Brazilian Unified Health System Research Articles

The continuous increase in the number of systemic lupus erythematosus cases in Brazil in the COVID-19 era.

This study aims to reevaluate and compare the data from the Brazilian Unified Health System (SUS) on the number of diagnoses of systemic lupus erythematosus (SLE) in the pre-pandemic period with those in the pandemic period, as well as to compare the first year (2020) of the COVID-19 pandemic in Brazil with the last year (2021), to update the data, and to verify whether SLE disease control measures were effective in 2021. There was a consistent and significant increase in the incidence of SLE cases all over Brazil between the first and second pandemic years and between the pre-pandemic triennium and the second pandemic year. Therefore, it is inescapable to have larger clinical studies with different populations to better understand the relationship between these two conditions and find measures to improve the control of this disease.

Availability of Genetic Tests in Public Health Services in Brazil: Data from the Brazilian Rare Diseases Network

Introduction: The Brazilian Policy for Comprehensive Care for People with Rare Diseases (BPCCPRD) was published in 2014, accrediting several reference centers and incorporating many genetic tests for the diagnosis of rare diseases (RDs). The Brazilian Network of Rare Diseases (RARAS) comprises more than 40 institutions that offer diagnosis and treatment for RDs in Brazil. This network includes Reference Services for Rare Diseases (RDRS), Reference Services for Newborn Screening (NSRS), and University Hospitals distributed in all Brazilian regions. Objective: The aim of the study was to map the availability and distribution of the BPCCPRD diagnostic procedures in the Brazilian Unified Health System through RARAS. Method: Data were collected through a questionnaire on the Research Electronic Data Capture platform, with 22 questions regarding the availability of procedures. Thirty-seven coordinators from RARAS participating centers received the questionnaire link for participation by email from August/2020 to March/2021. All participating institutions ethically approved this project. Results: Of the 37 institutions, 23 (62.16%) offered cytogenetic tests, 20 (54.05%) offered molecular procedures, and 22 (59.46%) offered inborn errors of metabolism diagnostic tests. The Southern blot analysis, enzyme assays on cultured tissue and urinary organic acid tests had the highest outsourcing rate. On the other hand, the procedures most frequently performed on-site were bone marrow karyotype and long-term cultured karyotype. It was observed that 10 of the 37 centers (27%) did not provide access to investigated procedures (on-site or outsourced). The North and Midwest regions stood out in terms of the unavailability of such techniques in at least 40% of the evaluated institutions. Discussion and Conclusion: This study reveals large discrepancies in the supply of diagnostic procedures in the Brazilian territory. Moreover, there is a broad collaboration between services through the outsourcing of multiple diagnostic techniques to address this issue. Finally, this work corroborates the importance of mapping services for the diagnosis and treatment of individuals with RDs to propose actions for the better supply and distribution of these procedures.

Cost-effectiveness analysis and budgetary impact of anidulafungin treatment for patients with candidemia and other forms of invasive candidiasis in Brazil.

Candidemia and other forms of invasive candidiasis (C/IC) are serious conditions, especially for immunosuppressed individuals with prolonged hospitalization in intensive care units (ICU). This study analyzed the incremental cost-effectiveness and budgetary impact (BI) of treatment for IC with anidulafungin compared to amphotericin B lipid complex (ABLC) and amphotericin B deoxycholate (ABD) or conventional amphotericin B (CAB), in the Brazilian Unified Health System (SUS). A decision model was conducted with a time horizon of two weeks from the perspective of SUS. The primary effectiveness endpoints were survival and treatment response rate. All patients were followed up until successful therapy or death. BI analysis was performed based on the measured demand method. A five-year time horizon was adopted based on the number of hospitalizations (per 1,000 hospitalizations). For effectiveness measured in the successful response rate (SRR), anidulafungin dominated the ABLC and ABD formulations. In the results of the analysis with the effectiveness measured according to survival, anidulafungin had a better cost-effectiveness ratio (R$988.26/survival) compared to ABD (R$16,359.50/survival). The BI estimate related to the incorporation of anidulafungin suggests savings of approximately 148 million reais in 5 years when comparing it to ABD. The economic evaluation of anidulafungin and its comparators found it to be cost-effective. The consensus of international scientific societies recommends it as a first-line drug for IC, and its incorporation by SUS would be important.

