scholarly journals How the ‘plates’ of a health system can shift, change and adjust during economic recessions. A qualitative interview study of public and private health providers in Brazil’s São Paulo and Maranhão states

2020 ◽  
Author(s):  
Giuliano Russo ◽  
Maria Luiza Levi Paim ◽  
Maria Teresa Seabra Soares de Britto e Alves ◽  
Bruno Luciano Carneiro Alves de Oliveira ◽  
Ruth Helena de Souza Britto Ferreira de Carvalho ◽  
...  
Keyword(s):  
Health System ◽  
Access To Care ◽  
Health Systems ◽  
Low Income ◽  
Sao Paulo ◽  
São Paulo ◽  
Public And Private ◽  
Qualitative Interview Study ◽  
Economic Recessions ◽  
The Impact

Background. Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already living the aftermath of the 2015 recession. Methods. Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings.Results. We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible – if insecure – working arrangements. Following a drop in employment and health plans, private health insurance companies streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but also credited for having moved to cater for higher-income customers in Maranhão.Conclusions. The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.

scholarly journals How the ‘plates’ of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil’s São Paulo and Maranhão states

PLoS ONE ◽  
2020 ◽  
Vol 15 (10) ◽  
pp. e0241017
Author(s):  
Giuliano Russo ◽  
Maria Luiza Levi ◽  
Maria Teresa Seabra Soares de Britto e Alves ◽  
Bruno Luciano Carneiro Alves de Oliveira ◽  
Ruth Helena de Souza Britto Ferreira de Carvalho ◽  
...  
Keyword(s):  
Health System ◽  
Qualitative Interview ◽  
Sao Paulo ◽  
Interview Study ◽  
São Paulo ◽  
Health Providers ◽  
Public And Private ◽  
Qualitative Interview Study ◽  
Economic Recessions ◽  
Shift Change

scholarly journals COVID-19 pandemic impact on dentists in Latin America’s epicenter: São-Paulo, Brazil

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256092
Author(s):  
Tatiane Fernandes Novaes ◽  
Maisa Camillo Jordão ◽  
Carlos Felipe Bonacina ◽  
André Oswaldo Veronezi ◽  
Carlos Ariel Rodrigues de Araujo ◽  
...  
Keyword(s):  
Health Care ◽  
Low Income ◽  
Health Care Professionals ◽  
Negative Impact ◽  
Sao Paulo ◽  
The State ◽  
Financial Impact ◽  
São Paulo ◽  
Ordinal Logistic Regression Analysis ◽  
The Impact

The state of São Paulo, Brazil, where more than 94.000 dentists are currently registered, has become the epicenter of COVID-19 in Latin America. The aim of this cross-sectional study was to evaluate the impact of COVID-19 pandemic on dentists in this state. A semi-structured questionnaire was sent via e-mail to 93.280 dentists with active registration in the Dental Council of São Paulo (CROSP). The impact of COVID-19 pandemic was assessed through questions related to demographic, socioeconomic, dental practice characteristics and personal protective equipment (PPE) use. Ordinal logistic regression analysis was performed to investigate the association between all the variables (p<0.05). Over 8 days, 2113 responses were received. Only 26.52% of the sample reported a low-income reduction (from 0–10%), while the majority of dentists reported a more negative financial impact, 35.6% with a reduction of more than 50% of their monthly income. Dentists who worked in the private sector and at the capital had a greater financial impact when compared to those of the public sector and countryside of the state (p<0.05). Furthermore, about 83% reported not having received any specific training to control the transmission of coronavirus in the health area. This study provides evidence of the negative impact of the COVID-19 pandemic on the routine of dentists in the state of São Paulo, Brazil. Hopefully, this study will help dental and other health care professionals to better understand the consequences of disease in dental settings and strengthen preparedness throughout the dental health care system.

Impact of COVID-19 pandemic in hospitalizations due to brain tumors from the epicenter of Latin America.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18785-e18785
Author(s):  
Isabella Batista Martins Portugal ◽  
Luis Eduardo Werneck De Carvalho ◽  
Jean Henri Schoueri ◽  
Leandro Fórnias Machado Rezende ◽  
Fernando Luiz Affonso Fonseca ◽  
...  
Keyword(s):  
Health Care ◽  
Latin America ◽  
Health System ◽  
Sao Paulo ◽  
Cns Tumors ◽  
São Paulo ◽  
Outbreak Period ◽  
Starting Point ◽  
The Impact ◽  
The City

