Death In Brazil Research Articles

Were the socio-economic determinants of municipalities relevant to the increment of COVID-19 related deaths in Brazil in 2020?

The COVID-19 pandemic in Brazil has been showing a pattern of distribution of related deaths associated with individual socioeconomic status (SES). However, little is known about the role of SES in the distribution of the mortality rate in different population, from an ecological perspective. The objective of this study was to evaluate the role of socioeconomic factors in the distribution of the COVID-19-related mortality rate among Brazilian municipalities in 2020. We conducted a retrospective, cross-sectional, observational, population-wide, and ecological study, using data of COVID-19-related deaths from the Influenza Epidemiological Surveillance Information System database (SIVEP-Gripe) and SES from the Social Vulnerability Index (SVI), the Human Development Index (HDI), the Geographic Index of the Socioeconomic Context and Social Studies (GeoSES), and 2010 Demographic Census (IBGE/Brazil). We computed crude, age- and sex-standardized, and the latter offset by the time of exposure to the epidemic mortality rates. To determine socioeconomic factors associated with mortality rates we used log-linear models with state codes as a random effect and Haversine variance-covariance matrix. 191,528 deaths were related to COVID-19 and distributed in 4,928 (88.55%) Brazilian municipalities. Whatever the socioeconomic indexes used, the R2 were very small to explain SMRT. Consistent across all socioeconomic indexes used, high-income, more educated, and well infrastructure municipalities generally had higher mortality rates. Excluding the effect of demographic structure and pandemic timing from mortality rates, the contribution of SES to explain differences in COVID-19-related mortality rates among municipalities in Brazil became very low. The impact of SES on COVID-19-related mortality may vary across levels of aggregation. Urban infrastructure, which includes mobility structures, more complex economic activities and connections, may have influenced the average municipal death rate.

Long-term commuting times and air quality relationship to COVID-19 in São Paulo

The Coronavirus Disease 2019 (COVID-19) epidemic is an unprecedented global health crisis and the effects may be related to environmental and socio-economic factors. In São Paulo, Brazil, the first death occurred in March 2020 and since then the numbers have grown to 175 new deaths per day in April 2021, positioning the city as the epicenter of the number of cases and deaths in Brazil. São Paulo is one of the largest cities in the world with more than 12 million inhabitants, a fleet of about 8 million vehicles and frequent pollutant concentrations above recommended values. Social inequalities are evident in the municipality, similarly to other cities in the world. This paper focuses on transportation activities related to air pollution and associated with cardiovascular and respiratory diseases especially on people who developed comorbidities during their whole life. This study relates travel trip data to air quality analysis and expanded to COVID-19 disease. This work studied the relationship of deaths in São Paulo due to COVID-19 with demographic density, with family income, with the use of public transport and with atmospheric pollution for the period between March 17th, 2020 and April 29th, 2021. The main results showed that generally passenger kilometers traveled, commuting times and air quality related diseases increase with residential distance from the city center, and thus, with decreasing residential density. PM2.5 concentrations are positively correlated with COVID-19 deaths, regions with high urban densities have higher numbers of deaths and long-distance frequent trips can contribute to spread of the disease.

Timing the race of vaccination, new variants, and relaxing restrictions during COVID-19 pandemic

Late in 2019, China identified a new type of coronavirus, SARS-CoV-2, and due to its fast spread, the World Health Organisation (WHO) declared a pandemic named COVID-19. Some variants of this virus were detected, including the Delta, which caused new waves of infections. This work uses an extended version of a SIRD model that includes vaccination effects to measure the impact of the Delta variant in three countries: Germany, Israel and Brazil. The calibrated models were able to reproduce the dynamics of the above countries. In addition, hypothetical scenarios were simulated to quantify the impact of vaccination and mitigation policies during the Delta wave. The results showed that the model could reproduce the complex dynamics observed in the different countries. The estimated increase of transmission rate due to the Delta variant was highest in Israel (7.9), followed by Germany (2.7) and Brazil (1.5). These values may support the hypothesis that people immunised against COVID-19 may lose their defensive antibodies with time since Israel, Germany, and Brazil fully vaccinated half of the population in March, July, and October. The scenario to study the impact of vaccination revealed relative reductions in the total number of deaths between 30% and 250%; an absolute reduction of 300 thousand deaths in Brazil due to vaccination during the Delta wave. The second hypothetical scenario revealed that mitigation policies saved up to 300 thousand Brazilians; relative reductions in the total number of deaths between 24% and 120% in the three analysed countries. Therefore, the results suggest that both vaccination and mitigation policies were crucial in decreasing the spread and the number of deaths during the Delta wave.

