1
|
Fraga LL, Nascimento BR, Haiashi BC, Ferreira AM, Silva MHA, Ribeiro IKDS, Silva GA, Vinhal WC, Coimbra MM, Silva CA, Machado CRL, Pires MC, Diniz MG, Santos LPA, Amaral AM, Diamante LC, Fava HL, Sable C, Nunes MCP, Ribeiro ALP, Cardoso CS. Combination of Tele-Cardiology Tools for Cardiovascular Risk Stratification in Primary Care: Data from the PROVAR+ Study. Arq Bras Cardiol 2024; 121:e20230653. [PMID: 38597537 DOI: 10.36660/abc.20230653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/13/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Tele-cardiology tools are valuable strategies to improve risk stratification. OBJECTIVE We aimed to evaluate the accuracy of tele-electrocardiography (ECG) to predict abnormalities in screening echocardiography (echo) in primary care (PC). METHODS In 17 months, 6 health providers at 16 PC units were trained on simplified handheld echo protocols. Tele-ECGs were recorded for final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:5 sample of normal individuals underwent clinical questionnaire and screening echo interpreted remotely. Major heart disease was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, or wall-motion abnormalities. Association between major ECG and echo abnormalities was assessed by logistic regression as follows: 1) unadjusted model; 2) model 1 adjusted for age/sex; 3) model 2 plus risk factors (hypertension/diabetes); 4) model 3 plus history of cardiovascular disease (Chagas/rheumatic heart disease/ischemic heart disease/stroke/heart failure). P-values < 0.05 were considered significant. RESULTS A total 1,411 patients underwent echo; 1,149 (81%) had major ECG abnormalities. Median age was 67 (IQR 60 to 74) years, and 51.4% were male. Major ECG abnormalities were associated with a 2.4-fold chance of major heart disease on echo in bivariate analysis (OR = 2.42 [95% CI 1.76 to 3.39]), and remained significant after adjustments in models (p < 0.001) 2 (OR = 2.57 [95% CI 1.84 to 3.65]), model 3 (OR = 2.52 [95% CI 1.80 to3.58]), and model 4 (OR = 2.23 [95%CI 1.59 to 3.19]). Age, male sex, heart failure, and ischemic heart disease were also independent predictors of major heart disease on echo. CONCLUSIONS Tele-ECG abnormalities increased the likelihood of major heart disease on screening echo, even after adjustments for demographic and clinical variables.
Collapse
Affiliation(s)
- Lucas Leal Fraga
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Serviço de Cardiologia e Cirurgia Carvdiovascular, Belo Horizonte, MG - Brasil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Serviço de Cardiologia e Cirurgia Carvdiovascular, Belo Horizonte, MG - Brasil
- Hospital Madre Teresa - Serviço de Hemodinâmica, Belo Horizonte, MG - Brasil
- Universidade Federal de Minas Gerais - Departamento de Clínica Médica - Faculdade de Medicina, Belo Horizonte, MG - Brasil
| | - Beatriz Costa Haiashi
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil
| | - Alexandre Melo Ferreira
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil
| | - Mauro Henrique Agapito Silva
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil
| | | | - Gabriela Aparecida Silva
- Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil
| | - Wanessa Campos Vinhal
- Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil
| | - Mariela Mata Coimbra
- Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil
| | - Cássia Aparecida Silva
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Serviço de Cardiologia e Cirurgia Carvdiovascular, Belo Horizonte, MG - Brasil
| | - Cristiana Rosa Lima Machado
- Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil
| | - Magda C Pires
- Universidade Federal de Minas Gerais - Instituto de Ciências Exatas - Departamento de Estatística, Belo Horizonte, MG - Brasil
| | - Marina Gomes Diniz
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil
| | | | - Arthur Maia Amaral
- Universidade Federal de Ouro Preto - Departamento de Medicina, Ouro Preto, MG - Brasil
| | - Lucas Chaves Diamante
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil
| | - Henrique Leão Fava
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil
| | - Craig Sable
- Children's National Health System - Cardiology, Washington, District of Columbia - EUA
| | - Maria Carmo Pereira Nunes
- Universidade Federal de Minas Gerais - Departamento de Clínica Médica - Faculdade de Medicina, Belo Horizonte, MG - Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil
| | - Antonio Luiz P Ribeiro
- Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil
| | - Clareci Silva Cardoso
- Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil
| |
Collapse
|
2
|
Baldoni NR, de Oliveira-da Silva LC, Gonçalves ACO, Quintino ND, Ferreira AM, Bierrenbach AL, Padilha da Silva JL, Pereira Nunes MC, Ribeiro ALP, Oliveira CDL, Sabino EC, Cardoso CS. Gastrointestinal Manifestations of Chagas Disease: A Systematic Review with Meta-Analysis. Am J Trop Med Hyg 2024; 110:10-19. [PMID: 38052078 DOI: 10.4269/ajtmh.23-0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/20/2023] [Indexed: 12/07/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Nayara Ragi Baldoni
- University of Itaúna, Itaúna, Brazil
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | | | - Ana Carolina Oliveira Gonçalves
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | - Nayara Dornela Quintino
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
- Divinópolis Regional Health Superintendence/Minas Gerais State Health Secretariat (SES-MG), Belo Horizonte, Brazil
| | | | - Ana Luiza Bierrenbach
- Teaching and Research Institute of Sírio-Libanês Hospital, São Paulo, Brazil
- Graduate Program, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | - Claudia Di Lorenzo Oliveira
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, Brazil
| | - Clareci Silva Cardoso
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| |
Collapse
|
3
|
Freitas PHBD, Meireles AL, Abreu MNS, Barbosa BCR, Paula WD, Cardoso CS. Assessment of the quality of life and mental health of healthcare students during the COVID-19 pandemic. Rev Bras Enferm 2023; 76Suppl 1:e20230068. [PMID: 38055432 DOI: 10.1590/0034-7167-2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/14/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to evaluate the quality of life (QOL) and the presence of symptoms related to depression, anxiety, and stress among students in the healthcare field, in comparison to the period before the COVID-19 pandemic. METHODS A comparative cross-sectional research was conducted at a Brazilian public university. QOL was assessed using the WHOQOL-bref scale, while symptoms of depression, anxiety, and stress were evaluated using the DASS-21 scale. Descriptive and inferential analyses were employed to compare the two time periods. RESULTS A total of 355 students participated in this study. During the pandemic, there were significant increases in severe depression symptoms (15.1% versus 24.8%), moderate anxiety (18.3% versus 29.4%), and moderate stress (40.9% versus 53.8%) observed among the participants. Additionally, a significant reduction in QOL was noted, particularly in the domain of social relationships (65.2 versus 59.6, p-value 0.029). CONCLUSION The study highlights a deterioration in both the quality of life and the mental health of healthcare students during the COVID-19 pandemic.
Collapse
Affiliation(s)
| | | | | | | | - Waléria de Paula
- Universidade Federal de Ouro Preto. Ouro Preto, Minas Gerais, Brazil
| | | |
Collapse
|
4
|
Baldoni NR, Quintino ND, Oliveira CDL, da Silva JLP, Ferreira AM, Ribeiro ALP, Sabino EC, Cardoso CS. Chagas disease and perceived quality of life: a cross-sectional study. Rev Soc Bras Med Trop 2023; 56:e02062023. [PMID: 37909506 PMCID: PMC10615335 DOI: 10.1590/0037-8682-0206-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Nayara Ragi Baldoni
- Universidade Federal de São João del-Rei, Departamento de Medicina, Divinópolis, MG, Brasil
- Universidade de Itaúna, Itaúna, MG, Brasil
| | | | | | | | - Ariela Mota Ferreira
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, MG, Brasil
| | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Faculdade Medicina, Belo Horizonte, MG, Brasil
| | | | - Clareci Silva Cardoso
- Universidade Federal de São João del-Rei, Departamento de Medicina, Divinópolis, MG, Brasil
| |
Collapse
|
5
|
Kleber Cabral Silva H, Silva Cardoso C, Di Lorenzo Oliveira C, Carrilho Menezes A, Avelar Maia Seixas AF, Machado Rocha G. Validation of a Satisfaction Scale with a Telemedicine COVID-19 Service: Satis-COVID. Telemed J E Health 2023; 29:1514-1522. [PMID: 37022788 DOI: 10.1089/tmj.2022.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Objectives: Despite being a widespread tool, telehealth was significantly incorporated during the COVID-19 pandemic period, but it still lacks analysis methodologies, greater digital security, and satisfaction assessment instruments that are still little explored and validated. The objective is to assess user satisfaction through the validation of a satisfaction scale with a telemedicine COVID-19 service (TeleCOVID). Methods: Cross-sectional study of a cohort of confirmed COVID-19 cases evaluated and monitored by the TeleCOVID team. To study the scale's measurement qualities, a factorial analysis was performed to test the validity of the construct. Correlation between items and the global scale was assessed using Spearman's correlation coefficient, and the instrument's internal consistency was assessed using Cronbach's alpha coefficient. Results: There were 1,181 respondents evaluating the care received from the TeleCOVID project. A total of 61.6% were female, and 62.4% aged between 30 and 59 years. The correlation coefficients indicated a good correlation between the items present in the instrument. The internal consistency of the global scale was high (Cronbach's alpha = 0.903) and the item-total correlations for the scale ranged from 0.563 to 0.820. The average overall user satisfaction was 4.58, based upon a 5-point Likert scale where 5 is the highest level of satisfaction. Conclusions: The results presented here show how much telehealth can contribute to improving access, resolutibility, and quality of care to the population in general in Public Health Care. In view of the results found, it can be said that the TeleCOVID team offered excellent care and fulfilled its proposed objectives. The scale fulfills its objective of evaluating the quality of teleservice, bringing good results in terms of validity and reliability, in addition to showing high levels of user satisfaction.
Collapse
|
6
|
Jidling C, Gedon D, Schön TB, Oliveira CDL, Cardoso CS, Ferreira AM, Giatti L, Barreto SM, Sabino EC, Ribeiro ALP, Ribeiro AH. Screening for Chagas disease from the electrocardiogram using a deep neural network. PLoS Negl Trop Dis 2023; 17:e0011118. [PMID: 37399207 PMCID: PMC10361500 DOI: 10.1371/journal.pntd.0011118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/21/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Worldwide, it is estimated that over 6 million people are infected with Chagas disease (ChD). It is a neglected disease that can lead to severe heart conditions in its chronic phase. While early treatment can avoid complications, the early-stage detection rate is low. We explore the use of deep neural networks to detect ChD from electrocardiograms (ECGs) to aid in the early detection of the disease. METHODS We employ a convolutional neural network model that uses 12-lead ECG data to compute the probability of a ChD diagnosis. Our model is developed using two datasets which jointly comprise over two million entries from Brazilian patients: The SaMi-Trop study focusing on ChD patients, enriched with data from the CODE study from the general population. The model's performance is evaluated on two external datasets: the REDS-II, a study focused on ChD with 631 patients, and the ELSA-Brasil study, with 13,739 civil servant patients. FINDINGS Evaluating our model, we obtain an AUC-ROC of 0.80 (CI 95% 0.79-0.82) for the validation set (samples from CODE and SaMi-Trop), and in external validation datasets: 0.68 (CI 95% 0.63-0.71) for REDS-II and 0.59 (CI 95% 0.56-0.63) for ELSA-Brasil. In the latter, we report a sensitivity of 0.52 (CI 95% 0.47-0.57) and 0.36 (CI 95% 0.30-0.42) and a specificity of 0.77 (CI 95% 0.72-0.81) and 0.76 (CI 95% 0.75-0.77), respectively. Additionally, when considering only patients with Chagas cardiomyopathy as positive, the model achieved an AUC-ROC of 0.82 (CI 95% 0.77-0.86) for REDS-II and 0.77 (CI 95% 0.68-0.85) for ELSA-Brasil. INTERPRETATION The neural network detects chronic Chagas cardiomyopathy (CCC) from ECG-with weaker performance for early-stage cases. Future work should focus on curating large higher-quality datasets. The CODE dataset, our largest development dataset includes self-reported and therefore less reliable labels, limiting performance for non-CCC patients. Our findings can improve ChD detection and treatment, particularly in high-prevalence areas.
Collapse
Affiliation(s)
- Carl Jidling
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Daniel Gedon
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Thomas B. Schön
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | | | - Clareci Silva Cardoso
- Preventive Medicine, School of Medicine, Universidade Federal de São João del-Rei, Divinópolis, Brazil
| | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | - Luana Giatti
- Preventive Medicine, School of Medicine, Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Preventive Medicine, School of Medicine, Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ester C. Sabino
- Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio L. P. Ribeiro
- Department of Internal Medicine, Faculdade de Medicina, Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio H. Ribeiro
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
7
|
de Freitas PHB, Meireles AL, Ribeiro IKDS, Abreu MNS, de Paula W, Cardoso CS. Symptoms of depression, anxiety and stress in health students and impact on quality of life. Rev Lat Am Enfermagem 2023; 31:e3884. [PMID: 37075384 PMCID: PMC10208634 DOI: 10.1590/1518-8345.6315.3884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/06/2022] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE to evaluate the association between quality of life and presence of symptoms of depression, anxiety, and stress in college students in the health area. METHOD cross-sectional study that included 321 students from undergraduate courses in the health area. Quality of life was measured using the World Health Organization scale, abbreviated version, in the physical, psychological, social relations and environment domains, and symptoms were assessed by the depression, anxiety and stress scale. Multivariate analysis was performed using robust linear regression to evaluate the association between quality of life and symptoms. RESULTS a negative association was observed between the quality of life and depression symptoms in all domains, while anxiety symptoms showed a negative association in the environment domain, and stress symptoms had a negative association in the psychological domain. Symptom severity was unfavorably associated with quality of life, that is, the greater the symptom severity, the lower the mean scores in all domains. CONCLUSION symptoms of depression, anxiety, and stress were prevalent and had a negative impact on students' quality of life, especially in the presence of depressive symptoms. The decrease in scores was significantly associated with the severity of symptoms.
