Shorter delay to treatment by integrated diagnostic services and NGO-provided support among breast cancer patients in two Brazilian referral centres

Background: The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies.Design and Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals.Results: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050).Conclusion: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic- histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow

Técnicas do Rastramento Ocular no Diagnóstico do Transtorno Depressivo: uma revisão sistemática

This systematic review aimed to verify the empirical evidence of the application of the eye tracking technique in depressive disorder. The PubMed, PsyInfo and Web of Science databases were used, using the following descriptors: ((Depression OR "Affective Disorders") AND ("Eye Tracking" OR Eye-Tracking OR "Eye Movements" OR "Eye Tracker" OR "Eye Gaze")). According to the eligibility criteria, sixteen relevant studies were identified and its methods, results and their main limitations were verified. The results suggest an increase in latency and reaction time to detect complex stimuli, e.g. the recognition of emotional facial expressions. In addition, greater numbers of fixations in stimuli of negative emotional content were observed. The findings demonstrate that changes in eye movement measurements in depressive disorder are associated with an attentional bias mechanism. It is concluded that Eye Tracking is a useful tool for psychophysiological assessment of depressive disorder.Esta revisão sistemática teve como objetivo verificar as evidências empíricas da aplicação da técnica de rastreamento ocular no transtorno depressivo. Foram utilizadas as bases de dados PubMed, PsyInfo e Web of Science, utilizando os seguintes descritores: ((Depression OR "Affective Disorders") AND ("Eye Tracking" OR Eye-Tracking OR "Eye Movements" OR "Eye Tracker" OR "Eye Gaze")). De acordo com os critérios de elegibilidade, foram identificados cinco estudos relevantes e verificados seus métodos, resultados e suas principais limitações. Os resultados sugerem um aumento na latência e no tempo de reação para detectar estímulos complexos, por ex. o reconhecimento de expressões faciais emocionais. Além disso, observou-se um maior número de fixações em estímulos de conteúdo emocional negativo. Os resultados demonstram que as alterações nas medidas dos movimentos oculares no transtorno depressivo estão associadas a um mecanismo de viés de atenção. Conclui-se que o rastreamento ocular é uma ferramenta útil para avaliação psicofisiológica do transtorno depressivo