23 research outputs found
Trends in socioeconomic inequalities in stunting prevalence in Latin America and the Caribbean countries::differences between quintiles and deciles
Desigualdade no acesso a medicamentos para doenças crÎnicas em mulheres brasileiras
O objetivo deste trabalho foi analisar a prevalĂȘncia de acesso a medicamentos para tratamento de doenças crĂŽnicas e a existĂȘncia de desigualdades socioeconĂŽmicas no acesso. Os dados sĂŁo da Pesquisa Nacional de Demografia e SaĂșde e da Mulher e da Criança de 2006, com uma amostra de 15.575 mulheres (15 a 49 anos). Dessas, 7.717 tiveram diagnĂłstico de doença crĂŽnica com necessidade de obtenção de medicamento e foram consideradas elegĂveis para o estudo. O desfecho foi construĂdo com base no diagnĂłstico de doença crĂŽnica e na necessidade de obtenção de medicamento para o tratamento. A anĂĄlise ajustada foi conduzida usando-se a regressĂŁo de Poisson. Os grupos que apresentaram maior prevalĂȘncia de acesso foram os domiciliados na zona rural, com uma ou duas doenças crĂŽnicas e com nĂvel socioeconĂŽmico mais elevado. A prevalĂȘncia de acesso encontrada foi alta, no entanto, as anĂĄlises demonstram que existe desigualdade socioeconĂŽmica no acesso a medicamentos a favor dos mais ricos, identificando como grupo mais vulnerĂĄvel aquele dos indivĂduos mais pobres e com maior nĂșmero de doenças crĂŽnicas
Natural History of MYH7-Related Dilated Cardiomyopathy
BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation
Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and lowâmiddle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of âsingle-useâ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for lowâmiddle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both highâ and lowâmiddleâincome countries
TendĂȘncias e desigualdades nos comportamentos de risco em adolescentes: comparação das coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil
Resumo: O objetivo do presente trabalho Ă© descrever tendĂȘncias e desigualdades nos comportamentos de risco Ă saĂșde em adolescentes. Estudo transversal, comparando duas coortes de nascimentos da cidade de Pelotas, Rio Grande do Sul, Brasil. Foram incluĂdos 1.281 adolescentes da coorte de 1982 e 4.106 da coorte de 1993 acompanhados em 2001 e 2011, respectivamente. Foi avaliado o consumo de ĂĄlcool, uso de drogas ilĂcitas, uso de tabaco, iniciação sexual < 16 anos, nĂŁo uso de preservativo e mĂșltiplos parceiros sexuais. Foram calculadas prevalĂȘncias totais para cada coorte, estratificadas por sexo e renda per capita, e medidas de desigualdades absoluta e relativa. Houve diminuição, de 2001 para 2011, na prevalĂȘncia de uso experimental de ĂĄlcool, uso de drogas, fumo e nĂŁo uso de preservativos, e aumento no nĂșmero de parceiros sexuais. O gap na prevalĂȘncia conforme sexo aumentou para o nĂŁo uso de preservativo, e para os outros aumentou. O gap entre grupos de renda diminuiu para iniciação sexual < 16 anos e aumentou para episĂłdios de embriaguez. Apesar da tendĂȘncia de diminuição na prevalĂȘncia dos comportamentos de risco, as desigualdades socioeconĂŽmicas persistiram
TendĂȘncias e desigualdades nos comportamentos de risco em adolescentes: comparação das coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil
Resumo: O objetivo do presente trabalho Ă© descrever tendĂȘncias e desigualdades nos comportamentos de risco Ă saĂșde em adolescentes. Estudo transversal, comparando duas coortes de nascimentos da cidade de Pelotas, Rio Grande do Sul, Brasil. Foram incluĂdos 1.281 adolescentes da coorte de 1982 e 4.106 da coorte de 1993 acompanhados em 2001 e 2011, respectivamente. Foi avaliado o consumo de ĂĄlcool, uso de drogas ilĂcitas, uso de tabaco, iniciação sexual < 16 anos, nĂŁo uso de preservativo e mĂșltiplos parceiros sexuais. Foram calculadas prevalĂȘncias totais para cada coorte, estratificadas por sexo e renda per capita, e medidas de desigualdades absoluta e relativa. Houve diminuição, de 2001 para 2011, na prevalĂȘncia de uso experimental de ĂĄlcool, uso de drogas, fumo e nĂŁo uso de preservativos, e aumento no nĂșmero de parceiros sexuais. O gap na prevalĂȘncia conforme sexo aumentou para o nĂŁo uso de preservativo, e para os outros aumentou. O gap entre grupos de renda diminuiu para iniciação sexual < 16 anos e aumentou para episĂłdios de embriaguez. Apesar da tendĂȘncia de diminuição na prevalĂȘncia dos comportamentos de risco, as desigualdades socioeconĂŽmicas persistiram
Characteristics of participants with information on normal values of HbA<sub>1c</sub><sup>*</sup>.
<p>1982 and 1993 Pelotas Birth Cohorts.</p
Unadjusted and adjusted mean and SE for HbA<sub>1c</sub> according to early-life, demographic, socioeconomic and behavioral factors, parent history of diabetes, nutritional status and waist circumference among adolescents in the 1993 Pelotas Birth Cohort.
<p>Unadjusted and adjusted mean and SE for HbA<sub>1c</sub> according to early-life, demographic, socioeconomic and behavioral factors, parent history of diabetes, nutritional status and waist circumference among adolescents in the 1993 Pelotas Birth Cohort.</p
Unadjusted and adjusted mean and SE for HbA<sub>1c</sub> according to early-life, demographic, socioeconomic and behavioral factors, parent history of diabetes, nutritional status and waist circumference among adults in the 1982 Pelotas Birth Cohort.
<p>Unadjusted and adjusted mean and SE for HbA<sub>1c</sub> according to early-life, demographic, socioeconomic and behavioral factors, parent history of diabetes, nutritional status and waist circumference among adults in the 1982 Pelotas Birth Cohort.</p