Collapse
Affiliation(s)
| | - Adriana Lúcia Meireles
- Universidade Federal de Ouro Preto, Departamento de Nutrição Clínica e Social, Ouro Preto, MG, Brasil
| | | | - Mery Natali Silva Abreu
- Universidade Federal de Minas Gerais, Departamento de Gestão em Saúde, Belo Horizonte, MG, Brasil
| | | | | |
Collapse
|
8
|
Tavares PA, Oliveira CDL, Ferreira AM, Baldoni NR, Quintino ND, Haikal DS, Bierrenbach AL, Ribeiro ALP, Sabino EC, Cardoso CS. Evaluation of the properties of WHODAS-12 measurements in individuals with Chagas disease in Brazil. Rev Inst Med Trop Sao Paulo 2023; 65:e30. [PMID: 37075337 PMCID: PMC10109441 DOI: 10.1590/s1678-9946202365030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/14/2023] [Indexed: 04/21/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Patrícia Aparecida Tavares
- Universidade Federal de São João del-Rei, Grupo de Pesquisas em Epidemiologia e Avaliação de Novas Tecnologias em Saúde UFSJ/CNPq, Divinópolis, Minas Gerais, Brazil
| | - Cláudia Di Lorenzo Oliveira
- Universidade Federal de São João del-Rei, Grupo de Pesquisas em Epidemiologia e Avaliação de Novas Tecnologias em Saúde UFSJ/CNPq, Divinópolis, Minas Gerais, Brazil
| | | | | | - Nayara Dornela Quintino
- Universidade Federal de São João del-Rei, Grupo de Pesquisas em Epidemiologia e Avaliação de Novas Tecnologias em Saúde UFSJ/CNPq, Divinópolis, Minas Gerais, Brazil
| | | | - Ana Luiza Bierrenbach
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Programa de Pós-Graduação, Goiânia, Goiás, Brazil
| | | | - Ester Cerdeira Sabino
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Clareci Silva Cardoso
- Universidade Federal de São João del-Rei, Grupo de Pesquisas em Epidemiologia e Avaliação de Novas Tecnologias em Saúde UFSJ/CNPq, Divinópolis, Minas Gerais, Brazil
| |
Collapse
|
9
|
Lovis C, Diniz CS, Chagas BA, Mendes MS, Prates R, Pagano A, Ferreira TC, Alkmim MBM, Oliveira CRA, Borges IN, Raposo MC, Reis ZSN, Paixão MC, Ribeiro LB, Rocha GM, Cardoso CS, Ribeiro ALP. Synchronous Teleconsultation and Monitoring Service Targeting COVID-19: Leveraging Insights for Postpandemic Health Care. JMIR Med Inform 2022; 10:e37591. [PMID: 36191175 PMCID: PMC9786675 DOI: 10.2196/37591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/13/2022] [Accepted: 06/06/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although a great number of teleconsultation services have been developed during the COVID-19 pandemic, studies assessing usability and health care provider satisfaction are still incipient. OBJECTIVE This study aimed to describe the development, implementation, and expansion of a synchronous teleconsultation service targeting patients with symptoms of COVID-19 in Brazil, as well as to assess its usability and health care professionals' satisfaction. METHODS This mixed methods study was developed in 5 phases: (1) the identification of components, technical and functional requirements, and system architecture; (2) system and user interface development and validation; (3) pilot-testing in the city of Divinópolis; (4) expansion in the cities of Divinópolis, Teófilo Otoni, and Belo Horizonte for Universidade Federal de Minas Gerais faculty and students; and (5) usability and satisfaction assessment, using Likert-scale and open-ended questions. RESULTS During pilot development, problems contacting users were solved by introducing standardized SMS text messages, which were sent to users to obtain their feedback and keep track of them. Until April 2022, the expanded system served 31,966 patients in 146,158 teleconsultations. Teleconsultations were initiated through chatbot in 27.7% (40,486/146,158) of cases. Teleconsultation efficiency per city was 93.7% (13,317/14,212) in Teófilo Otoni, 92.4% (11,747/12,713) in Divinópolis, and 98.8% (4981/5041) in Belo Horizonte (university campus), thus avoiding in-person assistance for a great majority of patients. In total, 50 (83%) out of 60 health care professionals assessed the system's usability as satisfactory, despite a few system instability problems. CONCLUSIONS The system provided updated information about COVID-19 and enabled remote care for thousands of patients, which evidenced the critical role of telemedicine in expanding emergency services capacity during the pandemic. The dynamic nature of the current pandemic required fast planning, implementation, development, and updates in the system. Usability and satisfaction assessment was key to identifying areas for improvement. The experience reported here is expected to inform telemedicine strategies to be implemented in a postpandemic scenario.
Collapse
Affiliation(s)
| | - Clara Sousa Diniz
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Azevedo Chagas
- Department of Computer Science, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mayara Santos Mendes
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Raquel Prates
- Department of Computer Science, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adriana Pagano
- Arts Faculty, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Maria Beatriz Moreira Alkmim
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Clara Rodrigues Alves Oliveira
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Isabela Nascimento Borges
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Magda César Raposo
- Telehealth Center, Universidade Federal de São João Del-Rei, Divinópolis, Brazil
| | - Zilma Silveira Nogueira Reis
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Cristina Paixão
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Bonisson Ribeiro
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo Machado Rocha
- Medical School, Campus Centro Oeste, Universidade Federal de São João del-Rei, Divinópolis, Brazil
| | - Clareci Silva Cardoso
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Telehealth Center, Universidade Federal de São João Del-Rei, Divinópolis, Brazil.,Medical School, Campus Centro Oeste, Universidade Federal de São João del-Rei, Divinópolis, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Institute for Health Technology Assessment, Porto Alegre, Brazil
| |
Collapse
|
10
|
Souza-Silva MVR, Domingues MLDP, Chagas VS, Pereira DN, de Sá LC, Almeida MSS, Sales TLS, Raposo MC, Guimarães NS, Oliveira JADQ, Ribeiro ALP, Cardoso CS, Martins MAP, Enes TB, Soares TBDC, Baldoni AO, Marcolino MS. Implementation of a text messaging intervention to patients on warfarin therapy in Brazilian primary care units: a quasi-experimental study. BMC Prim Care 2022; 23:54. [PMID: 35321654 PMCID: PMC8942053 DOI: 10.1186/s12875-022-01647-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
Background Warfarin remains the most affordable oral anticoagulant in many countries. However, it may have serious side effects, and the success of the therapy depends on the patient’s understanding of the medication and their adherence to treatment. The use of short messages services (SMS) is a strategy that can be used to educate patients, but there are no studies evaluating this intervention in patients taking warfarin. Therefore, we aimed to develop, implement, and assess the feasibility of an intervention using SMS to primary care patients taking warfarin in a medium-sized Brazilian city. Methods A bank of 79 SMS was drafted and validated by an expert panel. During 6 months, three times a week, patients received messages about anticoagulation with warfarin. At baseline and after 3 months, we assessed their knowledge and adherence with validated instruments. At the end of the follow-up, participants answered a satisfaction questionnaire. Subsequently, a scale-up phase was conducted, with another round of the intervention including 82 participants (29 from the first phase and 53 newly recruited). Seven months after the end of the scale-up, we asked the patients for their insights about the long-term effects of this program. All patients signed informed consent. The study was approved by the Research and Ethics committee of the Universidade Federal de Minas Gerais. Results In the pilot, 33 (89.2%) patients completed the follow-up. Among the participants who answered the satisfaction questionnaire (n = 29), 86.2% considered that the intervention motivated a healthy lifestyle and improved their understanding of warfarin therapy. All patients were willing to continue receiving the messages. Adherence measured by the Measure of Adherence to Treatment (MAT) test was high in the pre-intervention assessment and remained high (96.7% vs. 93.3%; p = 1.0000). The proportion of patients who achieved > 75% correct answers on the Oral Anticoagulation Knowledge (OAK) test increased from 6.5% to 25.6, p = 0.0703. In the scale-up, 23 patients answered the long-term assessment questionnaire. The main long-term knowledge reported was dietary information. Nine patients received the messages but did not remember their content. Conclusion The intervention was well-accepted and had a positive impact on patient’s knowledge about oral anticoagulation therapy. The scale-up assessment reinforced the need to constantly monitor digital interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01647-5.
Collapse
|
11
|
Sabino EC, Franco LAM, Venturini G, Velho Rodrigues M, Marques E, de Oliveira-da Silva LC, Martins LNA, Ferreira AM, Almeida PEC, Silva FDD, Leite SF, Nunes MDCP, Haikal DS, Oliveira CDL, Cardoso CS, Seidman JG, Seidman CE, Casas JP, Ribeiro ALP, Krieger JE, Pereira AC. Genome-wide association study for Chagas Cardiomyopathy identify a new risk locus on chromosome 18 associated with an immune-related protein and transcriptional signature. PLoS Negl Trop Dis 2022; 16:e0010725. [PMID: 36215317 PMCID: PMC9550069 DOI: 10.1371/journal.pntd.0010725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic Chagas Cardiomyopathy (CCC) usually develops between 10 and 20 years after the first parasitic infection and is one of the leading causes of end-stage heart failure in Latin America. Despite the great inter-individual variability in CCC susceptibility (only 30% of infected individuals ever present CCC), there are no known predictors for disease development in those chronically infected. METHODOLOGY/PRINCIPAL FINDINGS We describe a new susceptibility locus for CCC through a GWAS analysis in the SaMi-Trop cohort, a population-based study conducted in a Chagas endemic region from Brazil. This locus was also associated with CCC in the REDS II Study. The newly identified locus (rs34238187, OR 0.73, p-value 2.03 x 10-9) spans a haplotype of approximately 30Kb on chromosome 18 (chr18: 5028302-5057621) and is also associated with 80 different traits, most of them blood protein traits significantly enriched for immune-related biological pathways. Hi-C data show that the newly associated locus is able to interact with chromatin sites as far as 10Mb on chromosome 18 in a number of different cell types and tissues. Finally, we were able to confirm, at the tissue transcriptional level, the immune-associated blood protein signature using a multi-tissue differential gene expression and enrichment analysis. CONCLUSIONS/SIGNIFICANCE We suggest that the newly identified locus impacts CCC risk among T cruzi infected individuals through the modulation of a downstream transcriptional and protein signature associated with host-parasite immune response. Functional characterization of the novel risk locus is warranted.
Collapse
Affiliation(s)
- Ester Cerdeira Sabino
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Laboratório de Parasitologia Médica (LIM-46), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Lucas Augusto Moysés Franco
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Laboratório de Parasitologia Médica (LIM-46), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Gabriela Venturini
- Laboratorio de Genetica e Cardiologia Molecular, Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazila
- Genetics Department, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mariliza Velho Rodrigues
- Laboratorio de Genetica e Cardiologia Molecular, Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazila
| | - Emanuelle Marques
- Laboratorio de Genetica e Cardiologia Molecular, Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazila
| | - Lea Campos de Oliveira-da Silva
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Laboratório de Parasitologia Médica (LIM-46), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Ariela Mota Ferreira
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Felipe Dias Da Silva
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Laboratório de Parasitologia Médica (LIM-46), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | | | | | | | | | - Jonathan G. Seidman
- Genetics Department, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Christine E. Seidman
- Genetics Department, Harvard Medical School, Boston, Massachusetts, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Howard Hughes Medical Institute, Chevy Chase, Maryland, United States of America
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States of America
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Antonio Luiz Pinho Ribeiro
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jose E. Krieger
- Laboratorio de Genetica e Cardiologia Molecular, Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazila
| | - Alexandre C. Pereira
- Laboratorio de Genetica e Cardiologia Molecular, Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazila
- Genetics Department, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
12
|
Bierrenbach AL, Quintino ND, Moreira CHV, Damasceno RF, Nunes MDCP, Baldoni NR, de Oliveira da Silva LC, Ferreira AM, Cardoso CS, Haikal DS, Sabino EC, Ribeiro ALP, Oliveira CDL. Hospitalizations due to gastrointestinal Chagas disease: National registry. PLoS Negl Trop Dis 2022; 16:e0010796. [PMID: 36121897 PMCID: PMC9522308 DOI: 10.1371/journal.pntd.0010796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/29/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023] Open
Abstract
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.
Collapse
|
13
|
Damasceno RF, Sabino EC, Ribeiro ALP, Ferreira AM, de Oliveira-da Silva LC, Oliveira CDL, Cardoso CS, Vieira TM, Haikal DSA. Failure to use health services by people with Chagas disease: Multilevel analysis of endemic area in Brazil. PLoS Negl Trop Dis 2022; 16:e0010785. [PMID: 36121849 PMCID: PMC9522310 DOI: 10.1371/journal.pntd.0010785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/29/2022] [Accepted: 09/03/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to assess the prevalence of non-use of health services in the last year by people with Chagas disease (CD) in an endemic area in Brazil and the contextual and individual factors associated with this non-use. This is a multilevel study that considered contextual and individual data. Contextual data were collected from official publicly accessible databases of the Brazilian government, at the municipal level. The individual data came from the first follow-up of a Brazilian cohort that assessed patients with CD in 21 municipalities in endemic area for the disease. The sample consisted of 1,160 individuals with CD. The dependent variable "use of health services in the last year" was categorized as yes vs. no. The analysis was performed using Poisson regression with robust variance. The prevalence of non-use of health services in the last year was 23.5% (IC95%: 21.1-25.9). The contextual factor "larger population" (PR: 1.6; 95% CI = 1.2-2.0) and individual factors related to the lower severity of the disease as a functional class without limitations (PR: 1.6; 95% CI = 1.2-2.1) and unaltered N-terminal pro b-type natriuretic peptide levels (PR: 2.2; 95% CI = 1.3-3.6) increased the prevalence of non-use of the health service in the last year by people with CD. The results of this study showed that individual determinants are not isolated protagonists of the non-use of health services in the last year by people with CD, which reinforces the need for public policies that consider the contextual determinants of the use of health services by populations affected by the disease.
