Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Comunicação social e vacinação Social communication and vaccination

As campanhas de imunização vêm passando, ao longo dos anos, por um processo de aperfeiçoamento, especialmente com o advento dos dias nacionais de vacinação contra a poliomielite, realizados a partir de 1980. Há uma preocupação com o resultado do esforço em convocar pais e responsáveis por crianças menores de cinco anos. Várias estratégias são utilizadas. Foi criada uma marca que simbolizava, inicialmente, o compromisso com a erradicação da poliomielite e, posteriormente, com todas as vacinas previstas para o primeiro ano de vida. Foi o marco da comunicação que buscava dar unidade a esse processo sem perder as características mais localizadas. O Zé Gotinha é, até hoje, símbolo de vacina. Para além da polêmica sobre se campanha educa ou deseduca, fica o saldo positivo de uma experiência e a certeza de que é preciso buscar os motivos, continuar pesquisando, identificando metodologias e técnicas de maior aproximação com a população para que ela perceba a oferta de serviços e ações de saúde como direito de cidadania.<br>Over the years, various efforts have been made to improve immunization campaigns, especially through the 1980 introduction of National Vaccination Days against polio. Concern has been shown over the results of attempts to reach parents and others responsible for children under the age of five, and a variety of strategies have been tried. A trademark was created in Brazil, at first symbolic of the commitment to eradicate polio and, later, linked to all vaccines that should be administered during the first year of a child's life. This use of communication tools represents an endeavor to lend unity to the process without overriding local characteristics. Even today, Zé Gotinha symbolizes vaccines in Brazil. Leaving aside the controversy over whether campaigns inform or disinform, the experience has left its positive mark, clearly showing us it is necessary to explore motivations, advance research, and identify methodologies and techniques that will reach the general public and help people perceive that health services and activities are a citizen's right

Trabalho, saúde e subjetividade sob o olhar dos trabalhadores administrativo-operacionais de um hospital geral, público e universitário Work, health and subjectivity in the viewpoint of administrative and operational workers in a public general university hospital

Este estudo se inscreve no campo da saúde do trabalhador, analisando o trabalho hospitalar a partir das experiências dos trabalhadores. O objetivo da investigação foi analisar o sofrimento dos trabalhadores da área administrativo-operacional e as estratégias de produção de saúde, em razão da frequente ocorrência de adoecimentos e afastamentos do trabalho. O campo conceitual articula os conceitos de trabalho, saúde e subjetividade, buscando a ampliação da análise dos aspectos centrados no diagnóstico clínico. Nas estratégias metodológicas parte-se dos pressupostos da pesquisa-intervenção, utilizando o grupo-dispositivo para operar no campo, aliado às entrevistas individuais, observações nos locais de trabalho e intervenção fotográfica. As análises apontam a configuração do sofrimento do trabalhador administrativo-operacional relacionada à vivência da invisibilidade, gerada pelos embates nas relações profissionais na organização do trabalho no hospital, onde seu lugar é associado ao desvalor e à desqualificação. Os jogos de verdade no hospital mostram que o trabalho reconhecido como tendo valor está ligado à medicina e ao lugar de destaque que o saber médico ocupa historicamente no hospital. Os trabalhadores estudados sugerem vivências de impotência frente às demandas dos pacientes e familiares, considerando as limitações impostas pelas políticas públicas na área de saúde. Frente aos tensionamentos originados nessas vivências, produzem estratégias ligadas à produção da saúde e ao enfrentamento do cotidiano de trabalho no hospital. A pesquisa intervenção propiciou agenciamentos múltiplos no grupo, tornando mais viável efetivar as transformações necessárias nas relações de trabalho, trazendo novos sentidos e buscando outros modos de subjetivação.<br>This study falls within the field of occupational health, analyzing the hospital work from the experiences of workers. The purpose of this investigation was to analyze the suffering of administrative and operational workers and the strategies of health production, due to the frequent occurrence of illnesses and absences from work. The conceptual field articulates the concepts of work, health and subjectivity, seeking the extension of the analysis of the focus in clinical diagnosis. The methodological strategies are based on the assumptions of intervention research, using the group device to operate in the field, combined with individual interviews, observations in the workplace and photographic intervention. The analyses show the configuration of the suffering of administrative and operational worker as related to the experience of invisibility, generated by collisions in labor relations in the organization of work at the hospital, where his place is associated with unworthiness and disqualification. Games of truth in the hospital show that the work recognized as having value is linked to medicine and to the prominent place medical knowledge historically occupies in the hospital. The workers studied suggest experiences of powerlessness in the face of demands of patients and families, considering the limitations imposed by public health policies. In view of the tensions generated in these experiences, they produce strategies linked to the production of health and coping with daily work in the hospital. The intervention research has provided multiple assemblages in the group, making it feasible to carry out the necessary changes in working relationships, bringing new meaning and seeking other modes of subjectivation