Social inequalities in access to cancer screening and early detection: A population-based study in the city of São Paulo, Brazil

ObjectiveThis study monitors trends in access to cancer screening, focusing on mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA), assessing the magnitude of inequality in the city of São Paulo from 2003 to 2015 according to education level. MethodThis is a cross-sectional population-based study conducted with data from the 2003, 2008, and 2015 editions of the Health Survey of the City of São Paulo (ISA-Capital). Outcome variables were the proportion of mammography, Papanicolaou (Pap smear), and Prostate-Specific Antigen (PSA) tests according to the protocols. Inequality was measured by education level according to years of study. For static analysis, Poisson regression was used to estimate proportion ratios. ResultsThe proportion of Pap smears remained stationary at a high level (>89%) throughout the study period, while access to mammography and PSA tests significantly increased in the 2003‒2015 period. The present results indicate inequalities in access to cancer screening due to education, and being more expressive for mammography and PSA tests. However, this inequality significantly decreased over the period analyzed comparing the most educated individuals with those with the lowest educational level. In addition, an increase in the proportion of tests performed in the Brazilian Unified Health System was identified, especially for mammography and PSA tests, in the period 2003‒2015. ConclusionsThe inequalities observed in the access to preventive exams were influenced by the level of education. The offer of exams was expanded, more significantly for mammography and PSA, especially among the less educated group.

Legado da epidemia de Zika vírus: o impacto da associação causal para além da ciência de laboratório

Abstract More than four years after the Zika virus epidemic, we are left with the task of investigating its legacy. Here, we describe the impact of the causal association between the Zika virus and the abnormalities seen in fetuses, a search that marked the scientific and press agenda at the time. By using the Social Studies of Science and Technology, which establishes the scientific fact as co-produced by science and society, we carried out 17 semi-structured interviews between scientists, managers, health professionals and families of the children in eight Brazilian cities. We observed that causality had a partial and dubious impact on the organization of services - with the overlap between surveillance and care initially generating asymmetries in the Brazilian Unified Health System. Between families and health professionals, there are demands for research on interventions and care, considered as not being prioritized among scientists. Among the researchers, we notice a gap between study and coping, with the social being constituted by demands that are not integrated into the scientific field. For future public health crises, we point to multiplying the number of research questions and study designs, so that social demands find flow in scientific doing.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic.

To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

Integrality, absenteeism and resolubility of specialized care for pediatric patients: a cross-sectional study.

Dental Specialties Centers (CEOs) are clinics representing part of the secondary oral health care system of the Brazilian Unified Health System (SUS). Pediatric dentistry is not a requirement for service accreditation. However, the CEO of the Federal University of Rio Grande do Sul (CEO-UFRGS) has provided dental care for children aged 3-11 years since 2017. The utilization rates of health services are influenced by absenteeism. Therefore, evaluation of absences for dental appointments is of primary importance. This study aimed to evaluate referral characteristics, absenteeism, and resolubility of pediatric dentistry appointments at the CEO-UFRGS. This retrospective cross-sectional study was conducted at the Dental Teaching Hospital of the university and analyzed secondary data from referrals and medical records. From August 2017 to December 2019, 167 referrals and 96 medical records were reviewed, from which data of individual variables related to the referral process and treatment were collected. Data were collected by a single trained examiner and analyzed using SPSS software. The main reasons for referral to secondary care were dental caries and pulpal or periapical diseases associated with difficult-to-manage behavior. An absenteeism rate of 28.1% at the first pediatric dental visit and a resolution rate of 65.6% were found. Binary logistic regression analysis indicated that each day of waiting for specialized care resulted in a 0.3% of higher chance of absence for appointment. This also increased the chance by 0.7% in child who attended the first visit to complete treatment, suggesting that the waiting time for attendance was associated with absenteeism and resolubility. Public policies that expand providing child dental care in secondary care are recommended to improve access to and resolubility of services.