Collapse
Affiliation(s)
- Renata Fiúza Damasceno
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
- * E-mail:
| | | | - Antonio Luiz Pinho Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | | | - Cláudia Di Lorenzo Oliveira
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health–Centro Oeste Campus, Divinópolis, Minas Gerais, Brazil
| | - Clareci Silva Cardoso
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health–Centro Oeste Campus, Divinópolis, Minas Gerais, Brazil
| | - Thallyta Maria Vieira
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Desirée Sant’ Ana Haikal
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| |
Collapse
|
14
|
Ferreira AM, Sabino EC, Silva LCDOD, Oliveira CDL, Cardoso CS, Ribeiro ALP, Damasceno RF, Leite SF, Vieira TM, Nunes MDCP, Haikal DSA. Contextual influence on poor self-rated health in patients with Chagas disease: multilevel study. Cien Saude Colet 2022; 27:2827-2842. [PMID: 35730850 PMCID: PMC9306011 DOI: 10.1590/1413-81232022277.01682022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases in the world. Self-perceived health is considered a better predictor of mortality than objective measures of health status, and the context in which one lives influences this predictor. This study aimed to evaluate the prevalence and individual and contextual factors associated with poor self-rated health among CD patients from an endemic region in Brazil. It is a multilevel cross-sectional study. The individual data come from a cross-section of a cohort study named SaMi-Trop. Contextual data was collected from publicly accessible institutional information systems and platforms. The dependent variable was self-perceived health. The analysis was performed using multilevel binary logistic regression. The study included 1,513 patients with CD, where 335 (22.1%) had Poor self-rated health. This study revealed the influence of the organization/offer of the Brazilian public health service and of individual characteristics on the self-perceived health of patients with CD.
Collapse
Affiliation(s)
- Ariela Mota Ferreira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil
| | - Ester Cerdeira Sabino
- LIM46, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. São Paulo SP Brasil
| | | | - Cláudia Di Lorenzo Oliveira
- Grupo de Pesquisa em Epidemiologia e Novas Tecnologias em Saúde, Campus CCO, Universidade Federal de São João del-Rei. Divinópolis MG Brasil
| | - Clareci Silva Cardoso
- Grupo de Pesquisa em Epidemiologia e Novas Tecnologias em Saúde, Campus CCO, Universidade Federal de São João del-Rei. Divinópolis MG Brasil
| | | | - Renata Fiúza Damasceno
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil
| | - Sâmara Fernandes Leite
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil
| | - Thallyta Maria Vieira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil
| | | | - Desirée Sant’ Ana Haikal
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil
| |
Collapse
|
15
|
Menezes AC, Silva HKC, Seixas AFAM, Cardoso CS, Rocha GM. CARACTERÍSTICAS CLÍNICAS DOS PACIENTES COM SINTOMAS RESPIRATÓRIOS AGUDOS ATENDIDOS PELO SISTEMA DE TELEATENDIMENTO DE DIVINÓPOLIS/MG (TELECOVID). Braz J Infect Dis 2022. [PMCID: PMC9363076 DOI: 10.1016/j.bjid.2021.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introdução A pandemia de COVID-19 trouxe grandes desafios para a gestão e organização dos serviços de saúde, em decorrência de sua magnitude e potencial de disseminação. Neste sentido, novas medidas de enfrentamento à pandemia foram desenvolvidas, como ferramentas tecnológicas para assistência remota e monitoramento de casos. Este trabalho busca descrever as principais características clínicas dos pacientes com sintomas respiratórios agudos atendidos pelo Sistema de Teleatendimento (TeleCOVID) do município de Divinópolis/MG. Métodos Estudo transversal com amostra obtida por meio de registros eletrônicos de pacientes com sintomas respiratórios agudos, com idade igual ou superior a 18 anos, atendidos pelo Sistema TeleCOVID-Divinópolis, no período de um ano (05/2020 a 05/2021). As consultas foram realizadas por meio de ligação telefônica por profissionais médicos e enfermeiros, com preenchimento de questionário estruturado mediado por aplicativo de Telessaúde. Foi realizada análise descritiva da população com frequência absoluta e relativa e medidas de tendência central. Resultados No período, foram atendidos 8529 pacientes, sendo 62,2% do sexo feminino e idade média de 38,4 anos (9,5% com 60+ anos). A mediana de tempo entre o início dos sintomas e o atendimento foi de quatro dias. Os principais sintomas relatados foram tosse (30,7%), febre (26,7%), cefaleia (24,9%), coriza (23,0%), anosmia (21,1%), mialgia (19,3%) e odinofagia (11,4%). Quase metade (46,1%) dos pacientes informou contato com pessoa com COVID-19 e 39,3% informaram presença de sintomas gripais em algum familiar próximo, sendo que apenas 34,8% realizaram exame específico para COVID-19 (17,9% com resultado positivo). Dentre os pacientes atendidos, 11,1% apresentavam algum sinal de alerta, 4,2% foram encaminhados para avaliação presencial em Unidade de Urgência e 3,1% para a Unidade Básica de Saúde. Conclusão Os resultados mostram que o Sistema TeleCOVID contribuiu significativamente no enfrentamento da pandemia no município, com alta resolubilidade, incentivo à adesão às medidas preventivas e redução da sobrecarga nos serviços ambulatoriais e hospitalares. Mesmo considerando que grande parte dos pacientes atendidos apresentava sintomas leves, a proporção de testagem foi muito baixa. Ferramentas de teleatendimento são consideradas estratégias eficientes para fornecer cuidados adequados e seguros, e deveriam ser incorporadas como um suporte permanente à assistência à saúde da população.
Collapse
|
16
|
Rosendo LDS, Meireles AL, Cardoso CS, Bandeira MDB, Paula WD, Barroso SM. Relação entre Perfil, Hábitos, Vivências Acadêmicas e Resiliência de Universitários. Psicol cienc prof 2022. [DOI: 10.1590/1982-3703003242788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Resumo A falta de recursos para lidar com situações desafiadoras pode dificultar o ajuste do estudante à universidade e aumentar o risco de fracasso acadêmico. Pensando nisso, o objetivo deste estudo foi verificar se há relação entre o perfil, os hábitos de vida, as vivências acadêmicas e a resiliência de graduandos das áreas da saúde e Psicologia. Trata-se de um estudo transversal e inferencial. Participaram 361 graduandos dos cursos de Biomedicina, Educação Física, Enfermagem, Farmácia, Fisioterapia, Medicina, Nutrição, Terapia Ocupacional e Psicologia, matriculados em três instituições federais de Ensino Superior do interior de Minas Gerais. Utilizou-se um questionário sociodemográfico e de hábitos de vida, a Escala de Resiliência e o Questionário de Vivências Acadêmicas - versão reduzida -, respondidos de forma on-line pelos universitários, bem como análises descritivas e correlacionais. Os resultados mostraram resiliência média para a maioria dos universitários e boa adaptação ao contexto universitário, além de relações entre a resiliência e o período cursado, estar em psicoterapia, avaliar positivamente a própria saúde e todas as dimensões das vivências acadêmicas. Conclui-se que a resiliência é uma capacidade importante para enfrentar as demandas da graduação e que é possível desenvolvê-la, especialmente durante o começo da graduação e com a adoção de intervenções focadas no autoconhecimento, na autoeficácia e em boas estratégias de enfrentamento. Desenvolver a resiliência nos estudantes pode colaborar para a promoção da saúde desta população e a redução da evasão no Ensino Superior.
Collapse
|
17
|
Brito BODF, Attia ZI, Martins LNA, Perel P, Nunes MCP, Sabino EC, Cardoso CS, Ferreira AM, Gomes PR, Luiz Pinho Ribeiro A, Lopez-Jimenez F. Left ventricular systolic dysfunction predicted by artificial intelligence using the electrocardiogram in Chagas disease patients-The SaMi-Trop cohort. PLoS Negl Trop Dis 2021; 15:e0009974. [PMID: 34871321 PMCID: PMC8675930 DOI: 10.1371/journal.pntd.0009974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/16/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022] Open
Abstract
Background Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. Objective To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%. Methodology/principal findings This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3–128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. Conclusion The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD. Chagas disease (ChD) is caused by the protozoan parasite Trypanosoma cruzi and continues to be a health problem despite the control of its transmission. ChD is a heterogeneous condition with a wide variation in its clinical course and prognosis. The majority (60%–70%) of infected individuals remain asymptomatic throughout life. Although some develop only conduction defects and mild segmental wall motion abnormalities, others develop severe symptoms of heart failure (HF), thromboembolic phenomena, and life threatening ventricular arrhythmias. HF is one of major causes of the death of patients with ChD. There is some evidence on effective drugs against the parasite in the chronic form of the disease capable of preventing long-term adverse outcomes, but it is still limited. However low-cost medications are able to reduce mortality and improve the quality of life of patients with HF. Because of the lack of tertiary care facilities outside urban centers, an automatic diagnostic tool based on the ECG, which is a relatively simple exam without requiring human interpretation, would improve the capacity to recognize HF. Recently, digital signals of the electrocardiogram were recognized by Artificial Intelligence (AI) and associated with an excellent accuracy for HF in the general population. Our results demonstrate that AI-ECG could ensure a rapid recognition of HF in patients who require a referral to a cardiologist and the use of disease-modifying drugs. AI can be used as a powerful public heath tool, it can transform the lives of 6 million patients with ChD worldwide, and it may well have a formidable impact on patient management and prognosis.
Collapse
Affiliation(s)
| | - Zachi I. Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Larissa Natany A. Martins
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Statistics, Instituto de Ciência Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Carmo P. Nunes
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ester Cerdeira Sabino
- Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Paulo R. Gomes
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- * E-mail: (ALPR); (FL-J)
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail: (ALPR); (FL-J)
| |
Collapse
|
18
|
Nunes MCP, Buss LF, Silva JLP, Martins LNA, Oliveira CDL, Cardoso CS, Brito BODF, Ferreira AM, Oliveira LC, Bierrenbach AL, Fernandes F, Busch MP, Hotta VT, Martinelli LMB, Soeiro MCFA, Brentegani A, Salemi VMC, Menezes MM, Ribeiro ALP, Sabino EC. Incidence and Predictors of Progression to Chagas Cardiomyopathy: Long-Term Follow-Up of Trypanosoma cruzi-Seropositive Individuals. Circulation 2021; 144:1553-1566. [PMID: 34565171 DOI: 10.1161/circulationaha.121.055112] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are few contemporary cohorts of Trypanosoma cruzi-seropositive individuals, and the basic clinical epidemiology of Chagas disease is poorly understood. Herein, we report the incidence of cardiomyopathy and death associated with T. cruzi seropositivity. METHODS Participants were selected in blood banks at 2 Brazilian centers. Cases were defined as T. cruzi-seropositive blood donors. T. cruzi-seronegative controls were matched for age, sex, and period of donation. Patients with established Chagas cardiomyopathy were recruited from a tertiary outpatient service. Participants underwent medical examination, blood collection, ECG, and echocardiogram at enrollment (2008-2010) and at follow-up (2018-2019). The primary outcomes were all-cause mortality and development of cardiomyopathy, defined as the presence of a left ventricular ejection fraction <50% or QRS complex duration ≥120 ms, or both. To handle loss to follow-up, a sensitivity analysis was performed using inverse probability weights for selection. RESULTS We enrolled 499 T. cruzi-seropositive donors (age 48±10 years, 52% male), 488 T. cruzi-seronegative donors (age 49±10 years, 49% male), and 101 patients with established Chagas cardiomyopathy (age 48±8 years, 59% male). The mortality in patients with established cardiomyopathy was 80.9 deaths/1000 person-years (py) (54/101, 53%) and 15.1 deaths/1000 py (17/114, 15%) in T. cruzi-seropositive donors with cardiomyopathy at baseline. Among T. cruzi-seropositive donors without cardiomyopathy at baseline, mortality was 3.7 events/1000 py (15/385, 4%), which was no different from T. cruzi-seronegative donors with 3.6 deaths/1000 py (17/488, 3%). The incidence of cardiomyopathy in T. cruzi-seropositive donors was 13.8 (95% CI, 9.5-19.6) events/1000 py (32/262, 12%) compared with 4.6 (95% CI, 2.3-8.3) events/1000 py (11/277, 4%) in seronegative controls, with an absolute incidence difference associated with T. cruzi seropositivity of 9.2 (95% CI, 3.6-15.0) events/1000 py. T. cruzi antibody level at baseline was associated with development of cardiomyopathy (adjusted odds ratio, 1.4 [95% CI, 1.1-1.8]). CONCLUSIONS We present a comprehensive description of the natural history of T. cruzi seropositivity in a contemporary patient population. The results highlight the central importance of anti-T. cruzi antibody titer as a marker of Chagas disease activity and risk of progression.