e18785 Background: The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. In Brazil, the disease had its first case in the city of São Paulo, thus being the starting point and epicenter of this disease in Latin America. Neurological features are currently well recognized in COVID-19 indicating the neurotropic nature of the virus and include anosmia, myalgia, myositis, encephalitis, meningitis, cerebrovascular disease, Guillain–Barré syndrome, and post-infectious myelitis. CNS tumors though relatively rare (> 2% of all cancers) are a relevant source of cancer-related morbi-mortality worldwide. Although studies have reported higher COVID-19 severity in cancer patients, the consequences of the pandemic on health care for CNS tumors remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the hospital admissions (HA) due to CNS tumors in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to CNS tumors in the city of São Paulo comparing the outbreak period (January-June 2020) and a pre-pandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD-10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to CNS tumors was observed during the outbreak period (January-June 2020). Benign neoplasm of brain and other parts of CNS (-2, CI -2 to -1) and malignant neoplasm of brain (-5, CI -7 to -3) showed to be remarkably affected (see table). To our knowledge, this is the first scientific report of significant reduction of HAs due to CNS tumors during COVID-19 era. Conclusions: Our findings seem to be associated to delayed oncological diagnose and care to CNS tumor patients during the lockdown and health system collapse. A rebound help-seeking effect as well as more severe complications may present in the post‐pandemic. Further studies are needed to evaluate the impact of the ongoing pandemic in CNS neoplasms in order to strategically corroborate public health actions for short- and long-term implications of COVID-19 pandemic. [Table: see text]

scholarly journals Assessing the impact of discussing and practicing urban mobility on the travel behavior of young children and their caregivers: mixed-method empirical research in public preschools in São Paulo (Brazil)

2020 ◽  
Author(s):  
Mateus Humberto ◽  
Filipe Moura ◽  
Mariana Giannotti
Keyword(s):  
Young Children ◽  
Empirical Research ◽  
Low Income ◽  
Travel Behavior ◽  
Sao Paulo ◽  
São Paulo ◽  
Urban Mobility ◽  
Sustainable Mobility ◽  
Child Centered ◽  
The Impact

This manuscript seeks to evaluate changes in the travel behavior of young children (5-6 y/o.) and their caregivers following the implementation of a 4-month program in public preschools in São Paulo (Brazil) with a high prevalence of low-income immigrants. The program was developed around two intervention types: i) weekly inquiry sessions about urban mobility through the Philosophy with Children approach and ii) bimonthly outdoor walking activities in the surroundings of schools. In this way, it was possible to observe positive changes in the perceptions of children’s statements and in the social norms of their caregivers about transportation, as well as significant modal shifts of caregivers towards sustainable mobility, which were evaluated using difference-in-differences and time-series analyses. Besides the identification of changes in the behavior of adult caregivers through child-centered intervention types, this empirical research enabled unraveling the effect of the proposed measures according to the child’s gender, nationality, and level of social vulnerability, including the significant modal shifts towards walking and cycling identified among boys and out of car and motorcycle among native children, which were significant both in post and follow-up measures.In addition to contributions to the evaluation of school-based interventions with data from developing countries, the discussions presented in this paper intend to provide insights into the role of early childhood and perceptions in behavioral changes towards sustainable transport.

scholarly journals The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil

2020 ◽  
Vol 5 (2) ◽  
pp. e002122 ◽  
Author(s):  
Lucas Salvador Andrietta ◽  
Maria Luiza Levi ◽  
Mário C Scheffer ◽  
Maria Teresa Seabra Soares de Britt Alves ◽  
Bruno Luciano Carneiro Alves de Oliveira ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
System Performance ◽  
Health Financing ◽  
Sao Paulo ◽  
Comparative Case Study ◽  
São Paulo ◽  
Middle Income ◽  
Economic Recessions

IntroductionAlthough economic crises are common in low/middle-income countries (LMICs), the evidence of their impact on health systems is still scant. We conducted a comparative case study of Maranhão and São Paulo, two unevenly developed states in Brazil, to explore the health financing and system performance changes brought in by its 2014–2015 economic recession.MethodsDrawing from economic and health system research literature, we designed a conceptual framework exploring the links between macroeconomic factors, labour markets, demand and supply of health services and system performance. We used data from the National Health Accounts and National Household Sample Survey to examine changes in Brazil’s health spending over the 2010–2018 period. Data from the National Agency of Supplementary Health database and the public health budget information system were employed to compare and contrast health financing and system performance of São Paulo and Maranhão.ResultsOur analysis shows that Brazil’s macroeconomic conditions deteriorated across the board after 2015–2016, with São Paulo’s economy experiencing a wider setback than Maranhão’s. We showed how public health expenditures flattened, while private health insurance expenditures increased due to the recession. Public financing patterns differed across the two states, as health funding in Maranhão continued to grow after the crisis years, as it was propped up by transfers to local governments. While public sector staff and beds per capita in Maranhão were not affected by the crisis, a decrease in public physicians was observed in São Paulo.ConclusionOur case study suggests that in a complex heterogeneous system, economic recessions reverberate unequally across its parts, as the effects are mediated by private spending, structure of the market and adjustments in public financing. Policies aimed at mitigating the effects of recessions in LMICs will need to take such differences into account.

