The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil

Although international airports served as main entry points for SARS-CoV-2, the factors driving the uneven geographic spread of COVID-19 cases and deaths in Brazil remain mostly unknown. Here we show that three major factors influenced the early macro-geographical dynamics of COVID-19 in Brazil. Mathematical modeling revealed that the “super-spreading city” of São Paulo initially accounted for more than 85% of the case spread in the entire country. By adding only 16 other spreading cities, we accounted for 98–99% of the cases reported during the first 3 months of the pandemic in Brazil. Moreover, 26 federal highways accounted for about 30% of SARS-CoV-2’s case spread. As cases increased in the Brazilian interior, the distribution of COVID-19 deaths began to correlate with the allocation of the country’s intensive care units (ICUs), which is heavily weighted towards state capitals. Thus, severely ill patients living in the countryside had to be transported to state capitals to access ICU beds, creating a “boomerang effect” that contributed to skew the distribution of COVID-19 deaths. Therefore, if (i) a lockdown had been imposed earlier on in spreader-capitals, (ii) mandatory road traffic restrictions had been enforced, and (iii) a more equitable geographic distribution of ICU beds existed, the impact of COVID-19 in Brazil would be significantly lower.

Effects of Hurricane Michael on Access to Care for Pregnant Women and Associated Pregnancy Outcomes

Background: Disasters are associated with worse perinatal outcomes, perhaps due to inadequate prenatal care (PNC). Methods: Using 2017–2019 Florida vital statistics, we compared PNC use before and after Hurricane Michael. We categorized counties as most affected (Area A) or less affected (Area B and C). We examined whether Michael’s effects on perinatal outcomes varied by maternity care availability and used the Baron and Kenny method to assess whether delayed PNC initiation mediated perinatal outcomes. Log-binomial regression and semi-parametric linear regression were used, controlling for maternal and ZIP code tabulation area characteristics. Results: Compared to the one-year period pre-Michael, the week of the first PNC was later in all areas in the one-year period post-Michael, with the largest change in Area A (adjusted difference 0.112, 95% CI: 0.055–0.169), where women were less likely to receive PNC overall (aRR = 0.994, 95% CI = 0.990–0.998) and more likely to have inadequate PNC (aRR = 1.193, 95% CI = 1.127–1.264). Michael’s effects on perinatal outcomes did not vary significantly by maternity care availability within Area A. Delayed PNC initiation appeared to mediate an increased risk in small for gestational age (SGA) births after Michael. Conclusion: Women in Area A initiated PNC later and had a higher likelihood of inadequate PNC. Delayed PNC initiation may partially explain increased risk of SGA.

Feasibility of Screening for Frailty in Elderly Patients with Arterial Hypertension: Age Is Not a Hindrance?

The Russian clinical guidelines "Arterial hypertension in adults" (2020) contain a statement according to which elderly (≥65 years) patients should be screened for frailty using "Vozrast ne pomeha" (verbatim – "Age is not a hindrance") questionnaire, since the identification of frailty can affect drug treatment strategy and level of target blood pressure. The paper presents a critical analysis of this statement, which shows that recommendation to use "Vozrast ne pomeha" questionnaire for frailty screening is insufficiently evidence based and does not fully take into account the problem of geriatric care availability.

Forecasting assessment of dental care availability for the population of Ukraine in the conditions of healthcare reform (discussion)

In modern conditions dental treatment is one of the most common types of medical care in Ukraine, only 7.00 % of the young population are dentally healthy. During 2015–2019 the general practice of using 3.91 % of the consolidated state budget for health care for dental care was determined, mainly such funds were used for the maintenance of dental health care establishments. Resolution of the Cabinet of Ministers of Ukraine «Some issues of implementation of the program of state guarantees of medical care in 2020» from February 5, 2020 for № 65 provides the calculation of the tariff for dental services in the amount of UAH 9.19 per unit. Preliminary calculations indicate that comparing to 2019 during 2020 the state financial support of dental care will be reduced by 3444.20 million UAH (68.60 %). There are reasonable doubts about the rationality of the design of the Medical Guarantee Program in terms of treatment of dental diseases which carries the risk of further increase in dental morbidity and reduced availability of dental care for population. Key words: dentistry, treatment, financing, reform, accessibility, discussion.

Patient experiences with videoconferencing as social contact and in follow-up from oncology nurses in primary health care

Patients with various forms of cancer often have unmet psychosocial support needs. By interpretative phenomenological approach, this study aimed to acquire a deeper understanding of home-living patients with cancer’s experience and meaning from videoconferencing in oncological nursing follow-up in primary healthcare and contact with networks. Six patients from rural Norway participated. Three themes emerged: (1) From skepticism to videoconferencing-enthusiasm; (2) Oncology nurses ensured tablet mastery and delivered close follow-up; and (3) Oncology nurses helped ensure general social support using videoconferencing. Oncology follow-up care in rural areas using videoconferencing may enhance care availability and provision of psychosocial support meeting patients’ needs.