Collapse
Affiliation(s)
- Maria Carmo P Nunes
- Hospital das Clínicas and Faculdade de Medicina (M.C.P.N., B.O.d.F.B., A.L.P.R.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lewis F Buss
- Instituto de Medicina Tropical e Departamento de Moléstias Infecciosas e Parasitarias (L.F.B., E.C.S.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Jose Luiz P Silva
- Department of Statistics, Universidade Federal do Paraná, Curitiba, Brazil (J.L.P.S.)
| | - Larissa Natany A Martins
- Department of Statistics, Instituto de Ciências Exatas (L.N.A.M.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Bruno Oliveira de Figueiredo Brito
- Hospital das Clínicas and Faculdade de Medicina (M.C.P.N., B.O.d.F.B., A.L.P.R.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ariela Mota Ferreira
- Health Science Program, Universidade Estadual de Montes Claros, Brazil (A.M.F., M.M.M.)
| | - Lea Campos Oliveira
- Laboratório de Investigação Médica (LIM03), Hospital das Clinicas (L.C.O.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Ana Luiza Bierrenbach
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil (A.L.B.)
| | - Fabio Fernandes
- Instituto do Coração (F.F., V.T.H., L.M.B.M., M.C.F.A.S., A.B., V.M.C.S.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Michael P Busch
- Blood Systems Research Institute, San Francisco, CA (M.P.B.)
| | - Viviane Tiemi Hotta
- Instituto do Coração (F.F., V.T.H., L.M.B.M., M.C.F.A.S., A.B., V.M.C.S.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Luiz Mario Baptista Martinelli
- Instituto do Coração (F.F., V.T.H., L.M.B.M., M.C.F.A.S., A.B., V.M.C.S.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Maria Carolina F Almeida Soeiro
- Instituto do Coração (F.F., V.T.H., L.M.B.M., M.C.F.A.S., A.B., V.M.C.S.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Adriana Brentegani
- Instituto do Coração (F.F., V.T.H., L.M.B.M., M.C.F.A.S., A.B., V.M.C.S.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Vera M C Salemi
- Instituto do Coração (F.F., V.T.H., L.M.B.M., M.C.F.A.S., A.B., V.M.C.S.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Marcia M Menezes
- Health Science Program, Universidade Estadual de Montes Claros, Brazil (A.M.F., M.M.M.)
| | - Antonio Luiz P Ribeiro
- Hospital das Clínicas and Faculdade de Medicina (M.C.P.N., B.O.d.F.B., A.L.P.R.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ester Cerdeira Sabino
- Instituto de Medicina Tropical e Departamento de Moléstias Infecciosas e Parasitarias (L.F.B., E.C.S.), Faculdade de Medicina da Universidade de São Paulo, Brazil
| |
Collapse
|
19
|
Silva ACSD, Meireles AL, Cardoso CS, Barroso SM, Oliveira DCRD, De Paula W, Andrade MCR, Bandeira MDB. Relação entre Vivência Acadêmica e Ansiedade em Estudantes Universitários. ctc 2021. [DOI: 10.4013/ctc.2021.142.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Estudos têm investigado a ansiedade e a adaptação acadêmica em estudantes universitários, mas poucas pesquisas nacionais avaliaram a relação entre estas variáveis. O objetivo deste estudo foi avaliar o grau de adaptação acadêmica dos estudantes e suas relações com ansiedade e variáveis sociodemográficas e acadêmicas. Trata-se de Pesquisa de Levantamento (Survey), de corte transversal, parte de um estudo multicêntrico. Participaram 316 alunos da Universidade Federal de São João del-Rei, Universidade Federal de Ouro Preto e Universidade Federal do Triângulo Mineiro. Foram aplicados os seguintes instrumentos online: Questionário de Vivências Acadêmicas (QVA-r); Escala de Depressão, Ansiedade e Estresse (DASS-21) e Questionário sociodemográfico/acadêmico. Os resultados mostraram grau moderado de adaptação acadêmica, com maiores escores nas dimensões Carreira, Pessoal e Interpessoal e níveis moderados de ansiedade. Na regressão múltipla, maior nível de ansiedade foi preditor de menor adaptação acadêmica, nas dimensões Carreira, Estudo e Institucional. Para a dimensão Carreira, cursar Medicina também foi um fator preditor de menor adaptação. Para ansiedade, os fatores preditores foram: sexo feminino, cursar Enfermagem e ter menor idade. Esta pesquisa pode ser considerada um avanço na área, devido à carência de estudos nesta temática. Estudos futuros deverão incluir outras universidades e regiões do país.
Collapse
|
20
|
Oliveira CDL, Cardoso CS, Baldoni NR, Natany L, Ferreira AM, Oliveira LCD, Nunes MDCP, Quintino ND, Bierrenbach AL, Buss LF, Haikal DS, Cunha Neto E, Ribeiro ALP, Sabino EC. Cohort profile update: the main and new findings from the SaMi-Trop Chagas cohort. Rev Inst Med Trop Sao Paulo 2021; 63:e75. [PMID: 34586309 PMCID: PMC8494491 DOI: 10.1590/s1678-9946202163075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | | | - Larissa Natany
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Lea Campos de Oliveira
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Ana Luiza Bierrenbach
- Hospital Sírio-Libanês, Vital Strategies, São Paulo, São Paulo, Brazil.,Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Programa de Pós-Graduação, Goiânia, Goiás, Brazil
| | - Lewis F Buss
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Edecio Cunha Neto
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Laboratório de Imunologia, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Divisão de Imunologia Clínica e Alergia, São Paulo, São Paulo, Brazil
| | | | - Ester Cerdeira Sabino
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
21
|
Cruz DS, Souza NND, Rafael AF, Damasceno RF, Ribeiro ALP, Oliveira LCD, Sabino EC, Ghilardi FDR, Cruz Neto OC, Ferreira AM, Haikal DS, Cardoso CS, Oliveira CDL, Bierrenbach AL, Vieira TM. Serological screening for Chagas disease in an endemic region of Northern Minas Gerais, Brazil: the SaMi-Trop project. Rev Inst Med Trop Sao Paulo 2021; 63:e67. [PMID: 34495264 PMCID: PMC8428852 DOI: 10.1590/s1678-9946202163067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
Chagas disease (CD) is still a neglected disease. Infected individuals are
diagnosed late, being treated in worse clinical conditions. Thus, this study
aimed to analyze the prevalence and the factors associated with new confirmed
cases of CD identified by serological screening in an endemic region of Minas
Gerais State, Brazil. This is an analytical cross-sectional study with data from
a project of the Research Center in Tropical Medicine of Sao Paulo- Minas Gerais
(SaMi-Trop) conducted in two municipalities. Data collection included a
questionnaire with closed questions, a venous blood collection and an ELISA
serological test for CD. A total of 2,038 individuals with no previous diagnosis
of CD participated in the study. The result of the serological test for CD was
adopted as the dependent variable. The independent variables addressed personal
issues, health conditions and lifetime housing. A descriptive analysis of
individual variables was performed. Subsequently, a bivariate analysis was
performed using the Pearson’s chi-square test. Households sheltering individuals
positive for CD were georeferenced, and the analysis of spatial distribution was
performed using the quartic function to estimate the density of the nucleus.
Among the participants, 188 (9.2 %) were positive for CD. The profile of
participants with CD was associated with place of residence, age,
relative/family member with CD and living conditions. It is noteworthy that
there are still patients with CD who are unaware of their diagnosis in both,
rural and urban areas.
Collapse
Affiliation(s)
- Dardiane Santos Cruz
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, Minas Gerais, Brazil
| | - Núbia Nunes de Souza
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, Minas Gerais, Brazil
| | - Aline Ferreira Rafael
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, Minas Gerais, Brazil
| | - Renata Fiuza Damasceno
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, Minas Gerais, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas Gerais, Departamento de Medicina Interna, Belo Horizonte, Minas Gerais, Brazil
| | - Léa Campos de Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Medicina Laboratorial (LIM 03), São Paulo, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio de Rose Ghilardi
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Ariela Mota Ferreira
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, Minas Gerais, Brazil
| | - Desirée Sant'Ana Haikal
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, Minas Gerais, Brazil
| | | | | | - Ana Luiza Bierrenbach
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, São Paulo, Brazil
| | - Thallyta Maria Vieira
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros, Minas Gerais, Brazil
| |
Collapse
|
22
|
Baldoni NR, Quintino ND, Alves GCS, Oliveira CDL, Sabino EC, Ribeiro ALP, Cardoso CS. Quality of life in patients with Chagas disease and the instrument used: an integrative review. Rev Inst Med Trop Sao Paulo 2021; 63:e46. [PMID: 34161552 PMCID: PMC8216686 DOI: 10.1590/s1678-9946202163046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/08/2021] [Indexed: 01/06/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | - Ester Cerdeira Sabino
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | | | | |
Collapse
|
23
|
Ferreira AS, Baldoni NR, Cardoso CS, Oliveira CDL. Biomarkers of severity and chronification in chikungunya fever: a systematic review and meta-analysis. Rev Inst Med Trop Sao Paulo 2021; 63:e16. [PMID: 33656139 PMCID: PMC7924982 DOI: 10.1590/s1678-9946202163016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/19/2021] [Indexed: 12/28/2022] Open
Abstract
Currently, there are no biomarkers for Chikungunya fever (CHIK) in clinical practice that can accurately predict the severity or chronification of the disease. The aim of this study is to evaluate the existing literature on biomarkers related to the severity and chronification of CHIK. In this sense, a systematic review was conducted based on the PRISMA Statement guideline. Articles that described the association of biomarkers with the evolution of the disease (severity or chronification), published until August 20th 2019 were considered eligible. The search was carried out in the PubMed, Scopus, Virtual Health Library (VHL) and Science Direct databases. After searching the databases, 17 articles were added to the review, and after analyzing the articles, several biomarkers were associated with severity, such as increased levels of IL-6, IP-10, IL-1b, MIG, MCP-1, and reduced levels of RANTES and IL-8 or chronification, such as increased levels of IL-6, TNF-α, MCP-1, IL-12, INF-α, IL-13, INF-γ, GM-CSF, CRP, IL-1a, IL-15, Factor VII, IP-10, IL-10, IL-4, IL-1RA, IL-8, MIP-1α, MIP-1β, ferritin, MIG, ESR, NO, malondialdehyde, and reduced levels of RANTES, ferritin, eotaxin, HGF, IL-27, IL-17A, IL-29, TGF-β, IL-10, and thiols. IL-6, CRP and TNF-α were included in the meta-analysis to assess the relationship with chronification, although they did not reach statistical significance. It was concluded that several biomarkers showed a relationship with severity and chronification of CHIK; the search for these biomarkers can reveal prognostic factors and important therapeutic targets for the treatment of the disease.
Collapse
Affiliation(s)
- Andreia Silva Ferreira
- Universidade Federal de São João Del-Rei, Campus Centro-Oeste Dona
Lindu, Divinópolis, Minas Gerais, Brazil
| | - Nayara Ragi Baldoni
- Universidade Federal de São João Del-Rei, Campus Centro-Oeste Dona
Lindu, Divinópolis, Minas Gerais, Brazil
- Universidade de Itaúna, Itaúna, Minas Gerais, Brazil
| | - Clareci Silva Cardoso
- Universidade Federal de São João Del-Rei, Campus Centro-Oeste Dona
Lindu, Divinópolis, Minas Gerais, Brazil
| | | |
Collapse
|
24
|
Marcolino MS, Oliveira JAQ, Cimini CCR, Maia JX, Pinto VSOA, Sá TQV, Amancio K, Coelho L, Ribeiro LB, Cardoso CS, Ribeiro AL. Development and Implementation of a Decision Support System to Improve Control of Hypertension and Diabetes in a Resource-Constrained Area in Brazil: Mixed Methods Study. J Med Internet Res 2021; 23:e18872. [PMID: 33427686 PMCID: PMC7834943 DOI: 10.2196/18872] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
Background The low levels of control of hypertension and diabetes mellitus are a challenge that requires innovative strategies to surpass barriers of low sources, distance, and quality of health care. Objective The aim of this study is to develop a clinical decision support system (CDSS) for diabetes and hypertension management in primary care, to implement it in a resource-constrained region, and to evaluate its usability and health care practitioner satisfaction. Methods This mixed methods study is a substudy of HealthRise Brazil Project, a multinational study designed to implement pilot programs to improve screening, diagnosis, management, and control of hypertension and diabetes among underserved communities. Following the identification of gaps in usual care, a team of clinicians established the software functional requirements. Recommendations from evidence-based guidelines were reviewed and organized into a decision algorithm, which bases the CDSS reminders and suggestions. Following pretesting and expert panel assessment, pilot testing was conducted in a quasi-experimental study, which included 34 primary care units of 10 municipalities in a resource-constrained area in Brazil. A Likert-scale questionnaire evaluating perceived feasibility, usability, and utility of the application and professionals’ satisfaction was applied after 6 months. In the end-line assessment, 2 focus groups with primary care physicians and nurses were performed. Results A total of 159 reminders and suggestions were created and implemented for the CDSS. At the 6-month assessment, there were 1939 patients registered in the application database and 2160 consultations were performed by primary care teams. Of the 96 health care professionals who were invited for the usability assessment, 26% (25/96) were physicians, 46% (44/96) were nurses, and 28% (27/96) were other health professionals. The questionnaire included 24 items on impressions of feasibility, usability, utility, and satisfaction, and presented global Cronbach α of .93. As for feasibility, all professionals agreed (median scores of 4 or 5) that the application could be used in primary care settings and it could be easily incorporated in work routines, but physicians claimed that the application might have caused significant delays in daily routines. As for usability, overall evaluation was good and it was claimed that the application was easy to understand and use. All professionals agreed that the application was useful (score 4 or 5) to promote prevention, assist treatment, and might improve patient care, and they were overall satisfied with the application (median scores between 4 and 5). In the end-line assessment, there were 4211 patients (94.82% [3993/4211] with hypertension and 24.41% [1028/4211] with diabetes) registered in the application’s database and 7960 consultations were performed by primary health care teams. The 17 participants of the focus groups were consistent to affirm they were very satisfied with the CDSS. Conclusions The CDSS was applicable in the context of primary health care settings in low-income regions, with good user satisfaction and potential to improve adherence to evidence-based practices.
