ODS/10 - Redução da desigualdade
URI Permanente desta comunidade
Objetivo: Reduzir a desigualdade dentro dos países e entre eles.
Índice h
Scopus: 46
Navegar
Coleções desta Comunidade
- ODS/10 - Redução da desigualdade
- ODS/10 - Redução da desigualdade
- ODS/10 - Redução da desigualdade
Submissões Recentes
Review of strategies to investigate low sample return rates in remote tobacco trials: A call to action for more user-centered design research
(2023) VILARDAGA, R.; THRUL, J.; DEVITO, A.; KENDZOR, D. E.; SABO, P.; KHAFIF, T. C.
Remote collection of biomarkers of tobacco use in clinical trials poses significant challenges. A recent meta-analysis and scoping review of the smoking cessation literature indicated that sample return rates are low and that new methods are needed to investigate the underlying causes of these low rates. In this paper we conducted a narrative review and heuristic analysis of the different human factors approaches reported to evaluate and/or improve sample return rates among 31 smoking cessation studies recently identified in the literature. We created a heuristic metric (with scores from 0 to 4) to evaluate the level of elaboration or complexity of the user-centered design strategy reported by researchers. Our review of the literature identified five types of challenges typically encountered by researchers (in that order): usability and procedural, technical (device related), sample contamination (e.g., polytobacco), psychosocial factors (e.g., digital divide), and motivational factors. Our review of strategies indicated that 35% of the studies employed user-centered design methods with the remaining studies relying on informal methods. Among the studies that employed user-centered design methods, only 6% reached a level of 3 in our user-centered design heuristic metric. None of the studies reached the highest level of complexity (i.e., 4). This review examined these findings in the context of the larger literature, discussed the need to address the role of health equity factors more directly, and concluded with a call to action to increase the application and reporting of user-centered design strategies in biomarkers research.
Patient Health Questionnaire-9 Item Pairing Predictiveness for Prescreening Depressive Symptomatology: Machine Learning Analysis
(2023) GLAVIN, Darragh; GRUA, Eoin Martino; NAKAMURA, Carina Akemi; SCAZUFCA, Marcia; SANTOS, Edinilza Ribeiro dos; WONG, Gloria H. Y.; HOLLINGWORTH, William; PETERS, Tim J.; ARAYA, Ricardo; VEN, Pepijn Van de
Background: Anhedonia and depressed mood are considered the cardinal symptoms of major depressive disorder. These are the first 2 items of the Patient Health Questionnaire (PHQ)-9 and comprise the ultrabrief PHQ-2 used for prescreening depressive symptomatology. The prescreening performance of alternative PHQ-9 item pairings is rarely compared with that of the PHQ-2.Objective: This study aims to use machine learning (ML) with the PHQ-9 items to identify and validate the most predictive 2-item depressive symptomatology ultrabrief questionnaire and to test the generalizability of the best pairings found on the primary data set, with 6 external data sets from different populations to validate their use as prescreening instruments.Methods: All 36 possible PHQ-9 item pairings (each yielding scores of 0-6) were investigated using ML-based methods with logistic regression models. Their performances were evaluated based on the classification of depressive symptomatology, defined as PHQ-9 scores >= 10. This gave each pairing an equal opportunity and avoided any bias in item pairing selection.Results: The ML-based PHQ-9 items 2 and 4 (phq2&4), the depressed mood and low-energy item pairing, and PHQ-9 items 2 and 8 (phq2&8), the depressed mood and psychomotor retardation or agitation item pairing, were found to be the best on the primary data set training split. They generalized well on the primary data set test split with area under the curves (AUCs) of 0.954 and 0.946, respectively, compared with an AUC of 0.942 for the PHQ-2. The phq2&4 had a higher AUC than the PHQ-2 on all 6 external data sets, and the phq2&8 had a higher AUC than the PHQ-2 on 3 data sets. The phq2&4 had the highest Youden index (an unweighted average of sensitivity and specificity) on 2 external data sets, and the phq2&8 had the highest Youden index on another 2. The PHQ-2 >= 2 cutoff also had the highest Youden index on 2 external data sets, joint highest with the phq2&4 on 1, but its performance fluctuated the most. The PHQ-2 >= 3 cutoff had the highest Youden index on 1 external data set. The sensitivity and specificity achieved by the phq2&4 and phq2&8 were more evenly balanced than the PHQ-2 >= 2 and >= 3 cutoffs.Conclusions: The PHQ-2 did not prove to be a more effective prescreening instrument when compared with other PHQ-9 item pairings. Evaluating all item pairings showed that, compared with alternative partner items, the anhedonia item underperformed alongside the depressed mood item. This suggests that the inclusion of anhedonia as a core symptom of depression and its presence in ultrabrief questionnaires may be incompatible with the empirical evidence. The use of the PHQ-2 to prescreen for depressive symptomatology could result in a greater number of misclassifications than alternative item pairings.
