O uso de fontes não-tradicionais para a vigilância em saúde: atendimentos de urgência para detecção precoce de eventos

Preparation and response to Public Health emergencies involve efforts in developing systems for early detection, alert and response. Models for dealing with notification delay and diversification of data sources are some of the commonly used strategies for faster information and action. In this paper, we present the strategy implemented in Rio de Janeiro municipality, where data from urgency and emergency visits were acquired and modeled, in order to detect trend shifts and generate alerts. From the ICD-10 field in electronic records, time series representing events of interest were created. A GAM model was fitted for smoothing, slope determination in each point, and alert generation. The results obtained are displayed in a dashboard, monitored daily. From 2023, multiple events of interest were identified through the dashboard, some of which lead to coordinated communication and actions in the territory. We draw attention to the potentials in the use of these type of data on identifying events of interest in a timely manner, approaching the concepts of a modern surveillance.A preparação e resposta às emergências em Saúde Pública envolve o investimento em sistemas de detecção precoce, alerta e resposta. Modelos de correção de atraso de notificação e a diversificação de fontes de dados utilizadas são algumas abordagens comumente utilizadas para geração de informação e ação mais oportunos. Neste artigo é apresentada a estratégia implementada no município do Rio de Janeiro de utilização de dados de atendimentos de urgência e emergência unida à aplicação de modelos de detecção de tendências para geração automatizada de alertas. A partir de CIDs marcados nos prontuários eletrônicos de atendimentos, monitoram-se séries temporais de eventos de interesse no município. Um modelo GAM é ajustado às séries para suavização, determinação da inclinação e geração dos alertas. Os resultados são exibidos em painel e monitorados diariamente. Desde 2023, múltiplos eventos de interesse foram identificados através do painel e resultaram em comunicação coordenada e ações no território. Os resultados exaltam a potencialidade no uso desses dados na identificação de eventos de interesse em tempo oportuno, alinhando-se a conceitos de uma vigilância moderna

The identifying depression early in adolescence risk stratified cohort (IDEA-RiSCo) : rationale, methods, and baseline characteristics

Background: The characterization of adolescents at high risk for developing depression has traditionally relied on the presence or absence of single risk factors. More recently, the use of composite risk scores combining information from multiple variables has gained attention in prognostic research in the field of mental health. We previously developed a sociodemographic composite score to estimate the individual level probability of depression occurrence in adolescence, the Identifying Depression Early in Adolescence Risk Score (IDEA-RS). Objectives: In this report, we present the rationale, methods, and baseline characteristics of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo), a study designed for in-depth examination of multiple neurobiological, psychological, and environmental measures associated with the risk of developing and with the presence of depression in adolescence, with a focus on immune/inflammatory and neuroimaging markers. Methods: Using the IDEA-RS as a tool for risk stratification, we recruited a new sample of adolescents enriched for low (LR) and high (HR) depression risk, as well as a group of adolescents with a currently untreated major depressive episode (MDD). Methods for phenotypic, peripheral biological samples, and neuroimaging assessments are described, as well as baseline clinical characteristics of the IDEA-RiSCo sample. Results: A total of 7,720 adolescents aged 14-16 years were screened in public state schools in Porto Alegre, Brazil. We were able to identify individuals at low and high risk for developing depression in adolescence: in each group, 50 participants (25 boys, 25 girls) were included and successfully completed the detailed phenotypic assessment with ascertainment of risk/MDD status, blood and saliva collections, and magnetic resonance imaging (MRI) scans. Across a variety of measures of psychopathology and exposure to negative events, there was a clear pattern in which either the MDD group or both the HR and the MDD groups exhibited worse indicators in comparison to the LR group. Conclusion: The use of an empirically-derived composite score to stratify risk for developing depression represents a promising strategy to establish a risk-enriched cohort that will contribute to the understanding of the neurobiological correlates of risk and onset of depression in adolescence

Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries

Background The COVID-19 pandemic was a health emergency requiring rapid scal resource mobilisation to support national responses. The use of e ective health nancing mechanisms and policies, or lack thereof, a ected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health nancing policies adopted in 15 countries during the pandemic, develop a framework for resilient health nancing, and use this pandemic to argue a case to move towards universal health coverage (UHC). Methods In this case study, we examined the national health nancing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health nancing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health nancing. Findings Resilient health nancing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain scal space for health to move towards UHC while building on resilient health nancing structures that can better prepare health systems for future health emergencies. We observed that ve key nancing policies were implemented across the countries— namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, e cient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure e cient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. Interpretation Our ndings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health nancing policies robust and need to politically commit to public nancing mechanisms that work to prepare for future emergencies and as a lever for UHC.We thank the management team of the Bill & Melinda Gates Foundation and the Saw Swee Hock School of Public Health (National University of Singapore, Singapore) for all the administrative support given. This research was funded by the Bill & Melinda Gates Foundation (Investment ID INV-005598)