Collapse
Affiliation(s)
- Milena Soriano Marcolino
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Antonio Queiroz Oliveira
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Junia Xavier Maia
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Thábata Queiroz Vivas Sá
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kaique Amancio
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lissandra Coelho
- Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, Brazil
| | - Leonardo Bonisson Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Antonio Luiz Ribeiro
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
25
|
Rodrigues LS, Tinoco MS, Silva LGRD, Cardoso CS, Sousa LCCD, Gonçalves AMRF, Baldoni AO. Barriers and enablers to deprescribing benzodiazepines in older adults: elaborating an instrument and validating its content. Geriatr Gerontol Aging 2021. [DOI: 10.53886/gga.e0210059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To elaborate and validate an instrument on barriers and enablers to deprescribing benzodiazepines in the patient’s perspective. METHODS: This study was conducted in 3 stages: (1) a methodological stage, (2) a semi-structured pilot interview with 25 older adults undergoing clonazepam deprescribing, and (3) content validation with the Delphi technique. Content validation was performed by 50 specialists with degrees and/or experience with primary health care and/or health care of older adults, such as physicians, pharmacists, and nurses. For evaluating the obtained results, we analyzed the concordance of evaluations with the coefficient of content validity (CCV). We considered values equal to or higher than 0.8 as acceptable levels of concordance. RESULTS: The instrument was considered validated in the first round of evaluation, where all items obtained a CCV of more than 0.8 in the specialists’ assessment. Nevertheless, they proposed improvements that were incorporated to the final version of the questionnaire. CONCLUSION: The instrument represents an important tool to be used by health care professionals for optimizing benzodiazepine deprescribing, with suitable levels of clarity and validity.
Collapse
|
26
|
Cardoso CS, Baldoni NR, Melo CF, Rezende LO, Noronha K, Oliveira CDL, Quintino ND, D`Alessandro TAL, Andrade MV. Health care network for chronic conditions: an intervention and evaluation in the health system. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Health assessments are necessary for the (re) formulation of effective public policies and to guarantee the quality of care offered. This study aim to evaluate the perception of health professionals concerning the institutional capacity of the health system to care for Chronic Conditions (CC) after intervention in a medium-sized municipality in Minas Gerais, Brazil.
Methods
It is a panel study with evaluation before, during and after an intervention in the health system with a focus on three CC, i.e., i) diabetes; ii) hypertension; and iii) pregnant women. Health care professionals from primary and specialized care units were interviewed using the Assessment of Chronic Illness Care (ACIC) scale, which was applied in nine focal groups organized by health care unit.
Results
A total of 240 professionals participated of this evaluation, being 94, 63 and 82 participants in 2013, 2015 and 2018 respectively. The ACIC scores showed an positive evolution in the capacity of the health system to care for CC over the years. In the first wave the global score was 5.40 (basic capacity), while in the third wave the score was 9.38 (optimal capacity), with a significant increase in the scores (p < 0.01).
Conclusions
An important gain in the institutional capacity of the municipality was evidenced for the care of chronic conditions after intervention in the health system. Such an enhancement of the health system to operate in the CC might be sustainable over the time. Furthermore, its impact may directly reflect on the health indicators of the population.
Key messages
The results showed a strengthening of the local health system. These findings can subsidize other municipalities with a similar reality in the organization of the health care network and, consequently improve the care provided to chronic conditions.
Collapse
Affiliation(s)
- C S Cardoso
- Medicine, Federal University of São João del-Rei, Divinópolis, Brazil
| | - N R Baldoni
- Medicine, Federal University of São João del-Rei, Divinópolis, Brazil
| | - C F Melo
- Medicine, Federal University of São João del-Rei, Divinópolis, Brazil
| | - L O Rezende
- Medicine, Federal University of São João del-Rei, Divinópolis, Brazil
| | - K Noronha
- Economy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - C D L Oliveira
- Medicine, Federal University of São João del-Rei, Divinópolis, Brazil
| | - N D Quintino
- Medicine, Federal University of São João del-Rei, Divinópolis, Brazil
| | | | - M V Andrade
- Medicine, Federal University of São João del-Rei, Divinópolis, Brazil
| |
Collapse
|
27
|
Ferreira AM, Sabino ÉC, de Oliveira LC, Oliveira CDL, Cardoso CS, Ribeiro ALP, Damasceno RF, Nunes MDCP, Haikal DSA. Impact of the social context on the prognosis of Chagas disease patients: Multilevel analysis of a Brazilian cohort. PLoS Negl Trop Dis 2020; 14:e0008399. [PMID: 32598390 PMCID: PMC7351237 DOI: 10.1371/journal.pntd.0008399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/10/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
The present study aims to investigate how the social context contributes to the prognosis of Chagas disease (CD). This is a multilevel study that considered individual and contextual data. Individual data came from a Brazilian cohort study that followed 1,637 patients who lived in 21 municipalities to which CD is endemic, over two years. Contextual data were collected from official Brazilian government databases. The dependent variable was the occurrence of cardiovascular events in CD during the two-year follow-up, defined from the grouping of three possible combined events: death, development of atrial fibrillation, or pacemaker implantation. Analysis was performed using multilevel binary logistic regression. Among the individuals evaluated, 205 (12.5%) manifested cardiovascular events in CD during two years of follow-up. Individuals living in municipalities with a larger rural population had protection for these events (OR = 0.5; 95% CI = 0.4-0.7), while those residing in municipalities with fewer physicians per thousand inhabitants (OR = 1.6; 95% CI = 1.2-2.5) and those living in municipalities with lower Primary Health Care (PHC) coverage (OR = 1.4; 95% CI = 1.1-2.1) had higher chances of experiencing cardiovascular events. Among the individual variables, the probability of experiencing cardiovascular events was higher for individuals aged over 60 years (OR = 1.4; 95% CI = 1.01-2.2), with no stable relationship (OR = 1.4; 95% CI = 0.98-2.1), without previous treatment with Benznidazole (OR = 1.5; 95% CI = 0.98-2.9), with functional class limitation (OR = 2.0; 95% CI = 1.4-2.9), with a QRS complex duration longer than 120 ms (OR = 1.5; 95% CI = 1.1-2.3), and in individuals with high NT-proBNP levels (OR = 6.4; 95% CI = 4.3-9.6). CONCLUSION: The present study showed that the occurrence of cardiovascular events in individuals with CD is determined by individual conditions that express the severity of cardiovascular involvement. However, these individual characteristics are not isolated protagonists of this outcome, and the context in which individuals live, are also determining factors for a worse clinical prognosis.
Collapse
Affiliation(s)
- Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | | | | | - Cláudia Di Lorenzo Oliveira
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health–Centro Oeste Campus, Brazil
| | - Clareci Silva Cardoso
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health–Centro Oeste Campus, Brazil
| | - Antônio Luiz Pinho Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Renata Fiúza Damasceno
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | | | - Desirée Sant’ Ana Haikal
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| |
Collapse
|
28
|
Quintino ND, Sabino EC, da Silva JLP, Ribeiro ALP, Ferreira AM, Davi GL, Oliveira CDL, Cardoso CS. Factors associated with quality of life in patients with Chagas disease: SaMi-Trop project. PLoS Negl Trop Dis 2020; 14:e0008144. [PMID: 32459812 PMCID: PMC7252596 DOI: 10.1371/journal.pntd.0008144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/16/2020] [Indexed: 11/19/2022] Open
Abstract
TRIAL REGISTRATION NCT02646943.
Collapse
Affiliation(s)
- Nayara Dornela Quintino
- School of Medicine, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | | | | | | | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Gabriela Lemes Davi
- School of Medicine, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | | | - Clareci Silva Cardoso
- School of Medicine, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| |
Collapse
|
29
|
de Oliveira LC, Pereira NB, Moreira CHV, Bierrenbach AL, Salles FC, de Souza-Basqueira M, Manuli ER, Ferreira AM, Oliveira CDL, Cardoso CS, Ribeiro ALP, Sabino EC. ELISA Saliva for Trypanosoma cruzi Antibody Detection: An Alternative for Serological Surveys in Endemic Regions. Am J Trop Med Hyg 2020; 102:800-803. [PMID: 32100675 PMCID: PMC7124906 DOI: 10.4269/ajtmh.18-0330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/17/2020] [Indexed: 11/07/2022] Open
Abstract
Chagas is a neglected disease endemic in Latin America. Vector transmission control had been aggressively performed. Recent entomological surveillance in Brazil has revealed natural infection rates ranging from 0.40% to 0.52%. Although serological surveys are complex to develop, they are important for disease control. In this study, we validated the use of saliva in ELISA commercial kits with a cohort of 100 patients with Chagas disease followed at Hospital das Clinicas in São Paulo, Brazil, and 50 healthy controls. Five ELISA kits for detecting antibodies against Trypanosoma cruzi were tested. The best discrimination between Chagas patients and controls was observed with the Wiener kit, which yielded a sensitivity of 97% and a specificity of 100%. Our findings reveal that the use of saliva may be an alternative to large-scale screening surveys in detecting T. cruzi antibodies; it is a noninvasive sample collection method potentially key to large-scale screening in children.
Collapse
Affiliation(s)
- Léa Campos de Oliveira
- LIM03, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - Antonio Luiz P. Ribeiro
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | |
Collapse
|
30
|
do Nascimento IJB, Oliveira JADQ, Wolff IS, Ribeiro LD, Souza e Silva MVR, Cardoso CS, Mars M, Ribeiro AL, Marcolino MS. Use of smartphone-based instant messaging services in medical practice: a cross-sectional study. SAO PAULO MED J 2020; 138:86-92. [PMID: 32321110 PMCID: PMC9673850 DOI: 10.1590/1516-3180.2020.0010.r1.28032020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Instant messaging services (IMS) are widely used in medical practice. OBJECTIVE To evaluate perceptions regarding use and usability of IMS within clinical practice and assess users' knowledge of the ethical and legal context involved in using IMS within medical practice. DESIGN AND SETTING Cross-sectional study conducted in different hospitals and medical institutions in Minas Gerais, Brazil. METHODS Medical students, medical residents, primary care physicians and specialist doctors answered an online questionnaire regarding epidemiological data, graduation level and use of IMS for medical communication. Responses were collected over a five-month period and data were assessed using the IBM-SPSS software. RESULTS 484 people answered the questionnaire: 97.0% declared that they were using IMS for medical-related purposes; 42.0%, to elucidate medical concerns every week; 75.0%, to share imaging or laboratory tests and patients' medical records; and 90.5%, to participate in clinical case-study private groups. Moreover, only 37.0% declared that they had knowledge of the legislative aspects of use of smartphones within clinical practice. Differences in the frequency of discussion of medical concerns within the daily routine between student/residents and general practitioners/specialists, and in the frequency of image-sharing and patient-guiding/assistance between students and medical doctors, were observed. CONCLUSIONS Our results provide reliable proof that medical doctors and students use IMS, as a tool for clinical case discussions, interactions between healthcare providers and patients, or dissemination of knowledge and information. Nonetheless, because of limitations to the ethical and legal regulations, evidence-based discussions between authorities, academics and medical institutions are needed in order to fully achieve positive outcomes from such platforms.
Collapse
Affiliation(s)
- Israel Junior Borges do Nascimento
- PharmB. Medical Research Specialist, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil; and Medical Research Specialist, Medical College of Wisconsin, Milwaukee, Wisconsin, United States.
| | - João Antonio de Queiroz Oliveira
- PharmD. MSc. Pharmacist, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Iago Souza Wolff
- MD. Physician, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Laura Defensor Ribeiro
- MD. Physician, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Maíra Viana Rego Souza e Silva
- MD. Physician, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Clareci Silva Cardoso
- MD, MSc, PhD. Professor, Department of Public Health, Medical School and TeleHealth Center, Universidade Federal de São João del-Rei, Divinópolis, Brazil.
| | - Maurice Mars
- MBChB, MD. Professor, Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Antonio Luiz Ribeiro
- MD, PhD. Professor, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Milena Soriano Marcolino
- MD, MSc, PhD. Professor, Medical School and TeleHealth Center, University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| |
Collapse
|
31
|
Viegas Andrade M, Noronha K, Di Lorenzo Oliveira C, Silva Cardoso C, Almeida Calazans J, Abreu Julião N, De Souza A, Aguiar Tavares P. Análise da linha de cuidado para pacientes com diabetes mellitus e hipertensão arterial: a experiência de um município de pequeno porte no Brasil. Rev bras estud popul 2019. [DOI: 10.20947/s0102-3098a0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
O artigo avalia a linha de cuidado de uma coorte de 260 indivíduos com diabetes mellitus e 295 indivíduos com hipertensão arterial sistêmica antes, durante e após a implantação do Laboratório de Inovações na Atenção às Condições Crônicas (LIACC). Essa intervenção buscou fortalecer a atenção primária à saúde, implantando o modelo de atenção às condições crônicas no município de Santo Antônio do Monte, Minas Gerais, Brasil, entre 2013 e 2014. Trata-se de um estudo observacional longitudinal que utiliza informações clínicas e laboratoriais dos prontuários dos pacientes dessas duas condições crônicas entre 2012 e 2017. Os desfechos avaliados foram baseados nas linhas guias da Secretaria de Estado de Saúde de Minas Gerais.Os resultados evidenciam o LIACC associado à universalização de macroprocessos da atenção primária, como o cadastramento e a classificação do risco familiar. Para pacientes com diabetes houve melhora em diversos marcadores no período, como o aumento da realização de consulta (de 90% em 2012 para 92% em 2017) e diminuição dos pacientes com exames fora das faixas de normalidade. Já para indivíduos com hipertensão, mesmo sendo observado um crescimento acentuado da realização de consultas (de 80% em 2012 para 84% em 2017), as melhorias clínicas foram menos evidentes. Conclui-se que o LIACC se configura como uma promissora intervenção para a melhoria do manejo de pacientes com doenças crônicas na atenção primária à saúde.
