Este estudo teve como objetivo realizar uma revisão bibliográfica sobre a influência da suscetibilidade genética na incidência e mortalidade de COVID-19. Trata-se de uma revisão descritiva da literatura realizada nas bases de dados PUBMED e Science direct utilizando os seguintes descritores: genetic susceptibility” AND “COVID-19”. Os critérios de inclusão foram artigos científicos disponíveis gratuitamente, nos idiomas inglês, espanhol e português e que foram publicados em 2020. Foram excluídos os artigos duplicados entre as bases. Ao final 58 estudos seguiam os critérios estabelecidos. Os genes ACE2 e TMPRSS2, têm potencial para intervenção profilática e terapêutica nos estágios iniciais de infecção por SARS-CoV-2, desempenhando um papel crucial para a entrada do vírus nas células hospedeiras. Além disso, o lócus do Antígeno Leucocitário Humano (HLA), parece ser crucial para influenciar a suscetibilidade e a gravidade do COVID-19. Indivíduos do sexo masculino apresentam uma maior taxa de mortalidade e de gravidade para a COVID-19, sendo relacionado a uma expressão mais significativa de ACE2 e diferenças na regulação epigenética de ACE2. A suscetibilidade genética pode contribuir para a variabilidade clínica interindividual associada ao COVID-19, permitindo uma avaliação de risco baseada em evidências levando a medidas preventivas personalizadas e opções terapêuticas.
Background: The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies.Design and Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals.Results: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050).Conclusion: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic-histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.
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Background: The diagnosis of breast cancer, from first medical visit until treatment initiation, requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies. Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals among patient groups. Results: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p= 0.033) and 4.44-fold (95%CI: 1.58-12.46; p= 0.004), respectively. The median time between the first medical visit and the diagnostic result and between the first medical visit and the initiation of treatment was, respectively, 56.0 and 116.5 days. For these time intervals, 54 (34.8%) and 114 (64.8%) patients had a delay of >90 days for diagnostic results and the initiation of treatment, respectively. For patients in the FAP and HNL who had a delay of >90 days, the median time between the first medical visit and the diagnostic results was 180 and 158 days, respectively (p= 0.032). If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median delay between diagnostic mammography and the diagnostic result was 65.0 or 29.0 days, respectively, compared to 53.0 days in the integrated (HNL) publicly financed system (p < 0.050). The median time between the first medical visit and the diagnostic results of all patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p < 0.050).Conclusions: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic-histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.
O final do ano de 2019 foi marcado pelo surgimento do vírus SARS-CoV-2, causador da Covid-19. Vírus este com alta transmissibilidade e que logo se tornaria um caso de emergência em saúde pública mundial, levando a uma crise sanitária que vem gerando impactos tanto na gestão em saúde quanto na economia.Travou-se uma corrida contra o tempo para se descobrir um tratamento eficaz, para se desenvolver uma vacina e para conter a disseminação do vírus tentando-se minimizar os impactos negativos sobre a economia. Uma das medidas de contenção utilizadas foi o isolamento social, o fechamento de estabelecimentos comerciais considerados não essenciais e a adoção de medidas de segurança como o uso de máscaras e de álcool em gel para higienização das mãos. No entanto, os estudos abordados neste livro mostram que os impactos da pandemia sobre a população ultrapassam aqueles relacionados ao número de infectados e de óbitos.O presente livro traz estudos que buscam analisar ações de gestão em saúde para o enfrentamento à Covid-19 bem como os impactos dessas ações na saúde das pessoas que vão para além da infecção pelo SARS-Cov-2.Em nossos livros selecionamos um dos capítulos para premiação como forma de incentivo para os autores, e entre os excelentes trabalhos selecionados para compor este livro, o premiado foi o capítulo I, intitulado "A PANDEMIA DA COVID-19: UM ANALISADOR DA GESTÃO EM SAÚDE NO BRASIL E NA FRANÇA".