Perspectives""Advance Care Planning in Brazil
(2023) TARDELLI, Natalia Rocha; FORTE, Daniel Neves; VIDAL, Edison Iglesias de Oliveira
Brazil is a country of continental size marked by extreme social inequalities. Its regulation of Advance Directives (AD) was not enacted by law but within the scope of the norms that govern the relationships between patients and physicians, as a resolution of the Federal Medical Council without any specific requirement for notarization. Despite this innovative starting point, most of the debate regarding Advance Care Planning (ACP) in Brazil has been dominated by a legal transactional approach focused on making decisions in advance and the creation of AD. Yet, other novel ACP models have recently emerged in the country with a focus on the creation of a specific quality of relationship between patients, families, and physicians aiming at the facilitating future decision-making. Most of the education on ACP in Brazil happens in the context of palliative care courses. As such, most ACP conversations are performed within palliative care services or by healthcare professionals with training in that area. Hence, the scarce access to palliative care services in the country means that ACP is still rare and that those conversations usually happen late in the course of disease. The authors posit that the existing paternalistic healthcare culture is one of the most important barriers to ACP in Brazil and envision with great concern the risk that its combination with extreme health inequalities and the lack of healthcare professionals' education on shared decision-making could lead to the misuse of ACP as a form of coercive practice to reduce healthcare use by vulnerable populations.
Dimensions of harassment at school: dialogs about gender with young high school students in Sao Paulo/Brazil
(2023) SILVA, Cristiane Goncalves da; LEITE, Vanessa Jorge; PONTES, Julia Clara de
In this article, we discuss uses of ""harassment"" as a category employed by young students from public high schools to make sense of violence and gender discrimination experiences that occur in and out of school. The analysis is based on fieldwork records produced within the scope of a multicenter, mixed -methods research carried out in nine schools located in Sao Paulo. Harassment appears as a polysemic category that, by naming violence, helps to face gender and generation hierarchies and inequalities. We infer that the young girls have questioned norms and attitudes that feed gender inequalities in schools; in addition, they have denounced the silence or inadequacy of the institution in facing the problem. This enables to identify convergences with a new sensibility regarding violence against women that globalized feminist discourses have brought to the surface.
Violence, Discrimination, and High Levels of Symptoms of Depression Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil
(2023) MEDEIROS, Danielle Souto de; MAGNO, Laio; GUIMARAES, Mark Drew Crosland; GRANGEIRO, Alexandre; EUSTORGIO FILHO, Marcos; SOARES, Fabiane; GRECO, Dirceu; WESTIN, Mateus; FERRAZ, Dulce; ZUCCHI, Eliana Miura; DOURADO, Ines
Purpose: This study aimed at describing the prevalence of symptoms of depression among 15-19 year old adolescent men who have sex with men (aMSM) and transgender women (aTGW), who were recruited in an HIV pre-exposure prophylaxis cohort study in three Brazilian capital cities. The study also examined potential associations, including violence and discrimination, with severe symptoms of depression among aMSM. Methods: This is a cross-sectional study of baseline data among 730 aMSM and 56 aTGWrecruited between February 2019 and February 2021. Sociodemographic and behavioral data were collected. The 20-item Center for Epidemiologic Studies Depression scale was used to screen for symptoms of depression. Scores of >= 22 points indicate the presence of severe symptoms associated with major depression. Logistic regression was used to assess independent associations among aMSM, adjusting for sociodemographic variables. Results: Our findings indicate a high prevalence of symptoms of depression (overall prevalence = 58.5% and 69.6%; 21.2% and 25.0% for mild/moderate, and 37.3% and 44.6% for severe) among these aMSM and aTGW, respectively. Psychological violence (aOR = 1.74; 95% CI = 1.12-2.70), sexual violence (aOR = 1.79; 95% CI = 1.07-2.98), and discrimination due to sexual orientation (aOR = 1.71; 95% CI = 1.23-2.38) were independently associated with severe symptoms of depression in aMSM. Discussion: The high prevalence of severe symptoms of depression and its association with psychological and sexual violence and discrimination creates cycles of vulnerability and carries important public health implications. Thus, our findings indicate public policies should consider assessing depression, psychological and sexual violence, as well as discrimination, especially in populations that will be targeted by interventions, such as the use of pre-exposure prophylaxis. (c) 2023 Society for Adolescent Health and Medicine.