Collapse
|
32
|
Marcolino MS, Alkmim MB, Pessoa CG, Maia JX, Cardoso CS. Development and Implementation of a Methodology for Quality Assessment of Asynchronous Teleconsultations. Telemed J E Health 2019; 26:651-658. [PMID: 31386601 DOI: 10.1089/tmj.2019.0049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There is a lack of evidence regarding audits or quality analysis of telehealth strategies in clinical practice. Our aim is to develop and implement a methodology for quality assessment of asynchronous teleconsultations. Materials and Methods: A random sample of asynchronous teleconsultations performed by the specialists from the Telehealth Network of Minas Gerais (TNMG), a public telehealth service in Brazil, was selected. The responses were evaluated regarding size, objectivity, quality, ethics, courtesy, and grammar, and received a score for each category: 1 = fair, 2 = moderate, and 3 = good. As each domain has a different importance in rating the overall quality of teleconsultation, each one was assigned a different weight, and a final score was calculated. Results: A total of 576 teleconsultations were assessed. Overall, the scores were good or moderate for all items. Only a few cases were classified as fair. Among medical specialties, pediatrics was the one that proportionally received the highest number of fair classifications, and the item "quality of the answers" was the one with highest number of worse classifications for this specialty. Corrective actions were implemented. With regard to the nonmedical specialties, the majority of the items were classified as good or moderate, and in rare cases some items received the fair rating. Conclusion: The methodology showed to be useful to evaluate the teleconsultation service. We established six domains that we considered important components to be assessed. This assessment was essential to identify the priority areas to receive correct actions. It may be easily replicated in other services worldwide.
Collapse
Affiliation(s)
- Milena Soriano Marcolino
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Beatriz Alkmim
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Cristiane Guimarães Pessoa
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Junia Xavier Maia
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Clareci Silva Cardoso
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil.,Department of Medicine, Universidade Federal de São João del-Rei, Divinópolis, Brazil
| |
Collapse
|
33
|
Oliveira LCD, Lee TH, Ferreira AM, Bierrenbach AL, Souza-Basqueira MD, Oliveira CDL, Cardoso CS, Moreira CHV, Oikawa MK, Ribeiro ALP, Busch MP, Sabino EC. Lack of evidence of seronegative infection in an endemic area of Chagas disease. Rev Inst Med Trop Sao Paulo 2019; 61:e11. [PMID: 30785565 PMCID: PMC6376933 DOI: 10.1590/s1678-9946201961011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022] Open
Abstract
The diagnosis of Chagas disease is based on the detection of Trypanosoma cruzi (T. cruzi)-specific antibodies. Nonetheless, there is concern about the sensitivity of current serological assays due to reports of T. cruzi PCR positivity among seronegative individuals. The aim of this study was to evaluate if T. cruzi seronegative infections occur in endemic areas. We recruited 2,157 individuals that were identified as having Chagas disease in a public health system database of an endemic region in Brazil. All participants were interviewed and 2,091 had a sample collected for serological and PCR testing. From these, 149 (7.1%) had negative serological results. PCR was positive in 610 samples (31.4%) of the 1,942 seropositive samples but in none of the 149 samples from seronegative participants. True T. cruzi seronegative infections seem to be rare (95% CI 0-3.7) and should not be a concern for blood supply, which relies on antibody screening.
Collapse
Affiliation(s)
- Léa Campos de Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, LIM 03, São Paulo, São Paulo, Brazil
| | - Tzong-Hae Lee
- Blood Systems Research Institute, San Francisco, California, USA
| | | | - Ana Luiza Bierrenbach
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, São Paulo, Brazil
| | | | | | | | - Carlos Henrique Valente Moreira
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.,Instituto de Infectologia Emílio Ribas, São Paulo, São Paulo, Brazil
| | | | - Antonio Luiz P Ribeiro
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Hospital das Clínicas, Belo Horizonte, Minas Gerais, Brazil
| | - Michael P Busch
- Blood Systems Research Institute, San Francisco, California, USA
| | - Ester Cerdeira Sabino
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
34
|
Aquino JA, Baldoni AO, Di Lorenzo Oliveira C, Cardoso CS, de Figueiredo RC, Sanches C. Pharmacotherapeutic empowerment and its effectiveness in glycemic control in patients with Diabetes Mellitus. Diabetes Metab Syndr 2019; 13:137-142. [PMID: 30641686 DOI: 10.1016/j.dsx.2018.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/01/2018] [Indexed: 01/22/2023]
Abstract
AIMS To develop an intervention and evaluate its effectiveness in pharmacotherapeutic empowerment of patients with type 2 diabetes mellitus (T2DM). METHOD This is an intervention study with before and after evaluation. The intervention was conducted between 2015 and 2016 with users of the Unified Health System (SUS) in Brazil. The study was divided into six stages: initial evaluation, three individual patient-pharmacist meetings every 15 days over 6 weeks, clinical discussion between pharmacists, and final evaluation. At each meeting with the patient, specific themes for empowerment were addressed using educational booklets and pharmaceutical care. Clinical and laboratory evaluations and questionnaires on self-efficacy (IMDSES), self-care (QAD) and distress (PAID-5) were conducted before and three months after the intervention. RESULTS 47 patients completed the intervention. Glycated hemoglobin of patients had a median reduced from 7.0% to 6.6% after the intervention (p = 0.02). There was a significant difference (p < 0.01) in the reduction in total cholesterol, fasting glycemia, creatinine and blood pressure. Participants showed significant improvements (p < 0.01) in scores related to self-efficacy and self-care and less distress related to T2DM. CONCLUSION The results of the study suggest that the strategy developed is effective in promoting the empowerment of T2DM patients, improved glycemic control and self-care.
Collapse
Affiliation(s)
- Jéssica Azevedo Aquino
- Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil
| | - André Oliveira Baldoni
- Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil
| | - Cláudia Di Lorenzo Oliveira
- Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil
| | - Clareci Silva Cardoso
- Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil
| | - Roberta Carvalho de Figueiredo
- Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil
| | - Cristina Sanches
- Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil.
| |
Collapse
|
35
|
Cardoso CS, Ribeiro ALP, Oliveira CDL, Oliveira LC, Ferreira AM, Bierrenbach AL, Silva JLP, Colosimo EA, Ferreira JE, Lee TH, Busch MP, Reingold AL, Sabino EC. Beneficial effects of benznidazole in Chagas disease: NIH SaMi-Trop cohort study. PLoS Negl Trop Dis 2018; 12:e0006814. [PMID: 30383777 PMCID: PMC6211620 DOI: 10.1371/journal.pntd.0006814] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/03/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD) remains uncertain. We evaluated, using data from the NIH-sponsored SaMi-Trop prospective cohort study, if previous treatment with benznidazole is associated with lower mortality, less advanced cardiac disease and lower parasitemia in patients with chronic ChD. METHODS The study enrolled 1,959 ChD patients and abnormal electrocardiogram (ECG) from in 21 remote towns in Brazil. A total of 1,813 patients were evaluated at baseline and after two years of follow-up. Those who received at least one course of benznidazole were classified as treated group (TrG = 493) and those who were never treated as control group (CG = 1,320). The primary outcome was death after two-year follow-up; the secondary outcomes were presence at the baseline of major ChD-associated ECG abnormalities, NT-ProBNP levels suggestive of heart failure, and PCR positivity. RESULTS Mortality after two years was 6.3%; it was lower in the TrG (2.8%) than the CG (7.6%); adjusted OR: 0.37 (95%CI: 0.21;0.63). The ECG abnormalities typical for ChD and high age-adjusted NT-ProBNP levels suggestive of heart failure were lower in the TrG than the CG, OR: 0.35 [CI: 0.23;0.53]. The TrG had significantly lower rates of PCR positivity, OR: 0.35 [CI: 0.27;0.45]. CONCLUSION Patients previously treated with benznidazole had significantly reduced parasitemia, a lower prevalence of markers of severe cardiomyopathy, and lower mortality after two years of follow-up. If used in the early phases, benznidazole treatment may improve clinical and parasitological outcomes in patients with chronic ChD. TRIAL REGISTRATION ClinicalTrials.gov, Trial registration: NCT02646943.
Collapse
Affiliation(s)
- Clareci Silva Cardoso
- School of Medicine, Federal University of São João del-Rei, Divinópolis, Brazil
- * E-mail:
| | | | | | | | | | | | | | | | | | - Tzong-Hae Lee
- Blood Systems Research Institute and University of California, San Francisco, California, United States of America
| | - Michael P. Busch
- Blood Systems Research Institute and University of California, San Francisco, California, United States of America
| | - Arthur Lawrence Reingold
- Department of Epidemiology, University of California, Berkeley, California, United States of America
| | | |
Collapse
|
36
|
Brito BODF, Pinto-Filho MM, Cardoso CS, Di Lorenzo Oliveira C, Ferreira AM, de Oliveira LC, Gomes P, Nunes MDCP, Sabino EC, Ribeiro ALP. Association between typical electrocardiographic abnormalities and NT-proBNP elevation in a large cohort of patients with Chagas disease from endemic area. J Electrocardiol 2018; 51:1039-1043. [PMID: 30497727 PMCID: PMC7001888 DOI: 10.1016/j.jelectrocard.2018.08.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/20/2022]
Abstract
Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram is a well-studied exam and has been considered an important tool for detection and evaluation of Chagas cardiomyopathy since the first years of its description. Many of its abnormalities have been described as associated with a worse prognosis. Serum BNP levels were described as inversely related to the left ventricular ejection fraction and as an independent predictor of death. It was not reported how electrocardiographic alterations correlate to NT-proBNP and its analog. The present study aims to describe the baseline electrocardiograms of a large cohort of patients with Chagas disease from endemic area and to establish an association between the number of electrocardiogram alterations and high levels of NT-ProBNP in Chagas disease patients. This study selected 1959 Chagas disease patients in 21 municipalities within a limited region in the northern part of the State of Minas Gerais (Brazil), 1084 of them had Chagas cardiomyopathy. NT-proBNP levels were suggestive of heart failure in 11.7% of this population. One or more electrocardiographic alterations have an Odds Ratio of 9.12 (CI 95% 5.62-14.80) to have NT-proBNP elevation. Considering the association between the number of 1, 2, and 3 or more alterations in electrocardiogram and NT-proBNP elevation, the ORs were 7.11 (CI 95% 4.33-11.67); 16.04 (CI 95% 9.27-27.77) and 47.82 (CI 95% 17.98-127.20), respectively. The presence and the number of typical electrocardiographic alterations of Chagas disease are independently associated with the severity of the cardiomyopathy.
Collapse
Affiliation(s)
- Bruno Oliveira de Figueiredo Brito
- Programa de Pós-graduação Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Marcelo Martins Pinto-Filho
- Programa de Pós-graduação Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | | | | | - Lea Campos de Oliveira
- Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Paulo Gomes
- Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Brazil
| | - Maria do Carmo Pereira Nunes
- Programa de Pós-graduação Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Programa de Pós-graduação Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Minas Gerais, Brazil; Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Brazil.
| |
Collapse
|
37
|
Marcolino MS, Oliveira JADQ, Silva GKME, Dias TD, Marino BCA, Antunes AP, Ribeiro AL, Cardoso CS. Satisfaction of Emergency Physicians with the Care Provided to Patients with Cardiovascular Diseases in the Northern Region of Minas Gerais. Arq Bras Cardiol 2018; 111:151-159. [PMID: 30183981 PMCID: PMC6122911 DOI: 10.5935/abc.20180143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/26/2018] [Accepted: 04/11/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The dissatisfaction of health professionals in emergency services has a negative influence on both the quality of care provided for acute myocardial infarction (AMI) patients and the retention of those professionals. OBJECTIVE To assess physicians' satisfaction with the structure of care and diagnosis at the emergency services in the Northern Region of Minas Gerais before the implementation of the AMI system of care. METHODS This cross-sectional study included physicians from the emergency units of the ambulance service (SAMU) and level II, III and IV regional hospitals. Satisfaction was assessed by using the CARDIOSATIS-Team scale. The median score for each item, the overall scale and the domains were calculated and then compared by groups using the non-parametric Mann-Whitney test. Correlation between time since graduation and satisfaction level was assessed using Spearman correlation. A p value < 0.05 was considered significant. RESULTS Of the 137 physicians included in the study, 46% worked at SAMU. Most of the interviewees showed overall dissatisfaction with the structure of care, and the median score for the overall scale was 2.0 [interquartile range (IQR) 2.0-4.0]. Most SAMU physicians expressed their dissatisfaction with the care provided (54%), the structure for managing cardiovascular diseases (52%), and the technology available for diagnosis (54%). The evaluation of the overall satisfaction evidenced that the dissatisfaction of SAMU physicians was lower when compared to that of hospital emergency physicians. Level III/IV hospital physicians expressed greater overall satisfaction when compared to level II hospital physicians. CONCLUSION This study showed the overall dissatisfaction of the emergency physicians in the region assessed with the structure of care for cardiovascular emergencies.
Collapse
Affiliation(s)
- Milena Soriano Marcolino
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
| | - João Antonio de Queiroz Oliveira
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
| | - Grace Kelly Matos e Silva
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Thatiane Dantas Dias
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Barbara Campos Abreu Marino
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | - Antonio Luiz Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
| | | |
Collapse
|
38
|
Zrein M, Granjon E, Gueyffier L, Caillaudeau J, Liehl P, Pottel H, Cardoso CS, Oliveira CDL, de Oliveira LC, Lee TH, Ferreira AM, Ribeiro ALP, Busch MP, Sabino EC. A novel antibody surrogate biomarker to monitor parasite persistence in Trypanosoma cruzi-infected patients. PLoS Negl Trop Dis 2018; 12:e0006226. [PMID: 29425201 PMCID: PMC5823467 DOI: 10.1371/journal.pntd.0006226] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/22/2018] [Accepted: 01/09/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Trypanosoma cruzi parasite, the causative agent of Chagas disease, infects about six million individuals in more than 20 countries. Monitoring parasite persistence in infected individuals is of utmost importance to develop and evaluate treatments to control the disease. Routine screening for infected human individuals is achieved by serological assays; PCR testing to monitor spontaneous or therapy-induced parasitological cure has limitations due to the low and fluctuating parasitic load in circulating blood. The aim of the present study is to evaluate a newly developed antibody profiling assay as an indirect method to assess parasite persistence based on waning of antibodies following spontaneous or therapy-induced clearance of the infection. METHODOLOGY/PRINCIPAL FINDINGS We designed a multiplex serology assay, an array of fifteen optimized T. cruzi antigens, to evaluate antibody diversity in 1654 serum samples from chronic Chagas patients. One specific antibody response (antibody 3, Ab3) showed a strong correlation with T. cruzi parasite persistence as determined by T. cruzi PCR positive results. High and sustained Ab3 signal was strongly associated with PCR positivity in untreated patients, whereas significant decline in Ab3 signals was observed in BZN-treated patients who cleared parasitemia based on blood PCR results. CONCLUSION/SIGNIFICANCE Ab3 is a new surrogate biomarker that strongly correlates with parasite persistence in chronic and benznidazole-treated Chagas patients. We hypothesize that Ab3 is induced and maintained by incessant stimulation of the immune system by tissue-based and shed parasites that are not consistently detectable by blood based PCR techniques. Hence, a simple immunoassay measurement of Ab3 could be beneficial for monitoring the infectious status of seropositive patients.