Spatio-temporal dynamics of rabies and habitat suitability of the common marmoset Callithrix jacchus in Brazil.

Rabies transmitted by wildlife is now the main source of human rabies in the Americas. The common marmoset, Callithrix jacchus, is considered a reservoir of rabies causing sporadic and unpredictable human deaths in Brazil, but the extent of the spillover risk to humans remains unknown. In this study, we described the spatiotemporal dynamics of rabies affecting C. jacchus reported to Brazil’s Ministry of Health passive surveillance system between 2008 and 2020, and combined ecological niche modelling with C. jacchus occurrence data to predict its suitable habitat. Our results show that 67 outbreaks (91 cases) of rabies affecting C. jacchus were reported by 41 municipalities between January 2008 and October 2020, with a mean of 5 outbreaks/year [range: 1–14]. The maximum number of outbreaks and municipalities reporting cases occurred in 2018, coinciding with higher surveillance of primate deaths due to Yellow Fever. A mean of 3 [1–9] new municipalities reported outbreaks yearly, suggesting potential spatial expansions of the C. jacchus variant in northeastern Brazil and emerging rabies spillover from vampire bat Desmodus rotundus to C. jacchus in the north and south. Outbreaks were concentrated in the states of Ceará (72%) and Pernambuco (16%) up to 2012, but are now reported in Piauí since 2013, in Bahia since 2017 (D. rotundus’ antigenic variant, AgV3) and in Rio de Janeiro since 2019 (AgV3). Besides confirming suitable habitat for this primate in the northeast and the east coast of Brazil, our Maximum Entropy model also predicted suitable habitat on the north and the west states of the country but predicted low habitat suitability among inland municipalities of the Caatinga biome reporting rabies. Our findings revealed new areas reporting rabies infecting C. jacchus, highlighting the need to implement strategies limiting spillover to humans and to better understand the drivers of C. jacchus rabies dynamics.

Translation and Cultural Adaptation into Portuguese of the Quality of Dying and Death Scale for Family Members of Patients in Intensive Care Units.

The translation and cultural adaptation of the Quality of Dying and Death in Brazil may provide a reliable and reproducible scale for collecting and analyzing data on the process of dying and death, given the absence of Brazilian studies that have produced or used scales in this topic. The purpose of this study was to perform the translation and cultural adaptation of the Quality of Dying and Death (QODD 3.2a) scale for intensive care patients’ relatives into Portuguese (Brazil). This methodological study was carried out in a public university of the São Paulo State University (UNESP) medical school, São Paulo, Brazil, in three stages: translation and back-translation by two native-speaking independent professionals, analysis by a committee of specialists, and a pre-test phase. The final version was created by seven experts after making semantic, idiomatic, and cultural changes to 16 items. The results indicated a satisfactory content validation index (CVI ≥ 0.80). This version was applied on 32 relatives of patients who were hospitalized in a public hospital in the interior of São Paulo. No item was excluded from the instrument. The content and face validity were achieved to a satisfactory standard, in addition to reaching the minimum parameters recommended in the literature. The Portuguese version of QODD 3.2a for relatives of deceased patients in intensive care is appropriate and culturally adapted for use in Brazil.

