Regional support in the health regions of Rio de Janeiro state: a strategy for strengthening SUS

Brazil is one of the few countries in the world with more than 200 million inhabitants that has a universal public health system. In its 30 years of existence, the Unified Health System (SUS) has brought many advances to the Brazilian society. However, it still faces challenges to ensure health services in quantity and quality to the entire population. Federal, state and municipal government levels share the responsibility for its management and financing. In this governance scheme, it is the Municipal Health Secretariats (MHS) of the 5,596 Brazilian municipalities that are primarily responsible for providing and managing health services. Given the importance of this responsibility, Councils of Municipal Health Departments (COSEMS) and the National Council of Municipal Health Departments (CONASEMS) were created in 1986. Their role is to promote the articulation and negotiation of their interests with the federal and state levels. In Rio de Janeiro, a team of specialized professionals has been providing support for COSEMS-RJ since 2012. The team carries out activities in the nine regions of the state, which has 92 municipalities and more than 16 million inhabitants, the 3rd largest population in Brazil. Its activities are maintained by CONASEMS, the Ministry of Health and the State University of Rio de Janeiro (UERJ). The objetive of this report is to present the experience of the expert team of COSEMS RJ as a strategy for strengthening regional governance and intergovernmental relations. Providing specialized technical support for MHS has improved local management of SUS and has allowed for the establishment of regionalized health care networks in Rio de Janeiro.

Key messages

The project improves the participation of municipal managers and teams in regional spaces. It strengthens their capacity for intergovernamental decision-making and regionalization of the health system. The project qualifies the municipal management for fundraising, knowledge building, policy implementing and monitoring, as well as participatory planning.

Associations of socioeconomic and health related factors with fall risk on community dwelling older adults from Alentejo

Introduction With the world, population ageing falls become a problem. Portugal follows this tendency, particularly in Alentejo. Ecological models evidence that biological, behaviour and socioeconomic factors explain falls. However, the role of socioeconomic and health-related factors on the risk of falls is not well known.

Objectives To analyse the association of socioeconomic and health-related factors with fall risk on community-dwelling older adults from Alentejo.

Methodology This observational study involved 384 community-dwelling older adults (73.6 ± 6.0 years), the minimal sample size calculated by Open Epi Online program, of whom 40.6% fell at least once in the previous year. Sociodemographic characteristics (age, gender, marital status, schooling, retirement age, living alone and yield) and health-related factors (number of health conditions, cognitive state, fat mass %, physical activity, and depression index) were accessed.

Results Univariate Regression Logistic showed that gender was the only sociodemographic characteristics which significantly explains falls occurrence, in which to be woman increases the likelihood of falling on 96% (OR: 1.96, p < 0.05). As regard health-related factors, results show that for each additional health condition the likelihood of falling increased 17%, for each additional 1% on fat mass this likelihood increased 4%, and for each additional point on depression index this likelihood increased 15.1% (OR: 1.04 to 1.17, p < 0.05).

Conclusion Health-related factors showed to be more preponderant in the occurrence of falls compared to socio-demographic characteristics. Women with more chronic conditions increased fat mass, and high depression index will be the most susceptible to falls. Thus, preventive measures should play particular attention to these persons.

A DNA Methylation-Based Test for Breast Cancer Detection in Circulating Cell-Free DNA

BACKGROUND

Breast cancer (BrC) is the most frequent neoplasm in women. New biomarkers, including aberrant DNA methylation, may improve BrC management. Herein, we evaluated the detection and prognostic performance of seven genes' promoter methylation (APC, BRCA1, CCND2, FOXA1, PSAT1, RASSF1A and SCGB3A1).

METHODS

Methylation levels were assessed in primary BrC tissues by quantitative methylation-specific polymerase chain reaction (QMSP) and in circulating cell-free DNA (ccfDNA) by multiplex QMSP from two independent cohorts of patients (Cohort #1, n = 137; and Cohort #2, n = 44). Receiver operating characteristic (ROC) curves were constructed, and log-rank test and Cox regression were performed to assess the prognostic value of genes' methylation levels.

RESULTS

The gene-panel APC, FOXA1, RASSF1A, SCGB3A1 discriminated normal from cancerous tissue with high accuracy (95.55%). In multivariable analysis, high PSAT1-methylation levels [>percentile 75 (P75)] associated with longer disease-free survival, whereas higher FOXA1-methylation levels (>P75) associated with shorter disease-specific survival. The best performing panel in ccfDNA (APC, FOXA1 and RASSF1A) disclosed a sensitivity, specificity and accuracy over 70%.

CONCLUSIONS

This approach enables BrC accurate diagnosis and prognostic stratification in tissue samples, and allows for early detection in liquid biopsies, thus suggesting a putative value for patient management.

Prevalence of congenital heart diseases in oral cleft patients

To establish the prevalence of congenital heart diseases (CHDs) in cleft patients, the type of cleft and the presence of a syndrome were coded in 220 patients. A Doppler echocardiogram with color-flow mapping (DE) was obtained in all patients. Mean age was 112.0 +/- 101.2 months (range, 1-576 months), and 56.8% (125) were males. Cleft lip and palate occurred in 144 patients (65.5%), cleft lip in 40 (18.2%), and cleft palate in 36 (16.4%). Cleft palates were more frequent among females. Twenty-four CHDs were diagnosed in 21 of 220 patients (9.5%): 7 mitral valve prolapses, 6 atrial septal defects, 4 patent ductus arteriosus, 3 ventricular septal defects, 2 cases of tetralogy of Fallot, 1 pulmonary stenosis, and 1 bicuspid aortic valve. The presence of CHD did not correlate with the type of cleft. Syndromes occurred in 28 patients (12.7%), and this association was higher among patients with a cleft palate.

Coarctation of the aorta in dizygotic twins

The incidence of congenital heart disease is higher in monozygotic than dizygotic twins, with a higher concordance rate. Although coarctation of the aorta has previously been reported in monozygotic twins, to the best of our knowledge it has not been described in dizygotic twins. We report here such a concurrence in dizygotic twins conceived by in-vitro fertilisation. The finding provides support for both genetic and environmental factors in the aetiology of congenital heart disease. Furthermore, it highlights our lack of data regarding the outcome of in-vitro fertilisation.

[Hemoglobinopathies in the Federal District, Brazil]

Em uma amostra de 3137 pessoas, residentes no Distrito Federal, foram detectadas as seguintes hemoglobinas: em 3009(95,92%) HbAA; em 91 (2,90%) HbAS; em 20(0,64%) HbAC; em 8 (0,26%) talassemia beta minor; em 5(0,16%) HbAJ alfa; em 3 (0,09%) HbAM e em 1 (0,03%) talassemia major associada com HbAS. A HbAS têm as seguintes freqüências, quanto ao grupo racial: branco - 1,84%; mulato claro 2,55%; mulato médio-3,68%; mulato escuro - 6,80%; negro -10,43% e mestiço de índio -3,85%.