Civil society and community social support initiatives for vulnerable groups in primary care center catchment areas: the role of the FHS during the pandemic
(2023) MENDONCA, Maria Helena Magalhaes de; SOARES, Mariangela Uhlmann; SPADACIO, Cristiane; ALVES, Marcia Guimaraes de Mello; SCHENKMAN, Simone; BOUSQUAT, Aylene Emilia Moraes; GIOVANELLA, Ligia
The pandemic highlighted new and old health risks that require health actions and social support. This study analyzed the knowledge of health professionals working in primary health care centers (PHCCs) regarding civil society and health service separately or along with health promotion and social support initiatives targeting vulnerable groups. The article begins by discussing the concept of social support and then goes on to present an analysis of empirical data from the multidimensional cross-sectional study ""Challenges facing primary health care in the response to COVID-19 in the SUS"", conducted using a nationally representative sample of PHCCs. Scores were calculated for selected and aggregated variables, and we calculated percentages for selected actions together with 95% confidence intervals at national and regional level. The percentage of PHCCs that supported actions and where the local community developed initiatives in the catchment area varied across regions, with rates being significantly higher in the Northeast and in non-urban municipalities with low MHDI, which was associated with actions developed in the catchment area by community health workers. The findings reveal several gaps and challenges, including the need to amplify the magnitude and scope of intra and intersectoral actions, strengthen ties between different actors, reverse the effects of the pandemic on health inequities and promote further research.
Economic Evaluations and Equity in the Use of Artificial Intelligence in Imaging Exams for Medical Diagnosis in People With Skin, Neurological, and Pulmonary Diseases: Protocol for a Systematic Review
(2023) SANTANA, Giulia Osorio; COUTO, Rodrigo de Macedo; LOUREIRO, Rafael Maffei; FURRIEL, Brunna Carolinne Rocha Silva; ROTHER, Edna Terezinha; PAIVA, Joselisa Peres Queiroz de; CORREIA, Lucas Reis
Background: Traditional health care systems face long-standing challenges, including patient diversity, geographical disparities, and financial constraints. The emergence of artificial intelligence (AI) in health care offers solutions to these challenges. AI, a multidisciplinary field, enhances clinical decision-making. However, imbalanced AI models may enhance health disparities. Objective: This systematic review aims to investigate the economic performance and equity impact of AI in diagnostic imaging for skin, neurological, and pulmonary diseases. The research question is ""To what extent does the use of AI in imaging exams for diagnosing skin, neurological, and pulmonary diseases result in improved economic outcomes, and does it promote equity in Methods: The study is a systematic review of economic and equity evaluations following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Eligibility criteria include articles reporting on economic evaluations or equity considerations related to AI-based diagnostic imaging for specified diseases. Data will be collected from PubMed, Embase, Scopus, Web of Science, and reference lists. Data quality and transferability will be assessed according to CHEC (Consensus on Health Economic Criteria), EPHPP Results: This systematic review began in March 2023. The literature search identified 9,526 publications and, after full-text screening, 9 publications were included in the study. We plan to submit a manuscript to a peer-reviewed journal once it is finalized, Conclusions: AI in diagnostic imaging offers potential benefits but also raises concerns about equity and economic impact. Bias in algorithms and disparities in access may hinder equitable outcomes. Evaluating the economic viability of AI applications is essential for resource allocation and affordability. Policy makers and health care stakeholders can benefit from this review's insights to make informed decisions. Limitations, including study variability and publication bias, will be considered in the analysis. This systematic review will provide valuable insights into the economic and equity implications of AI in diagnostic imaging. It aims to inform evidence-based decision-making and contribute to more efficient and equitable health care systems. International Registered Report Identifier (IRRID): DERR1-10.2196/48544
Methodological issues in qualitative research on HIV prevention: an integrative review
(2023) SPADACIO, Cristiane; SANTOS, Lorruan Alves dos; SORRENTINO, Isa da Silva; GOMES, Romeu; CASTELLANOS, Marcelo Eduardo Pfeiffer; ZUCCHI, Eliana Miura; GRANGEIRO, Alexandre; COUTO, Marcia Thereza
In view of the growing concern about the use of qualitative approach in health research, this article aims to analyze how the qualitative theoretical -method-ological framework of HIV prevention is presented in empirical research. We conducted an integrative literature review with the following guiding ques-tions: ""How is the qualitative theoretical-methodological framework expressed in empirical research on HIV prevention?""; ""What are the limits and poten-tials of the qualitative methodological designs employed?"". In the qualitative methodological discussion, five dimensions guided the methodological course and the presentation of findings, from the analysis of the characterization of qualitative studies to the contextualization of the studies and the methodologi-cal approaches used, highlighting the use of semi-structured interviews with thematic content analysis. We also examined social categories and analytical references, drawing attention to the plurality of these theoretical-conceptual references and to the authors' polyphony, and identified the limits and po-tentials of qualitative research. This study focuses on a scientific topic that is related to a wide variety of social groups and analyzes how they are af-fected by it, examining issues related to social inequality and other analytical possibilities surrounding HIV prevention, and providing resources for a com-prehensive methodological discussion. Hence, avoiding the risk of conducting qualitative research based on checklists that limit inventiveness and openness to different designs and forms of execution and analysis is as pivotal as ensur-ing that the research is consistent and detailed in publications.