Rapid changes in birth counts in Brazilian major cities during the COVID-19 pandemic

Since the beginning of the coronavirus pandemic, Brazil has been among the countries that have been heavily affected by this novel disease. From March 2020 onwards, records of deaths in Brazil increased as the number of COVID-19 infections skyrocketed. Consequently, many studies have tried to explain how this illness has affected the overall number of deaths since the start of the pandemic, and have examined the question of whether mortality related to COVID-19 has led to reductions in life expectancy. However, at the time of writing, there have been few empirical analyses of the effects of the pandemic on births. In this study, we sought to investigate whether the COVID-19 pandemic influenced the recent birth counts of six large cities in Brazil by assessing the most up-to-date vital statistics data that are available. Using data from the municipal health departments of these cities, we compared the number of monthly births from October–December 2020 and January–March 2021 with the number of new-borns in similar months and years before the pandemic. Our results show that there was a strong decline in the number of births in some of the cities analysed, and that most of the reductions occurred among women around the age of 30 years old. It appears that because of the uncertainty surrounding the pandemic, women have been postponing or foregoing the realisation of their fertility intentions, which may have led to a temporary baby bust in some cities of Brazil. However, the COVID-19 pandemic was not found to be associated with faster reductions in births in all Brazilian cities. Indeed, in the cities of Rio de Janeiro and Belo Horizonte, the decreasing trend in birth counts appears to have slowed down, or even reversed.

A retrospective cohort study of 238,000 COVID-19 hospitalizations and deaths in Brazil

The coronavirus disease (COVID-19) pandemic has overwhelmed health care systems in many countries and bed availability has become a concern. In this context, the present study aimed to analyze the hospitalization and intensive care unit (ICU) times in patients diagnosed with COVID-19. The study covered 55,563 ICU admissions and 238,075 hospitalizations in Brazilian Health System units from February 22, 2020, to June 7, 2021. All the patients had a positive COVID-19 diagnosis. The symptoms analyzed included: fever, dyspnea, low oxygen saturation (SpO2 < 95%), cough, respiratory distress, fatigue, sore throat, diarrhea, vomiting, loss of taste, loss of smell, and abdominal pain. We performed Cox regression in two models (ICU and hospitalization times). Hazard ratios (HRs) and survival curves were calculated by age group. The average stay was 14.4 days for hospitalized patients and 12.4 days for ICU patients. For hospitalized cases, the highest hazard mean values, with a positive correlation, were for symptoms of dyspnea (HR = 1.249; 95% confidence interval [CI], 1.225–1.273) and low oxygen saturation (HR = 1.157; 95% CI 1.137–1.178). In the ICU, the highest hazard mean values were for respiratory discomfort (HR = 1.194; 95% CI 1.161–1.227) and abdominal pain (HR = 1.100; 95% CI 1.047–1.156). Survival decreased by an average of 2.27% per day for hospitalization and 3.27% per day for ICU stay. Survival by age group curves indicated that younger patients were more resistant to prolonged hospital stay than older patients. Hospitalization was also lower in younger patients. The mortality rate was higher in males than females. Symptoms related to the respiratory tract were associated with longer hospital stay. This is the first study carried out with a sample of 238,000 COVID-19 positive participants, covering the main symptoms and evaluating the hospitalization and ICU times.

“I literally did not know what it was to feel pain”: the grieving process in families of pediatric oncological patients

Objective: Cancer is one of the most feared diseases, for being the second leading cause of death in Brazil and for presenting an extended and painful treatment. When the child is sick, the family experiences the getting ill, the losses that result from the treatment and the anticipatory grieving process by the possibility or certainty of close death. It is a difficult and little discussed theme, that requires more research investments. In face of this demand, the present study aimed to analyze the process of grief experienced by the caregiver relatives of children with cancer. Method: It was made an exploratory research, of qualitative approach. Because of overload standard, it counted with the participation of 10 caregiver relatives (father or mother) of children with cancer, that answered a semi-instructed interview script, understood by the textual analyzes in the IRaMuTeQ software (Interface de R pour les Analyses ultimensionnelles de Textes et de Questionnaires). Results: The results showed that the grieving process is present since the diagnosis and remains during the whole treatment. It is experienced due to the suffering, caused by all the losses that come from the treatment and by the possibility or certainty of the child’s death. Conclusion: There is the necessity of unveiling this theme, inviting parents to talk about the unspeakable – the grieves lived during the treatment -, and offer support to the family in all treatment’s phases, with special attention to the care of the caregiver.

