cochlear Implant (CI) surgery. Conclusion In view of the data, it is possible to perceive that the Judicialization of Health when we consider the CI surgery has represented a small portion of the cases, which does not demonstrate a large impact on the public budget and does not have an impact on the organization of the SUS.

Sociodemographic, behavioral, obstetric, and healthcare factors associated with low weight at birth: a case-control study.

Understanding social determinants is crucial for implementing preventive strategies, especially for low birth weight (LBW)-a public health issue that severely increases the risk of morbimortality in children. This study aimed to identify the factors associated with LBW among newborns, assisted by the Brazilian Unified Health System. It analyzed data from newborns and their mothers. The sample was selected by convenience from users of the public health system in Francisco Beltrão (Paraná, Brazil). Cases (n = 26) were babies weighing ≤ 2,500 g and controls (n = 52) > 2,500 g. All babies were assessed and paired by sex and date of birth in a 1:2 proportion. Statistical power was computed a posteriori, revealing a power of 87% (α = 0.05). Strong and significant differences were found in the bivariate analysis, in which the number of current smokers or those who quit during pregnancy was higher among mothers of babies with LBW. Moreover, the gestational weeks were lower among these cases. Logistic regression models indicated that the gestational week (odds ratio [OR] = 0.17, 95% confidence interval [CI]:0.05-0.54) and fathers' educational level (high school or above; OR = 0.22, 95% CI:0.06-0.99) were related to lower chances of low birth weight. Our findings confirm previous investigations on LBW's multi-causality, showing that the gestational week could reduce up to 82% chances of a baby being born with ≤ 2,500 g. Its association with paternal education underlines the importance of comprehensive policies to protect newborns.