Physical Education as a workforce of the Brazilian Unified Health System: an analysis of the types of professional bonds

Resumo Considerando a inserção de Profissionais de Educação Física como força de trabalho no Sistema Único de Saúde, este estudo teve como objetivo analisar os tipos de vínculos e a carga horária de trabalho desses profissionais nos diferentes níveis de atenção à saúde e regiões do Brasil entre 2007 e 2021. Trata-se de um estudo descritivo de abordagem quantitativa com base em pesquisa no Cadastro Nacional de Estabelecimentos de Saúde. Foi observado que a atenção primária à saúde constitui o principal nível de atuação, seguida da atenção secundária e terciária. Na atenção primária, o número de cadastros de Profissionais de Educação Física com vínculo de trabalho precário é maior do que os com vínculo protegido, mas o inverso ocorre na atenção secundária e terciária. Nas regiões Sul e Sudeste, foi revelado maior número de cadastro desses profissionais com vínculo de trabalho protegido, e nas demais regiões prevaleceu o vínculo de trabalho precário. Foi identificado que 44,7% dos cadastros de Profissionais de Educação Física possuem carga horária maior ou igual a 40 horas por semana. Em conclusão, a atenção à saúde pode ser prejudicada pelo tipo de vínculo de trabalho do profissional por causar rotatividade e dificuldade na continuidade do cuidado.

Cuidado em território vulnerabilizado e a COVID-19: interseccionalidade e dinâmica êmica na ética do cuidado

Abstract The aim of this study is to understand care, before, during and after the COVID-19 pandemic, in a vulnerabilized territory, considering intersectionality, care ethics and the emic dynamics. The method was qualitative research. The subjects were community leaders, and health professionals of Primary Health Care at the Family Health Unit (USF) of the Brazilian Unified Health System (SUS). Challenges and Potentialities in care were identified. Care went within, against and beyond the State in a decolonial way. Politicization and public policies’ improvement of care are understood as coping with the pandemic.

Situational analysis of syphilis cases taking place between 2015 and 2021 in the state of Rio Grande do Norte - Brazil

Introduction: Syphilis is a sexually transmitted infection that represents a severe public health problem worldwide and in Brazil it has not been different. The national compulsory notifications regarding syphilis cases are significantly increasing, and therefore, this fact alone justifies the study of such a relevant subject. Objective: This work presents a situational analysis of syphilis cases in the state of Rio Grande do Norte, Brazil, between 2015 and 2021, aiming primarily at assisting public healthcare authorities in decision-making processes to cope with the disease. Concomitantly, this research aims to build knowledge as well as to provide awareness to the population. Methods: This study analyzed data from compulsory notifications reports from 2015 to 2021, available in the database of the Brazilian Unified Health System’s Informatics Department, in the Brazilian Information System of Notifiable Diseases and in the Brazilian Health Surveillance Secretariat. Results: In the state, 70% of patients with syphilis are aged 15 to 39 years. The rate of patients affected with acquired syphilis that have low education is 48%, and for pregnant women, this value rises to 77%. The declared mixed-race patients represent 48% of notifications for acquired syphilis, and for mixed-race pregnant women, this value increases to 60%. In congenital syphilis, 98% of compulsory notifications occurred for children aged up to 7 days of birth. Conclusion: Syphilis in Rio Grande do Norte is a public health problem that mainly affects the vulnerable population, predominantly the groups at risk with low education, mixed race, and young-adult people, being of paramount importance to combat the disease through population awareness, as well as through constant and adequate compulsory notification.

Análise da tendência nas taxas de detecção de sífilis em gestantes e de incidência de sífilis congênita no Ceará no período de 2015 a 2021

ABSTRACT Objective: To analyze the trend in the detection rate of Syphilis in Pregnant Women (SP) and in the incidence rate of Congenital Syphilis (CS) in the state of Ceará. Methods: This is an ecological study that used the technique of interrupted time series to analyze monthly data on cases of SP and CS obtained from the Department of Informatics of the Brazilian Unified Health System (DATASUS) from January 2015 to July 2021. The Kernel test and the Lincoln-Petersen estimate were used to analyze the statistical significance. Results: In 2015, a monthly detection rate of SP was estimated at 5.4 and a CS incidence rate of 8.2 per one thousand live births (LB). The implementation of the ordinance that changed the criteria for defining cases of SP and CS resulted in an increase of 4.9 (p<0.0001; 95%CI; 3.33; 6.61) in the detection rate of SP and a decrease of 0.1 on the incidence of CS (p<0.001; 95%CI -0.2; -0.1). The COVID-19 pandemic did not impact the monthly detection rate of SP (p=0.558; 95%CI 5.92; 3.22), nor its trend (p=0.7397; 95%CI 0.28; 0.3), but there was an increase of 0.19 in CS (p<0.001; 95%CI 0.1; -0.31). Conclusion: Between 2015 and June 2021, the trend in the detection rate of SP and in the incidence rate of CS was impacted by changes in the criteria for defining cases of these diseases proposed by the Brazilian Ministry of Health and the COVID-19 pandemic.