Tendências da mortalidade em decorrência de traumas de trânsito no Brasil e nas unidades federativas entre os anos de 1997 e 2015 na população masculina

Abstract Background Traffic accidents are one of the main causes of death in Brazil and the increase in the mortality rate is concerning. Objective The study aims to perform a temporal analysis of mortality trends related to traffic accidents in Brazil and its states. Method This is an ecological study of time series of mortality from traffic accidents in Brazil and its Federative Units. Data was obtained from the Information System for Mortality (SIM), processed by Datasus and classified under the headings V01 to V89 (CID-10). Specific mortality rates were calculated and adjusted by age. The temporal tendency analysis was run on the Joinpoint Regression Program. Results The Brazilian male population showed no change in the average annual percentage for the mortality rate (-0.8%; CI 95% -1.7;0.1). Ten states showed increased mortality rates; nine presented a decline, and eight remained constant throughout the period. Conclusion The male population showed no change in the rates, but the mortality rate for the general Brazilian population decreased by 1% per year from 1997 to 2015. Both general and male populations had a decrease of 4.6% and 4.9% per year during the last years, respectively (2012-2015).

Fetal deaths in Brazil: What changed in the last decade and what can we learn from the current situation?

To determine fetal death rates (FDRs) according to maternal characteristics in Brazil. A serial cross-sectional analysis was conducted based on vital statistics of the Brazilian population from 2007 to 2019. FDRs were estimated according to maternal and pregnancy characteristics. Annual percent change (APC) of FDR was assessed by joinpoint regression model. Causes of death were compared between the ante-/intrapartum periods. A significant reduction in FDR occurred in Brazil during 2007-2019 (11.1 and 10.43 in 2007 and 2019, respectively; APC -0.44). Only the northern region showed an increase in FDR. In 2019, the northeast and southeast had the highest and lowest FDRs, respectively (11.4 and 7.8/1000 live births). In adolescents, FDR increased from 2007 to 2016 (APC 1.75). In 2019, missing information was significantly high for maternal skin color (99.7%), schooling (17.0%), and age (7.0%) in fetal death registries. The most common causes of fetal death in the ante-/intrapartum periods were fetus and newborn affected by maternal conditions. A reduction in FDR has been achieved in Brazil over the last decade. However, there is an unmet need for decreasing social and regional disparities. A better system to attribute causes of death is needed to identifying priorities in maternal-fetal health care.

Preoperative risk score and in-hospital death following isolated myocardial revascularization surgery

Cardiovascular disease is the leading cause of death in Brazil. The risk of in-hospital death after coronary artery bypass grafting (CABG) can be assessed by identifying preoperative factors and quantified through scores. This investigation analyzed associated with mortality in the hospital phase after isolated CABG, to develop a preoperative risk score (PRS) for postoperative in-hospital death. This observational, retrospective, single-center study examined comorbidities and complementary exams of 9,826 patients who underwent isolated CABG between January 1, 1999 and December 31, 2017 were analyzed to identify their correlation with postoperative in-hospital death. A total of 9,826 patients were divided into the construction group (7,860; 80%) and validation group (1,966; 20%). The mean age of the patients was 62.43 years. Most patients were men (70.2%). Fifteen independently related factors were identified for hospital mortality. The final logistic model was calculated in the construction group with a C-statistic of 0.745 (95% confidence interval [CI], 0.720–0.770). In the validation group, the score was tested by obtaining an area under the receiver operating curve of 0.716 (95% [CI], 0.666–0.767). Death occurred in 489 patients (5%). The risk of death ranged from 1.2% in those considered to be low risk (PRS &lt;85) to 16.3% among those considered to be very high risk (PRS &gt;211). The PRS score satisfactorily discriminated among patients who exhibited low, intermediate, high, and very high risk of death in the postoperative period. PRS could serve as an auxiliary tool in the preoperative period for surgical teams.