Introduction: There exist only few Brazilian studies about women's adherence on the clinical breast examination (CBE).Objectives: This study of women in northeast Brazil addressed socio-economic variables besides physical activity and ancestry and their impact on performance of CBE.Methods: Data were obtained by interviewing 307 women aged ≥ 40 years old. All interviews were performed in a public health center of Campina Grande, state of Paraíba, Northeast Brazil. Multinomial logistic regression analysis was applied to determine odds ratios (ORs) and confidence intervals (CI) of variables.Results: Of the 307 women 140 performed CBE never or irregular, whereas 137 and 30 performed it each year, respectively each second year. Women who used exclusively public health service centers had a 2.0-fold (OR = 0.495; 95%CI: 0.28 -0.74) decreased chance of annual CBE performance, compared to those ones who used public and private services (p = 0.006). In a model of logistic regression analysis, low-income women had a 3.1-fold (OR = 0.321; 95%CI: 0.11 -0.92) decreased chance to undergo CBE every year (p = 0.009). Unemployed women had a 2.8-fold (OR = 0.360; 95%CI: 0.15 -0.88) decreased chance of bi-annual CBE performance.Women who informed European ancestry had a 2.8 (95%CI: 1.45 -5.26) increased chance to perform CBE each year, compared to those ones who informed African or mixed ancestry (p = 0.005). Regular physical activity increased chance of annual CBE performance 1.9 (95%CI: 1.10 -3.29) times (p = 0.013). Conclusion:Low income and unemployment decreased chance of regular CBE performance. Compared to African and mixed ancestry, informed European ancestry increased chance of regular CBE performance. Physical activity was also positively associated with regular CBE performance. Present data indicated that even among women sampled in the same public health service center regular CBE performance depended strongly on the socio-economic and ethnic background of women.
INTRODUÇÃO: O DIABETES MELLITUS (DM) É UMA DOENÇA DE MÚLTIPLAS ETIOLOGIAS QUE AFETA INDIVÍDUOS DE TODAS AS RAÇAS/COR, ESCOLARIDADE, SEXO, IDADE E/O CONDIÇÃO SOCIAL, CAPAZ DE REDUZIR A QUALIDADE DE VIDA E ELEVAR MORTALIDADE NA POPULAÇÃO. ESTIMA-SE QUE NO BRASIL, DOS 9,1 MILHÕES DE DIABÉTICOS, 40%, TÊM 60 ANOS OU MAIS. OBJETIVO: AVALIAR A OCORRÊNCIA DE ÓBITOS DE IDOSOS BRASILEIROS EM DECORRÊNCIA DO DIABETES TIPO 1 E TIPO 2 ENTRE OS ANOS DE 2014 A 2018. METODOLOGIA: É UM ESTUDO QUANTITATIVO DA MORTALIDADE DE IDOSOS (≥ 60ANOS) BRASILEIROS POR DIABETES TIPOS 1 E 2 EM HOSPITAIS, AVALIADOS POR REGIÃO E DE ACORDO COM SEXO, ESCOLARIDADE E RAÇA SEGUNDO OS DADOS DO SIM/DATASUS (2014-2018). RESULTADOS: NO BRASIL, 21.621 IDOSOS MORRERAM POR DIABETES TIPO 1= 6.479 E DIABETES TIPO 2= 15.142, COM UMA MÉDIA DE 4.324 MORTES/ANO. HOUVE MAIS ÓBITOS DE MULHERES (57,03%). ENTRE AS REGIÕES BRASILEIRAS, O SUDESTE (28,34%) E NORDESTE (26,18%) FORAM AS QUE APRESENTARAM MAIORES VALORES. A BAHIA (25,72%) FOI O ESTADO NORDESTINO COM MAIOR MORTALIDADE. A PARAÍBA OCUPOU A SEXTA POSIÇÃO EM NÚMERO DE ÓBITOS NESSA MESMA REGIÃO. INDIVÍDUOS COM BAIXA ESCOLARIDADE (1 A 7 ANOS) MORRERAM APROXIMADAMENTE 2X E 4X MAIS QUE ANALFABETOS E QUE OS IDOSOS COM ALTA ESCOLARIDADE, RESPECTIVAMENTE. NESSE ESTUDO, REGISTROU-SE MAIS ÓBITOS ENTRE IDOSOS BRANCOS (52,5%) E PARDOS (37,8%), CONTRASTANDO COM OUTROS TRABALHOS SOBRE DM QUE TAMBÉM AVALIARAM RAÇA/COR DOS INDIVÍDUOS.
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