Uso do processo analítico hierárquico para eleger a preferência do paciente na avaliação da primeira linha de tratamento do câncer de mama metastático her2 hiperexpresso

Abstract Background The many combinations of chemotherapeutic agents and biologicals available in the Brazilian National Health System for the treatment of metastatic breast cancer require analysis that contribute to decision making. Objective The study’s primary aim was to evaluate the first-line treatment of HER2- overexpressing metastatic breast cancer from the Brazilian Unified Health System perspective using multicriteria decision analysis (MCDA). Method The treatment options evaluated were (a) pertuzumab combined with trastuzumab and docetaxel, and (b) trastuzumab in combination with docetaxel. Using the hierarchical analytical method, medical oncologists compared the relevance of five predefined criteria: overall survival, response to treatment, adverse events, cost- effectiveness, and budget impact. Results The therapeutic scheme considered more appropriate by the model was pertuzumab combined with trastuzumab and docetaxel. The most sensitive criteria were adverse events, cost-effectiveness, and budget impact. The results suggest that the classification has a close relationship with the perspective of healthcare professionals participating in the questionnaire. Conclusion Defining the treatment of an incurable disease associated with a short survival time and high-cost treatment options necessitates complex decision-making. MCDA allows the weighting of criteria and considering criteria that would be difficult to measure in other methods, such as cost-effectiveness. These aspects differ from economic models and contribute to a broader evaluation of health decision-making.

Vulnerabilidades em saúde e a importância da integração da produção local de medicamentos estratégicos para o SUS

Abstract A strengthened local supply chain is an essential and highly relevant condition for universal access to health care. This article enables a movement towards a public policy agenda that involve the entire productive health system, including strategic components of the production chain beyond active pharmaceutical ingredients (API), without which universal health access and health sovereignty become unfeasible, leaving the Brazilian Unified Health System (SUS) vulnerable. Within this perspective, qualitative bibliographic research was conducted together with field observation among key informants of the drug production supply chain from Brazil’s main Official Pharmaceutical Laboratory. Results showed that in addition to active pharmaceutical ingredients, other strategic health care items in the supply chain also constitute technological bottlenecks. These findings may contribute to expand the debate on health vulnerabilities, relating the productive and economic structure to universal access, thus establishing, nationally and internationally, a theoretical link between the economy, production local and social rights.

Investments of the Brazilian Unified Health System in vocology in the period from 2008 to 2022

RESUMO Objetivo Analisar os investimentos do Sistema Único de Saúde do Brasil destinados à vocologia. Métodos Estudo ecológico, de caráter quantitativo com dados públicos, secundários, disponibilizados na plataforma digital DataSUS/TABNet. Os dados referem-se à quantidade e aos valores dos procedimentos da vocologia, apresentados e aprovados durante o período de 2008 a 2022 no Brasil. Após a coleta e análise descritiva dos dados, foram adotados os valores absolutos, relativos, taxas de crescimento e déficit. Resultados No período analisado foram realizados 4.6 milhões de procedimentos realizados a um custo total de R$18.350 milhões. Destes, 2.4 milhões de procedimentos foram aprovados a receberem o pagamento pelas secretarias de saúde dos estados e municípios a um custo total de R$ 10.617 milhões aos cofres públicos. Estes valores repassados representaram uma taxa de crescimento nos investimentos destinados aos procedimentos da vocologia em até 491%, se comparado ao ano de 2008, porém acumulou-se uma taxa de déficit financeiro de até 360% em todo o período estudado. Conclusão Constatou-se que os investimentos públicos destinados à vocologia passaram por crescimento significativo em todos os índices analisados, apesar de não terem sido repassados a totalidade dos valores referentes aos procedimentos realizados.

Incorporation of health technologies: The importance of drug treatment of primary headaches in the Brazilian unified health system

Incorporation of health technologies: The importance of drug treatment of primary headaches in the Brazilian unified health system

Ozone therapy in brazil: achievements and challenges for the future.