Analysis of the number of deaths in Brazil between 2003 and 2020 and possible inferences about the COVID-19 pandemic and history of other diseases.

The historical number of yearly deaths in Brazil has a growing tendency since always. In recent years were observed increases in this number beyond the tendency, probably associated to epidemics. In this work it was implemented an analysis on public data, using the total number of deaths from violence, respiratory diseases, and deaths in hospitals. The historical series of deaths in Brazil from 2003 to 2019 was used to estimate the number of deaths in 2020 by a statistical projection, and this estimate value was compared with the number of deaths recorded as "Deaths with suspicion or confirmation of COVID-19". It was verified that deaths attributed to COVID-19 far exceed the statistical projections but this result was interpreted together with the numbers of deaths by respiratory diseases. Increasing of deaths between 2019 and 2020 can be partially explained by a lowering in the deaths of violence in 2019. In this paper it was verified that despite de pandemic the difference between number of deaths between 2020 and 2019 remained in the same order of magnitude as the difference in the past, in periods which can be associated to other infectious diseases as H1N1 and dengue, for example.

Time trend and spatial distribution of the cases of lethal violence against women in Brazil

to analyze the time trend and the spatial distribution of the cases of lethal violence against women in Brazil, according to age group and to race/skin color. an ecological study of time series, with spatial distribution of the deaths of women victims of aggression, registered in the Mortality Information System, resident in Brazil, Brazilian geographic regions and states. Due to underreporting of deaths in some states, correction factors of the mortality rates were employed. For the trend analysis, we adopted the polynomial regression model. In addition to that, the mean rates and annual upward/downward trends were distributed considering the Brazilian federative units as analysis units. the mean rate was 6.24 cases of lethal violence per 100,000 women, with a significant variation across the Brazilian regions and states. The main victims of violent death in Brazil are young, black-/brown-skinned and indigenous women, with a growing trend in these population segments. The North and Northeast regions stood out with the most significant mean annual increases (0.33; r2= 0.96 and 0.26; r2= 0.92, respectively). there was a stable trend regarding lethal violence against women, with significant regional differences. Young, black-/brown-skinned and indigenous women are more vulnerable to violent death in Brazil.

Tendência temporal e distribuição espacial dos casos de violência letal contra mulheres no Brasil

Objective: to analyze the time trend and the spatial distribution of the cases of lethal violence against women in Brazil, according to age group and to race/skin color. Method: an ecological study of time series, with spatial distribution of the deaths of women victims of aggression, registered in the Mortality Information System, resident in Brazil, Brazilian geographic regions and states. Due to underreporting of deaths in some states, correction factors of the mortality rates were employed. For the trend analysis, we adopted the polynomial regression model. In addition to that, the mean rates and annual upward/downward trends were distributed considering the Brazilian federative units as analysis units. Results: the mean rate was 6.24 cases of lethal violence per 100,000 women, with a significant variation across the Brazilian regions and states. The main victims of violent death in Brazil are young, black-/brown-skinned and indigenous women, with a growing trend in these population segments. The North and Northeast regions stood out with the most significant mean annual increases (0.33; r2= 0.96 and 0.26; r2= 0.92, respectively). Conclusion: there was a stable trend regarding lethal violence against women, with significant regional differences. Young, black-/brown-skinned and indigenous women are more vulnerable to violent death in Brazil.

Maternal Mortality in Brazil, 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019.