Vaccines past and future - a Brazilian perspective
(2023) KALIL, Jorge
In this opinion article, I provide a brief history of vaccine development, commenting on the classic ways of obtaining vaccines using the infectious agent itself. Then, I address the issue of viral vaccines, their successes , difficulties, discussing the issue of viral serotypes. Bacterial vaccines and their relative success. I present our studies on Rheumatic Heart Disease and the development of an anti-streptococcal vaccine. Then, I discuss vaccine development platforms, especially with the successes achieved with non-replicating viral vector vaccines and, above all, the great success of mRNA vaccines. mRNA vaccines were only possible after the advances obtained with the replacement of nucleotides that reduced the action of innate immunity. Will all vaccines be made from mRNA in the future? Next, I address the issue of vaccine administration routes, whether subcutaneously, intradermally, intramuscularly or nasal instillation. I expose data from my laboratory on the development of an intranasal vaccine that induced a protective mucosal response, preventing infection , consequently the transmission of the SARS-CoV-2 virus. Then, I discuss which future vaccines could be developed beyond acute infectious diseases. Finally, I discuss the advantages of developing safe, effective, multiple-use vaccines and how to make them accessible to the world's population by promoting health equity.
Critically ill patients with COVID-19-associated acute kidney injury treated with kidney replacement therapy: Comparison between the first and second pandemic waves in São Paulo, Brazil
(2023) SAMAAN, Farid; FREITAS, Rafaela Andrade Penalva; VIANA, Renata; GAMBARO, Livia; CUNHA, Karlla; VIEIRA, Tales Dantas; FEITOSA, Valkercyo; CORREA, Eric Aragao; MACIEL, Alexandre Toledo; ARANHA, Sylvia; OSAWA, Eduardo Atsushi; PILLAR, Roberta; FLATO, Elias Marcos da Silva; SILVA, Renata Cristina da; CARNEIRO, Elisa; SOUZA, Fabrizzio Batista Guimaraes de Lima; ROSSI, Paula Regina Gan; ABUD, Munira Bittencourt; KONIGSFELD, Henrique Pinheiro; SILVA, Riberto Garcia da; SOUZA, Ricardo Barbosa Cintra de; COUTINHO, Saurus Mayer; GOES, Miguel angelo; SILVA, Barbara Antunes Bruno da; ZANETTA, Dirce Maria Trevisan; BURDMANN, Emmanuel Almeida
IntroductionThis study aimed to compare the characteristics and outcomes of critically ill patients with COVID-19-associated acute kidney injury (AKI) who were treated with kidney replacement therapy (KRT) in the first and second waves of the pandemic in the megalopolis of Sao Paulo, Brazil.MethodsA multicenter retrospective study was conducted in 10 intensive care units (ICUs). Patients aged >= 18 years, and treated with KRT due to COVID-19-associated AKI were included. We compared demographic, laboratory and clinical data, KRT parameters and patient outcomes in the first and second COVID-19 waves.ResultsWe assessed 656 patients (327 in the first wave and 329 in the second one). Second-wave patients were admitted later (7.1 +/- 5.0 vs. 5.6 +/- 3.9 days after the onset of symptoms, p<0.001), were younger (61.4 +/- 13.7 vs. 63.8 +/- 13.6 years, p = 0.023), had a lower frequency of diabetes (37.1% vs. 47.1%, p = 0.009) and obesity (29.5% vs. 40.0%, p = 0.007), had a greater need for vasopressors (93.3% vs. 84.6%, p<0.001) and mechanical ventilation (95.7% vs. 87.8%, p<0.001), and had higher lethality (84.8% vs. 72.7%, p<0.001) than first-wave patients. KRT quality markers were independently associated with a reduction in the OR for death in both pandemic waves.ConclusionsIn the Sao Paulo megalopolis, the lethality of critically ill patients with COVID-19-associated AKI treated with KRT was higher in the second wave of the pandemic, despite these patients being younger and having fewer comorbidities. Potential factors related to this poor outcome were difficulties in health care access, lack of intra-hospital resources, delay vaccination and virus variants.