The practice of Ozone Therapy in Brazil began in 1975, with Doctor Heinz Konrad. In the 90’s, other professionals started to practice it in a precursory and unregulated way, with imported equipment. The work of physician Edison de Cezar Philippi stands out, who was a great disseminator and together with other physicians such as Dr. Glacus Brito, Dr. Maria Emília Serra, Dr. Ana Cristina Barreira, among others, founded the first association of Ozone Therapy in Brazil, which in 2006 became Brazilian Association of Ozone Therapy (ABOZ), with Dr. Maria Emília Gadelha Serra as its first president. In the state and regulatory scope, Ozone Therapy was an unknown technique. Numerous scientific articles were presented to the Ministry of Health, the Federal Council of
 Medicine, and ANVISA (equipment regulatory agency in Brazil). The first regulatory framework for Ozone Therapy in Brazil took place in 2015, with the publication of Resolution CFO 166/2015, which regulated Ozone Therapy in Dentistry.
 In 2018, Ozone Therapy was included as an integrative practice by the Ministry of Health of Brazil, with the publication of ORDINANCE N° 702 (21/03/2018) which included new practices in the National Policy on Integrative and Complementary Practices (PNPIC), of the Brazilian Unified Health System (SUS). From this milestone, the Professional Class Councils began to understand and regulate Ozone Therapy within the scope of each profession.
 Currently, dentistry, physiotherapy, pharmacy, nursing, veterinary medicine, and biomedicine councils have an official understanding of Ozone Therapy, each within its scope of action and with a specific definition of training. These resolutions collaborate to improve the scenario of Ozone Therapy in the country, bringing more possibilities for treatment, and health care for the entire population.
 Although there are numerous qualified studies for the practice to be regulated for medicine, the Federal Council of Medicine is still waiting for more scientific evidence, so it only authorizes activities in the experimental scope (registered clinical research).
 In the meantime, faced with the difficulties of understanding from the Federal Council of Medicine, the national congress approved a bill proposing that ozone therapy be authorized throughout the national territory. This bill is currently under review by the Senate and the next step is presidential sanction.
 Even with all the regulatory achievements in these 15 years of work, we still have many challenges to overcome. The main one is the regulation for use by doctors, so Ozone Therapy becomes an official technique. In addition, for Ozone Therapy to be carried out more ethically and scientifically, it is necessary to understand the scenario and some challenges:
 • How to establish boundaries between professional categories, since ozone has many application routes - not all professionals are prepared to perform more invasive routes.
 • The established model based on the diagnosis and treatment of the disease.
 • Banalization of the technique by unqualified professionals, leading to a false understanding and discrediting of the technique.
 • Difficulty in regulating equipment and minimum quality standards, while on the internet equipment from China enters without qualification.
 • Standardization and minimum criteria for the manufacture of Ozonized Oils, based on studies and not on empiricism.

Self-reported health conditions, quality of Primary Health Care and associated factors according to sexual and gender minorities

Introduction: Lesbians, gays, bisexuals, transvestites, transsexuals, transgenders, queers, intersexes, asexuals, pansexuals and other sexual and gender minorities constitute a population that has been little studied regarding the use and care in health services. Objective: From this perspective, the general objective of this study was to evaluate the quality of Primary Health Care according to members of sexual and gender minorities. Methods: This is an evaluative research, with a cross-sectional and descriptive-analytical design and a quantitative approach, performed by means of a web survey in Brazil. The script for data collection addressed sociodemographic characteristics, sexual orientation, gender identity, self-reported health conditions and the 23 items of the Primary Care Assessment Tool, reduced version for adult users. Results: The results represent 314 LGBTQIAP+ people, predominantly young, white, cisgender, homosexual and bisexual, from the five Brazilian regions, highlighting the states of Minas Gerais and São Paulo. The use of alcoholic beverages and other substances, the weight change and the presence of mental diseases were the most frequent self-reported health conditions. Primary health care was mostly evaluated with low overall scores, thus indicating low quality. The attributes “community guidance” and “coordination” (care integration) were marked by negative evaluations, indicating small extension. People belonging to sexual and gender minorities who worked, had kidney problems, had been hospitalized recently and that had their gender identity and sexual orientation known by health professionals were more likely to evaluate the Primary Health Care as good. Conclusion: This work points out as weaknesses in the care of the LGBTQIAP+ population the following atributes: family guidance, accessibility, longitudinality and available services, which can be prioritized to improve the quality of Primary Health Care in the Brazilian Unified Health System.