INTRODUCTION Maternal death continues to be one of the most challenging public health problems that needs to be addressed in low and middle-income countries. The objective of this study was to describe the problem of maternal death in Brazil, using estimates from the Global Burden of Disease Study (GBD).METHODS This study used data from the GBD 2019 to show the numbers of deaths and the Maternal Mortality Ratio (MMR) - number of deaths/100,000 live births - in Brazil and its 27 Federated Units (FU), for ages 10 to 54 years, from 1990 to 2019. The annual variation of the MMR was estimated in 1990, 2010, and 2019. The MMR were shown for specific causes as well as for five-year age groups. The estimates were presented with 95% uncertainty intervals (UI).RESULTS The number of maternal deaths, as well as the MMR showed a 49% reduction from 1990 to 2019. This reduction occurred heterogeneously throughout the country, and the profile of the MMR for specific causes changed between 1990 and 2019: from hypertensive gestation diseases, to indirect maternal deaths, followed by hypertensive gestation diseases. In the extreme age groups, the MMR is higher, with mortality increasing exponentially in direct proportion with age.CONCLUSIONS Maternal deaths in Brazil have decreased substantially since 1990; however, the numbers still fall short of what was established by the World Health Organization (WHO). Indirect causes are the greatest problem in more than 60% of the FU, especially for hypertensive pregnancy diseases.

Parâmetros eletrocardiográficos, ecocardiográficos e de biomarcadores cardíacos em ovinos intoxicados experimentalmente por Palicourea marcgravii (Rubiaceae)

ABSTRACT: The present study aimed to identify and describe cardiac alterations in sheep experimentally poisoned with Palicourea marcgravii through analysis of serum cardiac biomarkers (serum troponin I and creatine kinase - CK-MB) and electro and echocardiographic assessments to contribute to a better understanding of the poisoning pathophysiology. P. marcgravii is the main plant within a group of 22 species that cause sudden death in Brazil; its toxic principle is sodium monofluoroacetate. Eight healthy crossbreed male sheep, aged between five and twelve months, weighing 14 to 27kg, were evaluated. The animals received 1g kg-1 of P. marcgravii plants orally. The sheep were evaluated before administering the plant (T0) through electro and echocardiography and blood collection to assess cardiac biomarkers (CK-MB and cTnI). Collections and analyses were repeated every four hours until the animal’s death. During the study, there was the presence of extravasation of serum troponin I carried out in a qualitative test, with positive values at time T4, and the serum CK-MB biomarker had a peak at T4 and slightly decreased at T8. The electro and echocardiographic examinations showed that the cause of death in these animals was due to acute heart failure characterized by arrhythmias, tachycardia/ventricular fibrillation, drop in cardiac output, left ventricular (LV) systolic dysfunction by the progressive decrease in the LV ejection fraction (EF), decrease in LV fractional shortening (FS), and decrease in aortic flow velocity and aortic flow gradient. This study seems to be the first to evaluate cardiac alterations in sheep poisoned by P. marcgravii through cardiac biomarkers and electro and echocardiographic exams.

Intrauterine hipoxia and asphyxia at birth in a southern city of Brazil

INTRODUCTION: Intrauterine hypoxia and asphyxia at birth corresponds to the fourth cause of neonatal and perinatal death in Brazil, this data reflects the quality of care needed in maternity wards for the parturient and the newborn because it is preventable. Perinatal asphyxia is defined as there is an interruption in gas exchange or a damaged blood flow, leading to persistent hypoxemia and hypercapnia in the period before childbirth or intrapartum, which can lead to permanent lesions in several systems. OBJECTIVES: The study aims to analyze the epidemiological profile of the occurrence of intrauterine hypoxia and neonatal asphyxia considering maternal and fetal factors in the municipality of Pelotas, RS, between the years 2008 to 2018. METHODS: Cross-sectional study where secondary data obtained on the DATASUS platform on the prevalence of intrauterine hypoxia and asphyxia at birth in Pelotas, RS. Results: It was possible to observe that the prevalence was higher in male newborns, in cesarean deliveries that occurred in the private system. In addition, mortality was 15.75%, higher in the maternal age group between 25 and 29 years, in single pregnancies lasting 37 to 41 weeks and birth weight between 1.500 and 2.499 grams. The majority of deaths occurred before delivery. CONCLUSION: Intrauterine hypoxia and asphyxia at birth is an important cause of preventable perinatal morbidity and mortality with prevalence in preterm newborns weighing less than 2.500 grams. It allows assessing the quality of care for pregnant women and newborns during prenatal and delivery.

