OBJECTIVE To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil. METHODS Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model. RESULTS Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups. CONCLUSION There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.

RESUMO Ao longo dos últimos anos, metodologias de ensino na educação de nível superior evoluíram e têm valorizado cada vez mais o papel do estudante no processo ensino-aprendizagem e a construção do seu próprio conhecimento e de seus pares. No entanto, a estrutura formadora presente em grande parte dos cursos de ensino médico ainda carece de inovações em suas práticas pedagógicas que permitam a vivência de significativas experiências formadoras e que estimulem a aprendizagem baseada no diálogo e na interação entre os estudantes. Uma das propostas que têm sido estimuladas como alternativa para melhorar a formação médica é o Team Based Learning (TBL), que favorece a aprendizagem dinâmica, com discussões em grupo, ambiente motivador, cooperativo e solidário. Nesse contexto, este artigo tem como objetivo, por meio de um relato de experiência, descrever o planejamento, a implantação e o desenvolvimento de conteúdos sobre concepção e formação do ser humano e saúde reprodutiva utilizando o TBL como metodologia de ensino em um curso de Medicina da expansão do Programa Mais Médicos localizado no interior do Nordeste brasileiro. Inicialmente, os estudantes recebiam roteiros prévios de estudos sobre os conteúdos que seriam desenvolvidos na sala de aula e realizavam o estudo prévio das atividades desenvolvidas em sala de aula. Em sala, respondiam individualmente a um teste. Após, divididos em pequenos grupos, debatiam cada uma das questões e respostas que eles elegiam, entrando em consenso para a apresentação de uma única resposta do grupo. O TBL foi bastante útil ao processo de aprendizagem e na avaliação da formação dos acadêmicos. Os estudantes exercitaram suas habilidades de comunicação, argumentação e convencimento, melhorando sua interação entre pares, com os docentes e desempenho pessoal. Acredita-se que o TBL permitiu ofertar de forma mais articulada os conhecimentos necessários para responder às demandas e necessidades de saúde mais frequentes da população e auxiliar na transformação da realidade das condições de vida e saúde locais.

A saúde do trabalhador é tema central em pesquisas de saúde pública, entretanto se deve considerar a especificidade das atividades exercidas. Objetiva-se analisar a saúde dos trabalhadores da atividade agrícola no Brasil, que possuem ocupação também agrícola ou não agrícola, por meio da autopercepção de saúde e morbidades referidas. Utilizou-se a Pesquisa Nacional por Amostra de Domicílios (PNAD 2008), incorporando as informações do plano amostral complexo. Selecionaram-se trabalhadores da atividade agrícola com 18 anos ou mais, estratificando em: os que possuíam ocupação agrícola e não agrícola. Foi realizada regressão logística para autopercepção de saúde e calculadas as razões de chances para as morbidades referidas. A ocupação agrícola diminui a chance de referir saúde como Boa e aumenta a chance de referir doença de coluna/costas, hipertensão arterial e artrite/reumatismo. Os trabalhadores com ocupação agrícola apresentam mais morbidades referidas e piores condições de vida. A autopercepção de saúde dos trabalhadores, em geral, foi melhor entre os ocupados não agrícolas.

This study analyzed racial inequalities in health in 18,684 elderly Brazilians 65 years or older, interviewed in the National Household Sample Survey in 2008 (PNAD 2008), and who reported their color/race as white, brown, or black. Associations were estimated between self-rated health status, functional incapacity, and number of chronic conditions according to crude and adjusted regression analyses (α = 0.01). The majority of the elderly were white (56.2%). In the adjusted analysis, brown color/races was associated with worse self-rated health status (OR = 1.11; 95%CI: 1.03-1.18) and black color/race was associated with more chronic diseases (PR = 1.07; 95%CI: 1.02-1.13). Brown color/race appeared as a protective factor against functional incapacity. When brown and black elderly were combined in one category (“black”), “black” elderly continued to show worse self-rated health status (OR = 1.09; 95%CI: 1.02-1.16) and lower odds of functional incapacity (OR = 0.83; 95%CI: 0.76-0.92). “Black” color/race lost the association with number of chronic diseases. Color/race explained part of the health inequalities in elderly Brazilians, but other socioeconomic variables had a more striking effect.

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.