Follow-up of infants with congenital syphilis during the penicillin shortage period

ObjectiveTo analyze the follow-up, in specialized outpatient clinics, of infants reported with congenital syphilis during the penicillin shortage. MethodA cross-sectional study was carried out in ten public maternity hospitals affiliated with the Brazilian Unified Health System in the city of Fortaleza, state of Ceará. Clinical records of infants reported with congenital syphilis who were born alive in 2015 were used to describe correlates of attendance at recommended clinical follow-up appointments. ResultsA total of 469 infants reported with CS from January 1/2015 to December 31/2015 were included in the analysis. The results show that most infants did not attend the follow-up visits (368/469, 78.5%) and the main associated factors are that the follow-up clinic is located in a different hospital from that where the infant was born (OR: 3.7; CI: 2.20–6.22; p < 0.001) and the use of illicit drugs by the mother (OR: 3.2; CI: 1.57–6.87; p = 0.002). Only 33.7% (34/101) were followed until discharge. ConclusionThe majority of infants with reported congenital syphilis during this period did not attend the follow-up visits. Public health efforts aimed at reaching the parents of infants with CS should be a priority to ensure appropriate clinical identification and management of the associated outcomes of this vertically transmitted infection.

Investigating the Relationship between Climate and Hospital Admissions for Respiratory Diseases before and during the COVID-19 Pandemic in Brazil

This study aimed to analyze meteorological variables versus hospital admissions for respiratory diseases for the age groups of children under five and the elderly (over 65 years of age) in different climate regions of Brazil, for the years 2018 and 2020, i.e., before and after the outbreak of the COVID-19 pandemic. The aim of the study was, on one hand, to evaluate the influence of weather variables on respiratory disease in humans, and on the other hand, take into account two years with differing dynamics due to a worldwide pandemic that significantly changed people’s lifestyles. The human biometeorological index (Universal Thermal Climate Index, UTCI) was used as representative of the integral association of meteorological variables. UTCI data were obtained from the ERA5-HEAT reanalysis database, which provides hourly grid data with a spatial resolution of 0.25° × 0.25°. The Brazilian cities Manaus, Brasilia and Porto Alegre, which represent different climatic contexts in the country, were used in the analysis. The method compared temperature and climate reanalysis data to hospital admission data for respiratory diseases, obtained from the Brazilian Unified Health System database (DATASUS), according to the International Classification of Diseases, Tenth Edition (ICD-10). Correlation analysis was performed between variables (hospital admissions versus climate-related data) in order to identify associations between them, also accounting for different time-lag effects. We analyzed seasonal influences on the obtained correlations, correlation strength and direct or inverse relationships. Results showed that the pandemic interfered in the association between morbidity due to respiratory illnesses and climate-related variables.

Health economic impacts associated with the consumption of sugar-sweetened beverages in Brazil.

The consumption of sugar-sweetened beverages (SSBs) is among the main risk factors for non-communicable diseases (NCDs). This study aimed to estimate the financial costs of hospitalizations and procedures of high and medium complexity for NCDs attributable to the consumption of SSBs in the Brazilian Unified Health System (SUS) in 2019. This ecological study used data from the Global Burden of Disease (GBD) 2019 and the Department of Informatics of the Unified Health System (DATASUS). The attributable costs were estimated from the population-attributable fraction (PAF) and the costs in the treatment of chronic diseases [type 2 diabetes mellitus and ischemic heart disease (IHD)], stratified by sex, age group, level of complexity of treatment, and federative units. In 2019, in Brazil, US$ 14,116,240.55 were the costs of hospitalizations and procedures of high and medium complexity in the treatment of NCDs attributable to the consumption of SSBs. These values were higher in males (US$ 8,469,265.14) and the southeast and southern regions, mainly in the state of São Paulo. However, when evaluating these results at a rate per 10,000 inhabitants, it was observed that the states of Paraná, Tocantins, and Roraima had higher costs per 10,000 inhabitants. Regarding the age groups, higher costs were observed in the older age groups. This study revealed the high financial impact of the NCDs treatment attributed to the consumption of SSBs in Brazil and the variability among Brazilian macro-regions. The results demonstrate the urgency and need for the expansion of policies to reduce the consumption of SSBs in Brazil with strategies that consider regional particularities.