HOPE (SOLTI-1903) breast cancer study: real-world, patient-centric, clinical practice study to assess the impact of genomic data on next treatment decision-choice in patients with locally advanced or metastatic breast cancer

Background Metastatic breast cancer (mBC) causes nearly all BC-related deaths. Next-generation sequencing (NGS) technologies allow for the application of personalized medicine using targeted therapies that could improve patients' outcomes. However, NGS is not routinely used in the clinical practice and its cost induces access-inequity among patients. We hypothesized that promoting active patient participation in the management of their disease offering access to NGS testing and to the subsequent medical interpretation and recommendations provided by a multidisciplinary molecular advisory board (MAB) could contribute to progressively overcome this challenge. We designed HOPE (SOLTI-1903) breast cancer trial, a study where patients voluntarily lead their inclusion through a digital tool (DT). The main objectives of HOPE study are to empower mBC patients, gather real-world data on the use of molecular information in the management of mBC and to generate evidence to assess the clinical utility for healthcare systems.Trial design After self-registration through the DT, the study team validates eligibility criteria and assists patients with mBC in the subsequent steps. Patients get access to the information sheet and sign the informed consent form through an advanced digital signature. Afterwards, they provide the most recent (preferably) metastatic archival tumor sample for DNA-sequencing and a blood sample obtained at the time of disease progression for ctDNA analysis. Paired results are reviewed by the MAB, considering patient's medical history. The MAB provides a further interpretation of molecular results and potential treatment recommendations, including ongoing clinical trials and further (germline) genetic testing. Participants self-document their treatment and disease evolution for the next 2 years. Patients are encouraged to involve their physicians in the study. HOPE also includes a patient empowerment program with educational workshops and videos about mBC and precision medicine in oncology. The primary endpoint of the study was to describe the feasibility of a patient-centric precision oncology program in mBC patients when a comprehensive genomic profile is available to decide on a subsequent line of treatment

2-Pyridyl thiazoles as novel anti-Trypanosoma cruzi agents: structural design, synthesis and pharmacological evaluation

The present work reports on the synthesis, anti-Trypanosoma cruzi activities and docking studies of a novel series of 2-(pyridin-2-yl)-1,3- thiazoles derived from 2-pyridine thiosemicarbazone. The majority of these compounds are potent cruzain inhibitors and showed excellent inhibition on the trypomastigote form of the parasite, and the resulting structure-activity relationships are discussed. Together, these data present a novel series of thiazolyl hydrazones with potential effects against Chagas disease and they could be important leads in continuing development against Chagas disease

Integration of priority population, health and nutrition interventions into health systems: systematic review

Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction) and secondary (improved population coverage, access to health services, efficiency, and quality) using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. Targeted priority population health interventions we identified led to improved health outcomes, quality of care, patient satisfaction and access to care. Limited evidence with inconsistent findings across varied interventions in different settings means no general conclusions can be drawn on the benefits or disadvantages of integrated service delivery