Collapse
Affiliation(s)
- Maan Zrein
- R&D, INFYNITY BIOMARKERS SAS, Lyon, France
| | | | | | | | | | - Hans Pottel
- Faculty of Medicine, University of Leuven (KULAK), Kortrijk, Belgium
| | - Clareci Silva Cardoso
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-campus CCO, São João del-Rei, Brazil
| | - Claudia Di Lorenzo Oliveira
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-campus CCO, São João del-Rei, Brazil
| | - Lea Campos de Oliveira
- Instituto de Medicina Tropical e Faculdade de Medicina (FMUSP) da Universidade de São Paulo, São Paulo, Brazil
- Laboratorio de Investigação Médica (LIM03), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paolo, Brazil
| | - Tzong-Hae Lee
- Blood Systems Research Institute and University of California, San Francisco, California, United States of America
| | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| | - Antonio Luiz P. Ribeiro
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Michael P. Busch
- Blood Systems Research Institute and University of California, San Francisco, California, United States of America
| | - Ester Cerdeira Sabino
- Instituto de Medicina Tropical e Faculdade de Medicina (FMUSP) da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
39
|
Flôr CR, Oliveira CDL, Cardoso CS, Rabelo CF, Gontijo BL, Carvalho SFD, Bretas PMC, Silva HC, Pereira ML, Pádua CMD. Primary health care as assessed by health professionals: comparison of the traditional model versus the Family Health Strategy. Rev bras epidemiol 2017; 20:714-726. [DOI: 10.1590/1980-5497201700040013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/18/2017] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT: Introduction: The Family Health Strategy (FHS) should be first-contact care in the Brazilian Health System. However, Primary Health Care (PHC) still encompasses two models: the FHS and the traditional health care facilities. The expansion of the FHS has been slow and heterogeneous in many cities, rendering a comparative evaluation of key quality-related elements of PHC models crucial. Objective: To compare the performance of PHC models as perceived by health professionals. Methods: A cross-sectional study involving managers and health professionals from PHC of a medium-size city in South-eastern Brazil. Data were collected by applying the Primary Care Assessment Tool. The performance was estimated through primary health care indexes (general and partial PHCI by attributes). Univariate polytomous logistic regression was performed to compare care model performances according to their attributes. Strength of association was estimated by odds ratio with 95% confidence interval. Results: Three managers and 81 health professionals participated in the study. The FHS had a better index rating than the traditional care model for general PHCI and for the attributes longitudinality, comprehensiveness, family focus and professional level. Conclusion: Although the FHS attained higher scores compared to the traditional model, it has not yet achieved the performance expected. This scenario points to the need for increased FHS cover and quality improvements at the existing units.
Collapse
|
40
|
Oliveira CDL, Rocha KSC, Costa EM, Almeida RC, Faria ML, Aquino JA, Cabral HK, Barbosa-Júnior AR, Sakamoto RY, Cardoso CS. Perfil clínico do paciente diabético após internação devido a complicação por condição sensível à atenção primária. Rev Fac Ciênc Méd Sorocaba 2017. [DOI: 10.23925/1984-4840.2017v19i3a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objetivos: Avaliar clinicamente e classificar de acordo com o risco de novas complicações pacientes portadores de diabetes mellitus tipo 2 após internação hospitalar por condição sensível à atenção primária. Métodos: Foi conduzido um estudo transversal. Pacientes foram avaliados após 18 meses de internação. Foi aplicado um questionário com questões sociodemográficas e clínicas, avaliação clínica e laboratorial, além de eletrocardiograma. Um escore representado pelo somatório dos riscos cardiovascular, doença renal crônica e pé diabético foi elaborado. Um modelo de regressão linear foi ajustado para avaliar sexo e idade como fatores associados a uma maior probabilidade de aumento do escore. Resultados: Dentre os 98 pacientes elegíveis 37 foram entrevistados. A taxa de mortalidade observada 18 meses após a internação foi 32,6% (32/98). Sexo masculino e maior idade se apresentaram como fatores associados com um maior risco de complicações. Quando comparados, homens tiveram 3,89 mais pontos no escore do que as mulheres e a cada ano de idade representou um aumento de 16 pontos a mais. Discussão: Pacientes que foram internados por complicações sensíveis à atenção primária apresentaram alta mortalidade, avaliação clínica e quadro grave com alto risco para o desenvolvimento de novas complicações e piora das existentes. Conclusão: Os resultados apontam para uma situação de risco em que a hospitalização não representou uma mudança no acompanhamento clínico desses pacientes, mostrando a falta de diálogo entre a atenção terciária e a primária.
Collapse
|
41
|
Baldoni NR, Aquino JA, Sanches-Giraud C, Di Lorenzo Oliveira C, de Figueiredo RC, Cardoso CS, Santos TR, Alves GCS, Dal Fabbro AL, Baldoni AO. Collective empowerment strategies for patients with Diabetes Mellitus: A systematic review and meta-analysis. Prim Care Diabetes 2017; 11:201-211. [PMID: 27780683 DOI: 10.1016/j.pcd.2016.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/17/2016] [Accepted: 09/25/2016] [Indexed: 12/17/2022]
Abstract
AIMS To perform a systematic review and meta-analysis to identify and analyze collective empowerment strategies for patients with Diabetes Mellitus (DM). METHODS The systematic review was performed using PubMed/MEDLINE, Science Direct and BVS. The term "Diabetes Mellitus" was used with each of the following describers, along with the connector "AND": "self-care", "health education", "motivation" and "empowerment". Inclusion criteria were: intervention study with control group published between 2004 and 2014. For meta-analysis, RevMan V 5.3 software was used. RESULTS Among the nine analyzed articles, 66.7% (n=6) were developed in patients diagnosed with DM2. Concerning the indicators for intervention effectiveness evaluation, all articles (n=9) used glycated hemoglobin (HbA1c) and the most used instrument was Summary of Diabetes Self Care Activities Measure, representing 44.4% (n=4) of the studies. The types of strategies used were similar in the articles. There was evidence of a decrease in HbA1c levels in 66.7% (n=6). The meta-analysis found significant evidence indicating beneficial effects of empowerment. CONCLUSIONS Programs based on collective empowerment in DM have shown the interventions lead to improvement in clinical parameters, behavior, increased knowledge about DM, and self-care.
Collapse
MESH Headings
- Biomarkers/blood
- Blood Glucose/metabolism
- Chi-Square Distribution
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Glycated Hemoglobin/analysis
- Health Knowledge, Attitudes, Practice
- Humans
- Motivation
- Patient Education as Topic
- Patient Participation/methods
- Self Care
- Treatment Outcome
Collapse
Affiliation(s)
- Nayara Ragi Baldoni
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, Monte Alegre, CEP 14049-900 Ribeirão Preto, SP, Brazil.
| | - Jéssica Azevedo Aquino
- Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296 Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil.
| | - Cristina Sanches-Giraud
- Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296 Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil.
| | - Cláudia Di Lorenzo Oliveira
- Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296 Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil.
| | - Roberta Carvalho de Figueiredo
- Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296 Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil.
| | - Clareci Silva Cardoso
- Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296 Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil.
| | - Thiago Reis Santos
- Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296 Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil.
| | - Geisa Cristina Silva Alves
- Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296 Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil.
| | - Amaury Lelis Dal Fabbro
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, Monte Alegre, CEP 14049-900 Ribeirão Preto, SP, Brazil.
| | - André Oliveira Baldoni
- Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296 Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil.
| |
Collapse
|
42
|
Ferreira AM, Sabino EC, de Oliveira LC, Oliveira CDL, Cardoso CS, Ribeiro ALP, Haikal DS. Benznidazole Use among Patients with Chronic Chagas' Cardiomyopathy in an Endemic Region of Brazil. PLoS One 2016; 11:e0165950. [PMID: 27855177 PMCID: PMC5113907 DOI: 10.1371/journal.pone.0165950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/20/2016] [Indexed: 01/15/2023] Open
Abstract
Chagas disease (CD) is a neglected tropical disease that affects individuals in almost every country in Latin America. There are two available drugs with antiparasitic profiles; however, only benznidazole (BZN) has been approved for commercialization in Brazil. The usefulness of prescribing BZN for patients with chronic Chagas cardiomyopathy (CCC) is controversial. There are no studies in the literature describing the extent of BZN use at this stage or the profile of patients using this drug. The present study aimed to determine the prevalence and factors associated with previous BZN use among individuals with CCC. This cross-sectional study was conducted with 1,812 individuals with CCC from 21 Brazilian cities endemic for CD. The dependent variable was "prior use of BZN" (no vs. yes). The independent variables were grouped into socioeconomic, lifestyle and medical history aspects. Binary logistic regression (α ≥ 0.05) was used. Among the evaluated individuals, 27.2% reported previous use of BZN. The likelihood of prior use of BZN was higher among younger individuals (OR = 2.7), individuals with a higher education (OR = 2.7), individuals with a lower monthly per capita income (OR = 1.3), individuals who practiced physical exercise (OR = 1.5), individuals who had prior knowledge of the CD diagnosis (OR = 2.5), individuals without hypertension (OR = 1.3) and individuals with a longer time to the CD diagnosis (OR = 6.1). The present study revealed a small proportion of therapeutic BZN use among Brazilian CCC patients. This finding suggests a late diagnosis and undertreatment of the disease. BZN use was higher among individuals with better clinical and demographic conditions but with a lower income and a longer time to the CD diagnosis. Knowledge of the BZN usage profile may help reduce the current state of neglect of this disease and pave the way for future studies.
Collapse
Affiliation(s)
- Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Institute of the University of São Paulo, University of São Paulo (Universidade de São Paulo), São Paulo, São Paulo, Brazil
| | - Lea Campos de Oliveira
- Medical Investigation Laboratories-03 Clinics Hospital, Medical School, University of São Paulo (Universidade de São Paulo), São Paulo, São Paulo, Brazil
| | - Cláudia Di Lorenzo Oliveira
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-campus CCO, São João del-Rei, Brazil
| | - Clareci Silva Cardoso
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-campus CCO, São João del-Rei, Brazil
| | - Antônio Luiz Pinho Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais (Universidade Federal de Minas Gerais), Belo Horizonte, Minas Gerais, Brazil
| | - Desirée Sant’Ana Haikal
- Graduate Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| |
Collapse
|
43
|
Dos Santos de Sá F, Di Lorenzo Oliveira C, de Moura Fernandino D, Menezes de Pádua CA, Cardoso CS. Assessment of primary health care from the perspective of patients hospitalized for ambulatory care sensitive conditions. Fam Pract 2016; 33:243-8. [PMID: 26628635 DOI: 10.1093/fampra/cmv096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The hospitalization for ambulatory care sensitive conditions (ACSC) has been used to assess the effectiveness of primary health care (PHC). Due to the existence of different models of organization of PHC in Brazil, it is important to develop indicators and tools for their assessment. OBJECTIVE Assessment PHC from the perspective of patients hospitalized for ACSC. METHODS A cross-sectional study was carried out. The patients were interviewed for assessment of PHC quality using the primary care assessment tool and a questionnaire. Descriptive analyses were performed and the Primary Health Care Index (PHCI) was calculated according to the health service modality, either the traditional primary health care (TPHC) or the Family Health Program (FHP). The PHCI of the two health care models were compared. RESULTS A total of 314 ACSC patients were interviewed 26.4% from the FHP and 73.6% from the TPHC. In general, the PHCI dimension with the lowest score was health service access. There was no significant difference in the general PHCI for the two modalities of services (P = 0.16); however, comprehensiveness was better assessed in the TPHC, while longitudinality, family focus and community orientation were better evaluated by FHP users (P ≤ 0.05). CONCLUSION The FHP was found to be better qualified to establish longitudinality in the community, an important dimension for continued care. However, promoting access to and consolidating a proactive care model focussed on family shows to be a great challenge for the implementation of a quality and resolutive PHC in large urban centres.