THE IMPACT OF DIFFERENT URBAN LAND USE TYPES ON AIR POLLUTION IN THE MEGACITY OF SÃO PAULO

2020 ◽  
Vol 7 (1) ◽  
pp. 91
Author(s):  
Júlio Barboza Chiquetto ◽  
Maria Elisa Siqueira Silva ◽  
Rita Yuri Ynoue ◽  
Flávia Noronha Dutra Ribieiro ◽  
Débora Souza Alvim ◽  
...  
Keyword(s):  
Land Use ◽  
Air Pollution ◽  
Urban Land ◽  
Sao Paulo ◽  
Urban Land Use ◽  
São Paulo ◽  
Land Use Types ◽  
The Impact

A poluição do ar é influenciada por fatores naturais e antropogênicos. Quatro pontos de monitoramento (veicular, comercial, residencial e background urbano (BGU))da poluição do ar em São Paulo foram avaliados durante 16 anos, revelando diferenças significativas devidoao uso do solo em todas as escalas temporais. Na escala diurna, as concentrações de poluentes primários são duas vezes mais altas nos pontos veicular e residencial do que no ponto BGU, onde a concentração de ozonio (O3) é 50% mais alta. Na escala sazonal, as concentrações de monóxido de carbono(CO) variaram em 80% devido ao uso do solo, e 55% pela sazonalidade.As variações sazonais ede uso do solo exercem impactos similares nas concentrações de O3 e monóxido de nitrogênio (NO). Para o material particulado grosso (MP10) e o dióxido de nitrogênio(NO2), as variações sazonais são mais intensas do que as por uso do solo. Na série temporal de 16 anos, o ponto BGU apresentou correlações mais fortes e significativas entre a média mensal de ondas longas (ROL) e o O3 (0,48) e o MP10 (0,37), comparadas ao ponto veicular (0,33 e 0,22, respectivamente). Estes resultados confirmam que o uso do solo urbano tem um papel significativo na concentração de poluentes em todas as escalas de análise, embora a sua influência se torne menos pronunciada em escalas maiores, conforme a qualidade do ar transita de um sistema antropogênico para um sistema natural. Isto poderá auxiliar decisões sobre políticas públicas em megacidades envolvendo a modificação do uso do solo.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals Modelling the impact of delaying vaccination against SARS-CoV-2 assuming unlimited vaccine supply

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Marcos Amaku ◽  
Dimas Tadeu Covas ◽  
Francisco Antonio Bezerra Coutinho ◽  
Raymundo Soares Azevedo ◽  
Eduardo Massad
Keyword(s):  
Mathematical Model ◽  
Vaccination Campaign ◽  
Vaccination Rate ◽  
Sao Paulo ◽  
The State ◽  
São Paulo ◽  
Health Authorities ◽  
The World ◽  
The Moment ◽  
The Impact

Abstract Background At the moment we have more than 177 million cases and 3.8 million deaths (as of June 2021) around the world and vaccination represents the only hope to control the pandemic. Imperfections in planning vaccine acquisition and difficulties in implementing distribution among the population, however, have hampered the control of the virus so far. Methods We propose a new mathematical model to estimate the impact of vaccination delay against the 2019 coronavirus disease (COVID-19) on the number of cases and deaths due to the disease in Brazil. We apply the model to Brazil as a whole and to the State of Sao Paulo, the most affected by COVID-19 in Brazil. We simulated the model for the populations of the State of Sao Paulo and Brazil as a whole, varying the scenarios related to vaccine efficacy and compliance from the populations. Results The model projects that, in the absence of vaccination, almost 170 thousand deaths and more than 350 thousand deaths will occur by the end of 2021 for Sao Paulo and Brazil, respectively. If in contrast, Sao Paulo and Brazil had enough vaccine supply and so started a vaccination campaign in January with the maximum vaccination rate, compliance and efficacy, they could have averted more than 112 thousand deaths and 127 thousand deaths, respectively. In addition, for each month of delay the number of deaths increases monotonically in a logarithmic fashion, for both the State of Sao Paulo and Brazil as a whole. Conclusions Our model shows that the current delay in the vaccination schedules that is observed in many countries has serious consequences in terms of mortality by the disease and should serve as an alert to health authorities to speed the process up such that the highest number of people to be immunized is reached in the shortest period of time.