Excess mortality according to group of causes in the first year of the COVID-19 pandemic in Brazil.

To estimate excess mortality by cause of death in Brazil and states in 2020. We estimated the expected number of deaths considering a linear trend analysis with the number of deaths between 2015 and 2019 for each group of causes and each federative unit. We calculated standardized mortality ratios (SMR) and 95% confidence intervals for each SMR assuming a Poisson distribution. We performed the analyses in the R program, version 4.1.3. We observed a 19% excess in deaths in 2020 (SMR=1.19; 95%CI=1.18-1.20). The Infectious and Parasitic Diseases group stood out among the defined causes (SMR=4.80; 95%CI 4.78-4.82). The ill-defined causes showed great magnitude in this period (SMR=6.08; 95%CI 6.06-6.10). Some groups had lower-than-expected deaths: respiratory diseases (10% lower than expected) and external causes (4% lower than expected). In addition to the global analysis of the country, we identified significant heterogeneity among the federative units. States with the highest SMR are concentrated in the northern region, and those with the lowest SMR are concentrated in the southern and southeastern regions. Excess mortality occurs during the COVID-19 pandemic. This excess results not only from COVID-19 itself, but also from the social response and the management of the health system in responding to a myriad of causes that already had a trend pattern before it.

Burden of Cardiovascular diseases attributable to risk factors in Brazil: data from the "Global Burden of Disease 2019" study.

INTRODUCTION: To better understand trends in the main cause of death in Brazil, we sought to analyze the burden of cardiovascular risk factors (RF) and cardiovascular diseases (CVD) attributable to specific RFs in Brazil from 1990 to 2019, using the estimates from the GBD 2019 study. METHODS: To estimate RF exposure, the Summary Exposure Value (SEV) was used, whereas for disease burden attributed to RF, mortality and disability-adjusted life-years (DALY) due to CVD were used. For comparisons over time and between states, we compared age-standardized rates. The sociodemographic index (SDI) was used as a marker of socioeconomic conditions. RESULTS: In 2019, 83% of CVD mortality in Brazil was attributable to RF. For SEV, there was a reduction in smoking and environmental RF, but an increase in metabolic RF. High systolic blood pressure and dietary risks continue to be the main RF for CVD mortality and DALY. While there was a decline in age-standardized mortality rates attributable to the evaluated RF, there was also a stability or increase in crude mortality rates, with the exception of smoking. It is important to highlight the increase in the risk of death attributable to a high body mass index. Regarding the analysis per state, SEVs and mortality attributable to RF were higher in those states with lower SDIs. CONCLUSIONS: Despite the reduction in CVD mortality and DALY rates attributable to RF, the stability or increase in crude rates attributable to metabolic RFs is worrisome, requiring investments and a renewal of health policies.

Perception of bonding and occupational stress in a multidisciplinary cancer patients health team

Abstract Cancer is the second leading cause of death in Brazil and one of the positive features in the care of cancer patients is the professional-patient bond; however, due to the complexity of the disease, these professionals may develop occupational stress. This study investigated the perception of the bond and occupational stress of professionals who deal with cancer patients. Forty professionals from the surgical clinic and onco-hematology service at a hospital answered a questionnaire about bonding and stress at work. The results showed a greater perception frequency of the therapeutic bond, the same type identified as ideal. The onco-hematology team exhibited higher scores than the surgical clinic team in the perception of the bond and of the ideal therapeutic bond. The average occupational stress level of the participants was 2.08 (moderate), with no difference between the two teams. The power of health work models that use the bond between health professionals and cancer patients as a care technology stands out.