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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]

The aims of this study were to estimate the prevalence of gastrointestinal manifestations among individuals with positive serology for Chagas disease (ChD) and to describe the clinical gastrointestinal manifestations of the disease. A systematic review with meta-analysis was conducted based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Virtual Health Library, Web of Science, and Embase databases were used to search for evidence. Two reviewers independently selected eligible articles and extracted data. RStudio® software was used for the meta-analysis. For subgroup analysis, the studies were divided according to the origin of the individuals included: 1) individuals from health units were included in the health care service prevalence analysis, and 2) individuals from the general population were included in the population prevalence analysis. A total of 2,570 articles were identified, but after removal of duplicates and application of inclusion criteria, 24 articles were included and 21 were part of the meta-analysis. Most of the studies were conducted in Brazil. Radiological diagnosis was the most frequent method used to identify the gastrointestinal clinical form. The combined effect of meta-analysis studies showed a prevalence of gastrointestinal manifestations in individuals with ChD of 12% (95% CI, 8.0-17.0%). In subgroup analysis, the prevalence for studies involving health care services was 16% (95% CI, 11.0-23.0%), while the prevalence for population-based studies was 9% (95% CI, 5.0-15.0%). Megaesophagus and megacolon were the main forms of ChD presentation in the gastrointestinal form. The prevalence of gastrointestinal manifestations of ChD was 12%. Knowing the prevalence of ChD in its gastrointestinal form is an important step in planning health actions for these patients.

Background: Chagas disease (ChD) is a neglected tropical disease that is caused by the protozoan parasite Trypanosoma cruzi and can negatively impact quality of life (QoL). This study aimed to assess and compare QoL between individuals with and without ChD., Methods: This cross-sectional study was performed within a concurrent cohort study (REDS). The participants were derived from two blood donation centers: São Paulo capital and Montes Claros, Minas Gerais, Brazil. Participants with ChD were identified in blood donations by serological diagnosis between 2008 and 2010, and those without ChD were donors with negative serology identified during the same period. QoL was assessed using the World Health Organization Quality of Life-BREF questionnaire. Logistic regression was used to compare sociodemographic and clinical characteristics between the groups, and mean, standard deviation, and beta regression were used to compare QoL., Results: In total, 611 individuals participated in the study (328 with ChD and 283 without ChD). Participants with ChD had lower QoL in the physical (p=0.02) and psychological (p<0.01) domains than did individuals without CD., Conclusions: Individuals with ChD had worse QoL perceptions. These results provide a comprehensive understanding of the impact of ChD on individuals' QoL, while also highlighting potential opportunities for improving the care and treatment of those affected.

Chagas disease (CD) is a neglected disease caused by the protozoan Trypanosoma cruzi. It has high morbidity and mortality rates and mainly affects socially vulnerable populations. This is a cross-sectional study, with retrospective and prospective data collection. Using questionnaires applied to environmental surveillance coordinators, we characterized the status of CD surveillance activities in municipalities endemic for the disease in Northern Minas Gerais State (MG) and Jequitinhonha Valley (Vale do Jequitinhonha). Moreover, we spatialized the vulnerability index for chronic CD in the study area. The population consisted of 22 environmental surveillance coordinators, active in 2020, from Northern MG and Jequitinhonha Valley, 21 municipalities included in the SaMi-Trop research project, and Montes Claros municipality. After applying the questionnaires to the coordinators, a descriptive analysis of the variables was performed. To characterize the active municipalities, the explanatory variables collected in the questionnaire were compared with the dichotomous variable. Bivariate descriptive analysis was performed. Finally, geoprocessing techniques were used to spatialize the data and prepare maps. Regarding the team of endemic combat agents (ECA), 90.9% reported the lack of a specific team for CD vector control actions. Of the 22 municipalities participating in this study, nine were active (41.1%). Only 25% (n=2) of active municipalities (9% of the municipalities studied) met the target of visiting 50% of households per year. Finally, 81.1% of the coordinators stated that in their municipality, they developed actions linked to primary health care (PHC). The implementation of CD surveillance activities weakened in the endemic region. Few municipalities have a surveillance team, with low regularity of active surveillance and noncompliance with the program's goal. The results suggest insufficient recording of activities in the information system, considering that there are municipalities that report performing the activities, but no production record was observed in the system.

Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser-Meyer-Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

The SaMi-Trop project is a cohort study conducted in 21 municipalities of endemic areas of Chagas disease, including 1,959 patients with chronic Chagas cardiomyopathy. In this article we updated the results of the project, adding information from the second cohort visit. Trypanosoma cruzi-seropositive patients were enrolled from the primary care Telehealth service in Minas Gerais State, Brazil. The eligibility criterium for the second visit was the participation in the baseline evaluation. Of 1,959 participants at the baseline assessment, 1,585 (79.9%) returned after two years for the second evaluation. The mortality rate was 6.7%, but varied from 0.9% to 18.2% when it was stratified by certain clinical characteristics. A lower age-adjusted NT-Pro-BNP level (less than 300) and a prior benznidazole treatment were associated with lower mortality. There was an improvement in most quality of life domain scores. Participants have also reported fewer signs and symptoms and greater use of medication. The second follow-up visit will be complete in Oct 2021.

Chagas disease (CD) is a neglected tropical highly morbid disease that can have a negative impact on the quality of life (QoL). The purpose of this study was to conduct an integrative review to analyze the QoL of patients with CD in the chronic phase of the disease, as well as the instruments used and the effect of different interventions. The review was carried out based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guideline (PRISMA) using the PubMed, Scopus, Web of Science and Science Direct databases. An analysis of the reference list of the included articles was also carried out. Publications in all languages have been included. Two independent reviewers selected the eligible articles and extracted the data. A total of 1,479 articles were identified, and after applying the inclusion criteria 18 articles were included. Four different instruments were used to assess QoL and the most used was the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) [33.3% (n = 6)]. Investigations involving intervention showed a positive impact on the patients' QoL, and the Environment domain had the lowest score. Heterogeneity of instruments and lack of methodology standardization for assessing QoL was observed. QoL proved to be an important indicator for the planning and monitoring of patients with CD, however it is suggested that the instruments for its assessment should be the ones recommended by the validation studies. This process will allow the comparison of data between investigations.