scholarly journals The Impact of COVID-19 on Urban Agriculture in São Paulo, Brazil

2021 ◽  
Vol 13 (11) ◽  
pp. 6185
Author(s):  
André Ruoppolo Biazoti ◽  
Angélica Campos Nakamura ◽  
Gustavo Nagib ◽  
Vitória Oliveira Pereira de Souza Leão ◽  
Giulia Giacchè ◽  
...  
Keyword(s):  
Urban Agriculture ◽  
Technical Assistance ◽  
Community Gardens ◽  
Sao Paulo ◽  
Food Chains ◽  
São Paulo ◽  
Sales Channels ◽  
Paulo State ◽  
The Impact ◽  
The City

During the initial months of the COVID-19 pandemic, farmers worldwide were greatly affected by disruptions in the food chain. In 2020, São Paulo city experienced most of the effects of the pandemic in Brazil, with 15,587 deaths through December 2020. Here, we describe the impacts of COVID-19 on urban agriculture (UA) in São Paulo from April to August 2020. We analyzed two governmental surveys of 2100 farmers from São Paulo state and 148 from São Paulo city and two qualitative surveys of volunteers from ten community gardens and seven urban farmers. Our data showed that 50% of the farmers were impacted by the pandemic with drops in sales, especially those that depended on intermediaries. Some farmers in the city adapted to novel sales channels, but 22% claimed that obtaining inputs became difficult. No municipal support was provided to UA in São Paulo, and pre-existing issues were exacerbated. Work on community gardens decreased, but no garden permanently closed. Post COVID-19, UA will have the challenge of maintaining local food chains established during the pandemic. Due to the increase in the price of inputs and the lack of technical assistance, governmental efforts should be implemented to support UA.

scholarly journals Relationship between preterm birth and air pollution in Santos, Sao Paulo, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M E L Brandao ◽  
B A L F Braga ◽  
M L C Martins ◽  
P L A A Pereira
Keyword(s):  
Air Pollution ◽  
Preterm Birth ◽  
Air Pollutants ◽  
First Trimester ◽  
Sao Paulo ◽  
São Paulo ◽  
Air Humidity ◽  
Relative Air Humidity ◽  
The Impact ◽  
Fourth Quartile

Abstract Santos is a seaboard Brazilian city recognized by its port activity where the road and rail infrastructure along with the large transportation operation, displays an important factor to contribute with all kinds of toxic and air pollutants. Recent studies have suggested associations between air pollution and various birth outcomes. Pollutant gases such as NOx, O3 and particulate matter PM2,5, PM10 have been cited as factors involved in such outcomes. The present study aims to assess the relationship between atmospheric pollutants and perinatal outcomes in the city of Santos from Jan. 2012 to Dec. 2015. Cross-sectional study that analyzed 10.319 singleton births in an area set with 2 km radius of the monitoring stations. Birth weight and information on mother and pregnancy were obtained at the Brazilian “Born Alive National Information System”. Daily records of air pollutants (PM10, PM2.5, NO2 and O3), temperature and relative air humidity, for the study period, were obtained from São Paulo State Environmental Agency (CETESB). Associations between preterm birth and air pollutants mean levels at each gestational trimester were investigated using multiple logistic regression model controlled by the variables: infant sex, type of delivery, maternal education. prenatal care, and number of previous live births, temperature and relative air humidity. NO2 e PM2,5 was not associated with preterm birth. O3 was significantly associated in the first trimester in the fourth quartile (OR = 1,47 CI 95% 1,05; 2,07). PM10 was significantly associated in the first trimester for the fourth quartile (OR = 1,28 CI 95% 1,00; 1,64), second trimester for the second quartile (OR = 1,37 CI 95% 1,07; 1,77). Conclusions the results shows evidence that maternal exposure to air pollution especially during the first trimester of pregnancy may contribute to preterm birth. Further actions are needed towards controlling air pollution are strongly recommended for promoting early-life health. Key messages This is the first research of this kind that was made in Santos. It brings important evidence of the impact in the life of the population, especially those whose is not even born yet. It can be used as a resource to guide public policies in health, especially the guidelines that dictate the concentration of air pollutants and air quality.

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