Distribuição de hexosaminas em vários órgãos de Biomphalaria glabrata

Orientador: José Hazencleve DuarteDissertaçao (mestrado) -Universidade Federal do Paraná, Curso de Pós-Graduação em BioquímicaInclui referências: p. 15-1

Developmental defects on enamel in deciduous teeth of preterm and low birthweight infants

Orientador: Maria Valeriana Leme de Moura-RibeiroDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: O objetivo deste estudo observacional com grupo controle foi: a) verificar a presença de defeitos de desenvolvimento do esmalte (DDE) em dentes decíduos de crianças nascidas pré-termo (PT) e com baixo peso, e um grupo controle de nascidos a termo e com peso normal; b) investigar possíveis fatores etiológicos pré-natais e neonatais associados à presença dos DDE; c) situar as hipoplasias, de acordo com sua localização, como pré-natais ou pós-natais, segundo tabelas de cronologia de mineralização. Cada grupo foi formado por 61 crianças, examinadas entre 18 ¿ 35 meses de idade; todas nascidas no Centro de Atenção Integral à Saúde da Mulher ¿ Universidade Estadual de Campinas. Foi adotado o critério da FDI para a avaliação odontológica. Os dados da história médica foram colhidos retrospectivamente do prontuário do hospital. A análise estatística dos dados foi realizada através dos testes de Mann-Whitney, qui-quadrado e exato de Fisher. A freqüência encontrada entre pré-termos foi 57.4% de DDE, 52.5 % de opacidades e 21.3 % de hipoplasia. No grupo controle, 24.6% apresentaram DDE, 24.6% tiveram opacidades e 3.3%, hipoplasia. Os DDE estiveram significativamente associados com o nascimento PT e com baixo peso (p <0.001). Após a regressão logística multivariada, a apnéia permaneceu como a variável mais associada aos DDE. Pode-se concluir que crianças nascidas PT e com baixo peso apresentaram maior prevalência de DDE que aquelas nascidas a termo e com peso normal. O fator neonatal apnéia teve associação significativa com DDE. No entanto, cumpre ressaltar que utilizando os DDE como marcadores biológicos, estes defeitos localizados na porção de esmalte formado no período pré-natal indicam uma agressão sistêmica ocorrida neste período. Existem muitos aspectos a serem considerados na prematuridade ou no recém-nascido submetido a um processo hipóxico-isquêmico. Os DDE, utilizados como marcadores biológicos, podem ser um dado a mais na compreensão dos fatores sistêmicos envolvidos na prematuridade ou na lesão do SNC e suas conseqüênciasAbstract: The purpose of this observational study with control group was: a) verify the presence of developmental enamel defects (DDE) in deciduous teeth of infants born preterm (PT) and with low birthweight and in a control group of infants born full term and with normal birthweight; b) investigate possible prenatal and postnatal etiologic factors associated with DDE; c) classify hypoplasias according to their location as prenatal or postnatal, following mineralization tables. Each group was formed by 61 children, examined between 18 and 35 months of age; all born at the Center for Integral Assistance to Women¿s Health ¿ State University of Campinas. FDI criteria were followed for dental examination. Medical data was collected retrospectively from hospital records. The statistic analysis was performed with the Mann-Whitney, chi-square and Fisher¿s exact test, wherever appropriate. Among preterms, 57.4% had some type of DDE, 52.5 % had opacities and 21.3 % presented hypoplasia. Among full terms, 24.6% presented DDE, 24.6% had opacities and 3.3% had hypoplasia. DDE were significantly associated with preterm birth and low birth weight (p< 0.001). After the multivariate logistic regression, apnea remained as the variable most strongly associated with DDE. Concluding, infants born preterm and with low birthweight presented a higher prevalence of DDE than those born full term and with normal birth weight. The neonatal variable apnea presented a statistically significant association with DDE. Nevertheless, using DDE as biological markers, the defects observed in the tooth enamel formed during the neonatal period indicate that a systemic insult occurred in this period. There are many aspects that must be considered in prematurity and in infants that suffered hypoxic ischemic insults. DDE, used as biological markers, may be an additional element in the study of the variety of factors involved in prematurity or insults to the Central Nervous System and its consequencesMestradoCiencias BiomedicasMestre em Ciências Médica

Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia

<p>Abstract</p> <p>Background</p> <p>Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia.</p> <p>Methods</p> <p>Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours.</p> <p>Results</p> <p>The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system.</p> <p>Conclusion</p> <p>The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.</p

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Progress toward universal health coverage in Latin America and the Caribbean: outcomes, utilization, and financial protection

Área de Economí

Distribuição de hexosaminas em vários órgãos de Biomphalaria glabrata

Orientador: José Hazencleve DuarteDissertaçao (mestrado) -Universidade Federal do Paraná, Curso de Pós-Graduação em BioquímicaInclui referências: p. 15-1

Assessing Latin America's Progress Toward Achieving Universal Health Coverage

Área de Economí

Syntheses related to dendroketose: Carbohyd.Res.

NRC publication: Ye