Collapse
Affiliation(s)
- Francisco Dos Santos de Sá
- Research Group in Epidemiology and Evaluation of New Technology in Health, CNPq/UFSJ, Medical School, Federal University of de São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Cláudia Di Lorenzo Oliveira
- Research Group in Epidemiology and Evaluation of New Technology in Health, CNPq/UFSJ, Medical School, Federal University of de São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Débora de Moura Fernandino
- Research Group in Epidemiology and Evaluation of New Technology in Health, CNPq/UFSJ, Medical School, Federal University of de São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Cristiane A Menezes de Pádua
- Research Group in Epidemiology and Evaluation of New Technology in Health, CNPq/UFSJ, Medical School, Federal University of de São João del-Rei, Divinópolis, Minas Gerais, Brazil, Department of Social Pharmacy, Federal Universidade of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil and
| | - Clareci Silva Cardoso
- Research Group in Epidemiology and Evaluation of New Technology in Health, CNPq/UFSJ, Medical School, Federal University of de São João del-Rei, Divinópolis, Minas Gerais, Brazil, School of Public Health, University of California, Berkeley, CA, USA.
| |
Collapse
|
44
|
Soriano Marcolino M, Minelli Figueira R, Pereira Afonso Dos Santos J, Silva Cardoso C, Luiz Ribeiro A, Alkmim MB. The Experience of a Sustainable Large Scale Brazilian Telehealth Network. Telemed J E Health 2016; 22:899-908. [PMID: 27167901 DOI: 10.1089/tmj.2015.0234] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Brazil, the majority of healthcare resources are concentrated in the largest cities, whereas most communities lack proper healthcare assistance in primary care and have difficulties accessing specialists and diagnostic examinations. Considering this, the Telehealth Network of Minas Gerais (TNMG) was created. It is a public telehealth initiative that provides support to primary healthcare (PHC), performing teleconsultation and telediagnosis (electrocardiogram [ECG], Holter, ambulatory blood pressure monitoring, spirometry, and retinography analysis) mainly for small and remote cities in the state of Minas Gerais, Brazil. PURPOSE To describe the successful experience of the TNMG in 10 years of activities. METHODS The TNMG was created in 2005 and supported PHC in 82 cities as a research project and was progressively expanded. A methodology for implementation and maintenance was developed, including quality control. Nowadays it provides support to 750 cities, 88.0% of Minas Gerais state. The examinations performed by the PHC team, with additional basic clinical data, are transmitted through the Internet to the TNMG specialists for remote interpretation. The TNMG teleconsultations system has been used by the PHC team to address written clinical questions to university staff. RESULTS Until December 2015, 2,464,999 ECGs and 73,698 teleconsultations have already been performed: on average, 2,000 ECGs and 40 teleconsultations per day in 2015. More than 95% of users have declared to be satisfied or very satisfied with the service. A recent cost-benefit analysis of the project showed that for each dollar invested, 6.1 dollars are saved as a consequence of patient referral reduction. CONCLUSIONS The TNMG is a successful example of a sustainable telehealth service, integrated to primary care centers of remote and small cities. It overcomes geographical barriers to provide specialized healthcare, reducing the number of unnecessary referrals, and contributing to improve the case-resolving capacity and the quality of the PHC.
Collapse
Affiliation(s)
- Milena Soriano Marcolino
- 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
- 2 Medical School, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
| | - Renato Minelli Figueira
- 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Julia Pereira Afonso Dos Santos
- 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
- 2 Medical School, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
| | - Clareci Silva Cardoso
- 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
- 3 Universidade Federal de São João del-Rei , Divinópolis, Brazil
| | - Antonio Luiz Ribeiro
- 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
- 2 Medical School, Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
| | - Maria Beatriz Alkmim
- 1 Telehealth Center, University Hospital , Universidade Federal de Minas Gerais and Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
45
|
Cardoso CS, Sabino EC, Oliveira CDL, de Oliveira LC, Ferreira AM, Cunha-Neto E, Bierrenbach AL, Ferreira JE, Haikal DS, Reingold AL, Ribeiro ALP. Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile. BMJ Open 2016; 6:e011181. [PMID: 27147390 PMCID: PMC4861110 DOI: 10.1136/bmjopen-2016-011181] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants. PARTICIPANTS The study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension, and one-third of them had diabetes mellitus. N-terminal of the prohormone BNP (NT-ProBNP) level was >300 pg/mL in 30% of the sample. FINDINGS TO DATE Clinical and laboratory markers predictive of severe and progressive Chagas disease were identified as high NT-ProBNP levels, as well as symptoms of advanced heart failure. These results confirm the important residual morbidity of Chagas disease in the remote areas, thus supporting political decisions that should prioritise in addition to epidemiological surveillance the medical treatment of chronic Chagas cardiomyopathy in the coming years. The São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) represents a major challenge for focused research in neglected diseases, with knowledge that can be applied in primary healthcare. FUTURE PLANS We will continue following this patients' cohort to provide relevant information about the development and progression of Chagas disease in remotes areas, with social and economic inequalities. TRIAL REGISTRATION NUMBER NCT02646943; Pre-results.
Collapse
Affiliation(s)
- Clareci Silva Cardoso
- Federal University of São João del-Rei, Brazil
- University of California, Berkeley, California, USA
| | - Ester Cerdeira Sabino
- Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Lea Campos de Oliveira
- Laboratory of Medicine Laboratorial (LIM03), General Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ariela Mota Ferreira
- Health Science Programme, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Edécio Cunha-Neto
- Laboratory of Immunology, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology, iii-INCT, São Paulo, Brazil
| | - Ana Luiza Bierrenbach
- Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - João Eduardo Ferreira
- Institute of Mathematics and Statistics (IME), University of São Paulo, São Paulo, Brazil
| | - Desirée Sant'Ana Haikal
- Health Science Programme, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | | | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
46
|
Maia JX, de Sousa LAP, Marcolino MS, Cardoso CS, da Silva JLP, Alkmim MBM, Ribeiro ALP. The Impact of a Clinical Decision Support System in Diabetes Primary Care Patients in a Developing Country. Diabetes Technol Ther 2016; 18:258-63. [PMID: 26840128 DOI: 10.1089/dia.2015.0253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Telehealth strategies have the potential to improve diabetes care, but there is a lack of evidence about the impact of these strategies in developing countries. Our objective was to analyze the feasibility, usability, and clinical impact of a decision support system (DSS) in Brazilian primary care diabetes patients. MATERIALS AND METHODS This was a quasi-experimental study that included type 2 diabetes primary care patients >40 years of age. Patients were assessed before (during 6 months) and after the implementation of the DSS application (4 months). The DSS application, used by health professionals, included clinical evaluations and blood glucose measurements and generated specific recommendations based on the data entered. RESULTS In total, 145 patients were included (mean age, 62.0 ± 9.9 years), 62.1% were female, and 70.0% had been diagnosed with diabetes more than 5 years ago. Overall, there was no decrease in median hemoglobin A1c (HbA1c), from 7.7% (range, 6.5-9.8%) to 7.4% (range, 6.5-9.2%) (P for slope = 0.347). Subgroup analysis showed that patients with an HbA1c level of ≥9% at baseline had a significant reduction in median HbA1c level, from 10.5% (range, 9.9-11.3%) to 10.0% (range, 8.9-10.9%) (P for difference of slope between subgroups = 0.004). The reduction occurred in the first phase of the study, before the DSS use. Healthcare practitioners considered the DSS easy to use (99%) and believed that it provided useful information for patient care (100%). CONCLUSIONS In this study the improvement of glycemic control before the application in more decompensated patients (HbA1c ≥9%) probably reflects the systematization of diabetes care. The DSS use did not improve the HbA1c level, possibly because of the short follow-up and/or infrequent use by the healthcare practitioners.
Collapse
Affiliation(s)
- Júnia Xavier Maia
- 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil
| | | | - Milena Soriano Marcolino
- 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil
- 2 Medical School and Clinical Hospital, Federal University of Minas Gerais , Minas Gerais, Belo Horizonte, Brazil
| | - Clareci Silva Cardoso
- 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil
- 3 Federal University of São João Del-Rey , Divinópolis, Minas Gerais, Brazil
| | | | - Maria Beatriz Moreira Alkmim
- 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil
- 2 Medical School and Clinical Hospital, Federal University of Minas Gerais , Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Luiz Pinho Ribeiro
- 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil
- 2 Medical School and Clinical Hospital, Federal University of Minas Gerais , Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
47
|
Menezes MCD, Mingoti SA, Cardoso CS, Mendonça RDD, Lopes ACS. Intervention based on Transtheoretical Model promotes anthropometric and nutritional improvements - a randomized controlled trial. Eat Behav 2015; 17:37-44. [PMID: 25553558 DOI: 10.1016/j.eatbeh.2014.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 10/20/2014] [Accepted: 12/03/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyze the effects of an intervention based on the Transtheoretical Model on anthropometric and dietetic profile among women in the Primary Health Care in Brazil. DESIGN AND METHODS Randomized controlled trial. The control group participated in physical activity and open group-education regarding nutrition of usual care. The intervention group participated in 10 workshops based on the Transtheoretical Model. RESULTS Seventy-one women completed the study, with a mean age of 57.9±11.7years. Participants in the intervention group showed an improved body perception, reduced weight and body mass index post-intervention, and lower consumption of calories and foods high in fat. Significant weight reduction in the intervention group was associated with higher per capita income, reduced consumption of protein, reduced consumption of lipids, and the removal of visible fat from red meat and skin from chicken. CONCLUSION An intervention based on the Transtheoretical Model promoted reduction in consumption of foods high in calories and fat, with positive effects on weight and body perception. These results provide evidence of the applicability and benefit of the Transtheoretical Model within primary care.
Collapse
Affiliation(s)
- Mariana Carvalho de Menezes
- Postgraduate Program in Nursing, Universidade Federal de Minas Gerais, Research Group in Nutrition Interventions of University of Minas Gerais, 190 Alfredo Balena, Santa Efigênia, Belo Horizonte, MG 30190-100, Brazil.
| | - Sueli Aparecida Mingoti
- Department of Statistics, Universidade Federal de Minas Gerais, 6627 Antônio Carlos ave. Campus Pampulha, Belo Horizonte, MG 30161-970, Brazil.
| | - Clareci Silva Cardoso
- Department of Medicine, Universidade de São João Del Rei, Research Group in Epidemiology and Evaluation of New Technologies in Health, 400 Sebastião Gonçalves Coelho ave. Chanadour, Divinópolis, MG 35501-296, Brazil.
| | - Raquel de Deus Mendonça
- Postgraduate Program in Nursing, Universidade Federal de Minas Gerais, Research Group in Nutrition Interventions of University of Minas Gerais, 190 Alfredo Balena, Santa Efigênia, Belo Horizonte, MG 30190-100, Brazil
| | - Aline Cristine Souza Lopes
- Department of Nutrition, Universidade Federal de Minas Gerais, Research Group in Nutrition Interventions of University of Minas Gerais, Brazil.
| |
Collapse
|
48
|
Pereira SADS, Brener S, Cardoso CS, Proietti ABDFC. Sickle Cell Disease: quality of life in patients with hemoglobin SS and SC disorders. Rev Bras Hematol Hemoter 2013; 35:325-31. [PMID: 24255615 PMCID: PMC3832312 DOI: 10.5581/1516-8484.20130110] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/01/2013] [Indexed: 12/03/2022] Open
Abstract
Objective Sickle cell disease comprises chronic, genetically determined disorders,
presenting significant morbidity and high prevalence in Brazil. The goal of this
study was to evaluate the quality of life of sickle cell disease patients
(hemoglobin SS and SC) and their sociodemographic and clinical characteristics.
Methods Data was collected from clinical records and semi-structured interviews consisting
of clinical questionnaires and the World Health Organization Quality of Life-brief
questionnaire. Results Interviews were conducted with 400 patients, aged between 18 and 72, treated in
the Fundação HEMOMINAS in Belo Horizonte. The participants predominantly had
sickle cell disease hemoglobin SS variant (65.5%), were female (61.8%), single
(55.3), with up to 8 years of schooling (49.6%), and self-defined as mulattos
(50%). Pain crises, hospitalizations, blood transfusions, and other morbidities of
sickle cell disease had a significant impact on the quality of life of these
patients. Conclusion Within this group, the social profile was that of low income and unemployed with
sickle cell disease considered to be a significant impediment to finding a job.
Evaluating quality of life as a determining factor of health is essential for the
creation of specific policies and measures, appropriate for the specific
characteristics and social context of sickle cell disease.
Collapse
|
49
|
Cardoso CS, Pádua CM, Rodrigues-Júnior AA, Guimarães DA, Carvalho SF, Valentin RF, Abrantes R, Oliveira CDL. [Contribution of hospitalizations for primary care-sensitive conditions to the profile of admissions in the public health care system]. Rev Panam Salud Publica 2013; 34:227-234. [PMID: 24301733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 10/01/2013] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To describe the epidemiological profile of hospitalizations in the city of Divinópolis, state of Minas Gerais, Brazil, to estimate the prevalence of hospitalizations for primary care-sensitive conditions (HPCSC), and to evaluate the factors associated with the occurrence of HPCSC. METHODS A cross-sectional study was conducted of the two public health care institutions in Divinópolis qualified to hospitalize individuals; that is, a general hospital and an urgent care unit. The data were collected between July and October 2011. Admissions were screened based on information available through the state of Minas Gerais data exchange software SUS Fácil, hospital admission authorizations, and patient records. Descriptive analyses were carried out, with estimation of the prevalence of admissions according to the groups of the 10th revision of the International Classification of Diseases (ICD-10). The identification and classification of HPCSC was based on the Brazilian List of primary-care sensitive conditions published by the Ministry of Health. The strength of the association between HPCSC and selected variables was estimated based on the prevalence ratio. RESULTS Two thousand seven hundred seventy five admissions were identified. The main causes were neoplasms (18%), diseases of the circulatory system (16%), pregnancy and childbirth (15%), and external causes (12%). The prevalence of HPCSC was 36.6%, with the main diagnoses being diseases of the circulatory and respiratory systems. One third of the admissions occurred through the urgent care unit, which was also responsible for more than half of the HPCSC. Female sex, age younger than 13 years and older than 40 years, and living in Divinópolis were associated with higher chance of admission due to HPCSC (P < 0.01). CONCLUSIONS The results show a high prevalence of HPCSC, especially through the urgent care unit. This indicates an overburdening of urgent care services, hindering the implementation of a longitudinal continuum of care at the primary level.
Collapse
Affiliation(s)
- Clareci Silva Cardoso
- Grupo de Pesquisas em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, Universidade Federal de São João Del Rei, Divinópolis, MG, Brasil,
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Cardoso CS, Augusto F, Cremers I. An unusual case of colorectal human papillomavirus infection. Endoscopy 2012; 44 Suppl 2 UCTN:E273. [PMID: 22814917 DOI: 10.1055/s-0032-1309718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- C S Cardoso
- Department of Gastroenterology, Hospital S. Bernardo, Setúbal, Portugal.
| | | | | |
Collapse
|