The Centre for Data and Knowledge Integration for Health (CIDACS): Linking Health and Social Data in Brazil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2019-12-12T14:04:06Z No. of bitstreams: 1 Barreto ML The Center....pdf: 755227 bytes, checksum: c8bcc5d68108b60b3b2ec5cce6be8635 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2019-12-12T16:31:27Z (GMT) No. of bitstreams: 1 Barreto ML The Center....pdf: 755227 bytes, checksum: c8bcc5d68108b60b3b2ec5cce6be8635 (MD5)Made available in DSpace on 2019-12-12T16:31:27Z (GMT). No. of bitstreams: 1 Barreto ML The Center....pdf: 755227 bytes, checksum: c8bcc5d68108b60b3b2ec5cce6be8635 (MD5) Previous issue date: 2019CIDACS has received support from the Department of Science and Technology, Ministry of Health, Brazil; National Research Council (CNPq), Brazil and the Bill and Melinda Gates Foundation (CHAMADA MCTI/CNPq/MS/SCTIE/Decit/Fundação Bill e Melinda Gates N o 47/2014); Health Surveillance Secretariat, Ministry of Health, Brazil; Fundação de Apoio a Pesquisa do Estado da Bahia (FAPESB), Financiadora de Estudos e Projetos (FINEP), Secretaria de Ciência e Tecnologia do Estado da Bahia (SECTI) and Wellcome Trust.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / Federal University of Bahia. Institute of Collective Health. Salvador, BA, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / Federal University of Bahia. Institute of Collective Health. Salvador, BA, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / Federal University of Bahia. Computer Science Department. Salvador, BA, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / Federal University of Bahia. Statistics Department. Salvador, BA, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / University of Brasília. Tropical Medicine Centre. Brasília, DF, Brazil / Escola Fiocruz de Governo. Brasília, DF, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / University of Oxford. Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. Oxford, UK / London School of Hygiene and Tropical Medicine. Faculty of Epidemiology and Population Health. United, Kingdom.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.University College London. Institute of Health Informatics. United Kingdom.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / London School of Hygiene and Tropical Medicine. Faculty of Epidemiology and Population Health. United, Kingdom.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil / London School of Hygiene and Tropical Medicine. Faculty of Epidemiology and Population Health. United, Kingdom.The Centre for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador, Bahia-Brazil with the objective of integrating data and knowledge aiming to answer scientific questions related to the health of the Brazilian population. This article details our experiences in the establishment and operations of CIDACS, as well as efforts made to obtain high-quality linked data while adhering to security, ethical use and privacy issues. Every effort has been made to conduct operations while implementing appropriate structures, procedures, processes and controls over the original and integrated databases in order to provide adequate datasets to answer relevant research questions. Looking forward, CIDACS is expected to be an important resource for researchers and policymakers interested in enhancing the evidence base pertaining to different aspects of health, in particular when investigating, from a nation-wide perspective, the role of social determinants of health and the effects of social and environmental policies on different health outcomes

Towards the glocalisation of complementary and alternative medicine: homeopathy, acupuncture and traditional Chinese medicine practice and regulation in Brazil and Portugal

Complementary and alternative medicine (CAM) has been presented in the sociological literature as a global phenomenon. Yet CAM has simultaneously been shaped by different ‘civic epistemologies’, or national cultures, and re-embedded into local contexts. This ‘glocalism’ of CAM, in turn, is a result of intercultural exchanges over time. This chapter compares CAM practice and regulation in two countries with a long-standing relationship—Brazil and Portugal. Homeopathy, acupuncture and traditional Chinese medicine have been chosen as case studies. We show how Brazil and Portugal, despite their participation in CAM’s global culture, have presented differing national projects on the subject, as well as how these projects have resulted from intercultural hybridism over time. This chapter highlights the glocalism and interculturalism of CAM, a perspective largely absent from its sociological analysis to date