UNIDADES DE TERAPIA INTENSIVA NEONATAL: FATORES ASSOCIADOS E MÉTODOS CONTRA ERROS DE MEDICAÇÃO

O objetivo deste artigo é discutir os fatores associados e os métodos utilizados contra erros de medicação em unidades de terapia intensiva neonatal. Trata-se de uma revisão integrativa da literatura realizada sobre materiais indexados na Biblioteca Virtual em Saúde (BVS): Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Bibliografia Nacional em Ciências da Saúde da Argentina ( BINACIS), Base de Dados de Enfermagem (BDENF), Index Medicus para o Pacífico Ocidental (WPRIM) e Índice Bibliográfico Espanhol em Ciências da Saúde (IBECS). Foram utilizados os Descritores em Ciências da Saúde (DeCS) em conjunto com o operador booleano AND e OR, sendo: Unidades de Terapia Intensiva Neonatal AND Erros de Medicação AND Newborn OR Prevention. Após aplicação dos critérios de elegibilidade, foram selecionados 10 estudos para compor esta revisão. Concluiu-se que os fatores associados aos erros de medicação em unidades de terapia intensiva neonatal podem variar desde falhas no cálculo de doses, seleção restrita de doses, administração incorreta, problemas de prescrição, bem como desafios associados ao preparo, diluição e armazenamento de medicamentos. Dentre os métodos utilizados para mitigar a ocorrência de erros relacionados ao uso de medicamentos, destacam-se a implantação de tecnologias, como sistemas informatizados de prescrição médica e softwares específicos para neonatos, supervisão direta e indireta, experiência profissional, rotulagem adequada, registros corretos e o comprometimento a atitude da equipe de saúde emergiu como boas práticas na prevenção de erros. Além disso, a comunicação eficaz entre os profissionais de saúde, o desenvolvimento de fórmulas medicamentosas específicas para crianças e a educação continuada dos profissionais foram barreiras para garantir uma assistência mais segura.O objetivo deste artigo é discutir os fatores associados e métodos utilizados contra erros de medicação em unidades de terapia intensiva neonatal. Trata-se de uma revisão bibliográfica integrativa realizada sobre materiais indexados na Biblioteca Virtual em Saúde (BVS): Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Bibliografia Nacional em Ciências da Saúde da Argentina (BINACIS), Base de Dados de Enfermagem (BDENF), Index Medicus para o Pacífico Ocidental (WPRIM) e Índice Bibliográfico Espanhol em Ciências da Saúde (IBECS). Foram utilizados os Descritores em Ciências da Saúde (DeCS) em conjunto com o operador booleano AND e OR, sendo: Unidades de Terapia Intensiva Neonatal AND Erros de Medicação AND Newborn OR Prevention. Após aplicação dos critérios de elegibilidade, foram selecionados 10 estudos para compor esta revisão. Concluiu-se que os fatores associados aos erros de medicação em unidades de terapia intensiva neonatal podem variar desde erros no cálculo de doses, seleção restrita de doses, administração incorreta, problemas de prescrição, bem como dificuldades associadas ao preparo, diluição e armazenamento de medicamentos. Dentre os métodos utilizados para mitigar a ocorrência de erros relacionados ao uso de medicamentos, destacam-se a implantação de tecnologias, como sistemas informatizados de prescrição médica e programas de computador específicos para neonatos, supervisão direta e indireta, experiência profissional, rotulagem adequada, registros corretos e a a atitude comprometida da equipe de saúde emergiu como boas práticas na prevenção de erros. Por outro lado, a comunicação eficaz entre os profissionais de saúde, o desenvolvimento de fórmulas farmacológicas específicas para crianças e a formação continuada dos profissionais foram obstáculos para garantir cuidados mais seguros.Este artigo tem por objetivo abordar os fatores associados e métodos utilizados contra erros de medicação nas unidades de terapia intensiva neonatal. Trata-se de uma revisão integrativa da literatura realizada nos materiais indexados na Biblioteca Virtual em Saúde (BVS): Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS),  Bibliografia Nacional em Ciências da Saúde da Argentina (BINACIS), Base de dados de Enfermagem (BDENF),  Index Medicus para o Pacífico Ocidental (WPRIM) e o Índice Bibliográfico Español en Ciencias de la Salud (IBECS). Foram utilizados os Descritores em Ciências da Saúde (DeCS) em cruzamento com o operador booleano AND e OR, da seguinte forma: Unidades de Terapia Intensiva Neonatal AND Erros de Medicação AND Recém-Nascido OR Prevenção. Após a aplicação dos critérios de elegibilidade foram selecionados 10 estudos para compor essa revisão. Conclui-se que os fatores associados a erros de medicação nas unidades de terapia intensiva neonatal podem ocorrer, desde falhas no cálculo da dose, seleção restrita da dose, administração incorreta, problemas na prescrição, além de desafios associados à preparação, diluição e armazenamento dos medicamentos. Dentre as métodos utilizados para mitigar a ocorrência de erros relacionados ao uso de medicações, observou-se a  implementação de tecnologias, como sistemas informatizados de pedidos médicos e softwares específicos para neonatos, supervisão direta e indireta, experiência profissional, rotulagem adequada, registros corretos e a atitude comprometida da equipe de saúde emergiram como boas práticas na prevenção de erros. Além disso, a comunicação eficaz entre profissionais de saúde, desenvolvimento de fórmulas de medicamentos específicos para crianças e a educação continuada dos profissionais constituíram-se como barreiras para a garantia de uma assistência mais segura

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension