1Brasil Ministério de Desenvolvimento Social. Informações do projeto de lei orçamentária anual 2017.

No abstract

BackgroundPrevious research using routine data identified rapid mass privatisation as an important driver of mortality crisis following the collapse of Communism in Central and Eastern Europe. However, existing studies on the mortality crisis relying on individual level or routine data cannot assess both distal (societal) and proximal (individual) causes of mortality simultaneously. The aim of the PrivMort Project is to overcome these limitations and to investigate the role of societal factors (particularly rapid mass privatisation) and individual-level factors (e.g. alcohol consumption) in the mortality changes in post-communist countries.MethodsThe PrivMort conducts large-sample surveys in Russia, Belarus and Hungary. The approach is unique in comparing towns that have undergone rapid privatisation of their key industrial enterprises with those that experienced more gradual forms of privatisation, employing a multi-level retrospective cohort design that combines data on the industrial characteristics of the towns, socio-economic descriptions of the communities, settlement-level data, individual socio-economic characteristics, and individuals’ health behaviour. It then incorporates data on mortality of different types of relatives of survey respondents, employing a retrospective demographic approach, which enables linkage of historical patterns of mortality to exposures, based on experiences of family members. By May 2016, 63,073 respondents provided information on themselves and 205,607 relatives, of whom 102,971 had died. The settlement-level dataset contains information on 539 settlements and 12,082 enterprises in these settlements in Russia, 96 settlements and 271 enterprises in Belarus, and 52 settlement and 148 enterprises in Hungary.DiscussionIn addition to reinforcing existing evidence linking smoking, hazardous drinking and unemployment to mortality, the PrivMort dataset will investigate the variation in transition experiences for individual respondents and their families across settlements characterized by differing contextual factors, including industrial characteristics, simultaneously providing information about how excess mortality is distributed across settlements with various privatization strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3249-9) contains supplementary material, which is available to authorized users.

Research on intergenerational social mobility and health-related behaviours yields mixed findings. Depending on the direction of mobility and the type of mechanisms involved, we can expect positive or negative association between intergenerational mobility and health-related behaviours. Using data from a retrospective cohort study, conducted in more than 100 towns across Belarus, Hungary and Russia, we fit multilevel mixed-effects Poisson regressions with two measures of health-related behaviours: binge drinking and smoking. The main explanatory variable, intergenerational educational mobility is operationalised in terms of relative intergenerational educational trajectories based on the prevalence of specified qualifications in parental and offspring generations. In each country the 3associations between intergenerational educational mobility, binge drinking and smoking was examined with incidence rate ratios and predicted probabilities, using multiply imputed dataset for missing data and controlling for important confounders of healthrelated behaviours. We find that intergenerational mobility in relative educational attainment has varying association with binge drinking and smoking and the strength and direction of these effects depend on the country of analysis, the mode of mobility, the gender of respondents and the type of health-related behaviour. Along with accumulation and Falling from Grace hypotheses of the consequences of intergenerational mobility, our findings suggest that upward educational mobility in certain instances might be linked to improved health-related behaviours.

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil’s response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (TelessáudeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were “asymptomatic” patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management.

Objectives. To describe changes in mortality among men and women with different levels of education in three Eastern European countries undergoing major political change (1982-2013). Methods. Data were collected as part of the PrivMort retrospective cohort study. Participants in Russia, Belarus and Hungary provided information on the educational attainment, healthrelated behaviors, and vital statistics of their close relatives (n=179,691). Odds ratios (OR) for mortality and relative indices of inequality (RII) were estimated for individuals aged 20-65 between 1982 and 2013, comparing those with university, secondary and less than secondary education attainment. Results. Those in lower educational groups were significantly more likely to die in most time periods and subgroups. The RII increased over time in all countries and both genders, except Hungarian men. Alcohol consumption and smoking have increasingly contributed to educational inequalities in mortality during this period. Conclusion. Educational inequalities in mortality in these Eastern European countries have continued to grow during recent decades.

An unprecedented mortality crisis struck Eastern Europe during the transition from socialism to capitalism. Working-class men without a college degree suffered the most. Some argue that economic dislocation caused stress and despair, leading to adverse health behavior and ill health (dislocation-despair approach). Others suggest that hazardous drinking inherited as part of a dysfunctional working-class culture and populist alcohol policy were the key determinants (supply-culture approach). We enter this debate by performing the first quantitative analysis of the association between economic dislocation in the form of industrial employment decline and mortality in postsocialist Eastern Europe. We rely on a novel multilevel dataset, fitting survival and panel models covering 52 towns and 42,800 people in 1989-1995 in Hungary and 514 medium-sized towns in the European part of Russia. The results show that deindustrialization was significantly associated with male mortality in both countries directly and indirectly mediated by adverse health behavior as a dysfunctional coping strategy. Both countries experienced severe deindustrialization, but social and economic policies seem to have offset Hungary’s more immense industrial employment loss. The policy implication is that social and economic policies addressing the underlying causes of stress and despair can improve health.

Background Rising midlife mortality in the United States (US) has raised concerns, particularly the increase in "deaths of despair" (due to drugs, alcohol, and suicide). While life expectancy is also stalling in other countries such as the UK, whether midlife mortality is rising outside the US is not known. Methods We document trends in midlife mortality in the US, UK and a group of 16 high-income countries in Western Europe, Australia, Canada, New Zealand, and Japan, as well as 7 Central and Eastern European (CEE) countries from 1990-2019. We use annual mortality data from the World Health Organization Mortality Database to analyze sex and age-specific (25-44, 45-54, and 55-64) age-standardized death rates across 13 major cause-of-death categories. Findings US midlife mortality rates worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic disease, nervous system disease, respiratory disease, and infectious/parasitic diseases. Deaths due to homicide, transport accidents, and cardiovascular disease declined overall since 1990 but saw recent increases or stalling of improvements. Midlife mortality has also recently increased in the UK for 45-54-year-olds, and in Canada, Poland, and Sweden among 25-44-year-olds. Conclusion The US is increasingly falling behind not only high-income but also CEE countries heavily impacted by the post-Soviet mortality crisis of the 1990s. While levels of midlife mortality in the UK are substantially lower than in the US overall, there are signs that UK midlife mortality is worsening relative to the rest of Europe.