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Objectives: Analyze the hospitalizations of patients admitted for Chagas disease with gastro-intestinal involvement (CD-GI) in the Brazilian Unified Health System, describe the epidemiological profile, mortality and costs. Methods: This is an observational study that uses secondary data from the National Hospital Information System (SIH-SUS) for the years 2017–2019. CD-GI admissions were defined by specific ICD-10 codes that identify the main diagnosis. Results: From 2017 to 2019, there were 4,407 hospitalizations for CD-GI in Brazil, considering only public hospitals and those associated with the SUS. This corresponds to an average of 1,470 hospitalizations per year, or 0.6 per 100,000 inhabitants, with significant regional variation. Hospitalizations increased with age and were slightly higher in men. More than 60% were emergencies and in 50% the procedure performed was surgical. The most used code was the one for megaesophagus followed by megacolon. In-hospital mortality was 5.8% and 17.2% went to intensive care units. The median cost was USD$ 553.15 per hospitalization, and an overall cost of USD$ 812,579.98 per year to the SUS budget. Conclusion: The numbers, rates and costs presented here are possibly underestimated but they give us an idea of the overall profile of hospitalizations due to CD-GI, which are not rare and are related to significant in-hospital mortality. CD-GI is a neglected manifestation of a neglected disease. Author summary: The gastrointestinal involvement of Chagas disease is a neglected manifestation of a neglected disease. Despite this, it causes immense suffering to those affected, which lasts for years. The diagnosis is usually late and the treatment is difficult to access and inadequate, causing the patient to be operated on an emergency basis with major complications and, consequently, high mortality. Here we present the epidemiological profile and costs of public and government-funded hospitalizations, using the Brazilian national database. [ABSTRACT FROM AUTHOR]

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Chagas disease (CD) is a neglected tropical disease and its main consequence is chronic chagasic cardiomyopathy (CCC). The clinical manifestations of CD can cause functional limitation and impact on the perception of quality of life (QoL). We evaluated the QoL profile of patients with CD living in remote regions, and their association with socio-demographic, behavioral, and clinical characteristics.A cross-sectional study, using the baseline of a cohort study (SaMi-Trop) was conducted in the state of Minas Gerais, Brazil, an endemic region for CD. The cohort is composed of 1959 patients with CD. The patients were interviewed, and blood collection and electrocardiogram (ECG) were performed. The WHOQOL-BREF scale was used to assess QoL. Descriptive statistics were performed and, for the QoL scale, measures of central tendency and dispersion were calculated. Inflated beta regression models constructed using the gamlss framework were used, and fitted using R software. A significance level of 5% for all analyzes was adopted.QoL was evaluated in 625 participants. The Environment (57.66) and Social Relationships (73.17) domains presented the lowest and highest QoL score respectively. There was no statistically significant difference between QoL domains in the presence of CCC. In the multivariate analysis, the factors associated with a lower QoL were in the Physical domain age increase (OR: 0.95, CI: 0.91–0.99) and using an angiotensin converting enzyme inhibitor (OR 0.89; CI: 0.80–0.99); in the Social Relations domain a history of acute myocardial infarction (OR: 0.75; CI: 0.61–0.92); and in the Environment domain age increase (OR 0.94, CI 0.91–0.97). The factor associated with higher QoL was the use of angiotensin receptor blockers (OR: 1.15; CI 1.04–1.26).The findings of this study reinforce the importance of QoL indicators for planning care and clinical management of patients from remote regions with CD. Trial registration: NCT02646943. Author summary: Chagas disease (ChD) is a neglected tropical disease, with the majority of the individuals affected living in Latin America. Functional limitation and poor perception of quality of life (QoL) may be identified. QoL indicators are important for planning and to improve patients care. However there is a gap in the literature regarding the evaluation of QoL in patients living with chronic CD, in remote regions assisted by primary health care in their territory of residence. A cross-sectional study was conducted using the baseline of a prospective cohort performed in remote towns in Minas Gerais state, Brazil. Lower QoL scores were identified in the Environment domain followed by the Physical domain. Higher scores were found in the Social Relations domain. Low QoL scores have been associated with clinical aspects such as use of angiotensin converting enzyme inhibitor (ACEI), and history of acute myocardial infarction, and socio-demographic aspects such as increasing age. QoL is positively associated with medicine use of angiotensin receptor antagonists (ARA). The subjective perception of QoL was not associated with the severity of the disease using as a marker the presence of CCC in the evaluated population. [ABSTRACT FROM AUTHOR]

The growing burden of chronic diseases is challenging health systems as well as economic and social development in many countries. Integration of care delivery is one of the key strategies to tackle these issues. Transitioning towards integrated care requires the capacity of managing change. This article explores the experience of the Laboratory for Innovations in Chronic Conditions in the municipality of Santo Antônio do Monte (Brazil), as a promoter and facilitator of the shift towards an integrated chronic care model. The purpose of this paper is to describe, analyse and extract relevant lessons from this experience concerning the role of a change agent to (1) overcome the challenges of diffusion of integrated care innovations at scale and pace and to (2) promote learning for implementation of integrated care delivery. Following a detailed description of the experience in itself, covering its background, context, core elements at the different levels of care and financing model, the main preliminary results obtained are presented. The article closes with the main lessons learnt: (1) the experience of the Laboratory shows that health care delivery systems that promote learning and innovation are more flexible and better prepared to face the challenges imposed by a complex epidemiologic, demographic and socioeconomic environment; (2) the development of healthcare networks requires a solid blueprint and change agents supporting the process, and to tackle the challenge of chronicity is essential to reinforce primary care but not sufficient, as integrated care models are also needed. [ABSTRACT FROM AUTHOR]