Impact of COVID-19 in the screening and treatment of breast cancer in the Brazilian public health system: Data from a healthcare data warehouse.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18807-e18807
Author(s):  
Alessandra Menezes Morelle ◽  
Fernando Castilho Venero ◽  
Rafael Dal Ponte Ferreira ◽  
Pedro Tofani Santanna ◽  
Rommel Fabricio Pereira da Silva ◽  
...  
Keyword(s):  
Public Health ◽  
Breast Cancer ◽  
Health System ◽  
Data Warehouse ◽  
Public Health System ◽  
Real Life ◽  
Outcome Data ◽  
Real World Data ◽  
Healthcare Data ◽  
The Impact

e18807 Background:Since December 2019, the world is facing a pandemic caused by a novel coronavirus (SARS-CoV-2). We sought to analyze the behavior of cancer treatments and procedures in breast cancer in Brazil after the beginning of the COVID-19 pandemic through an artificial intelligence platform with real life data. Methods:Data evaluation was performed using the TechTrials platform. This platform created a unique healthcare data warehouse containing hundreds of different publicly available data sources about Brazilian Public Health System and with proprietary technology, developed several analytics products that explore and release real-world data (RWD) insights. For this analysis data were extracted from DATASUS – SIA (outpatients information system). For each outcome, data from January 2011 to February 2020 were used to adjust a time series to predict values for March to November 2020. Those values were compared with the observed ones. Results: Biopsies, mammograms and procedures showed a sharp decrease (41.9%, 73.7% and 31.1%, respectively), in April 2020 (following month of the first COVID-19 case in Brazil) with some recovering in the following months. All observed values of biopsies, the number of mammograms from March to October and the number of procedures in April and May were significantly smaller than the predicted ones. Number of women undergoing chemotherapy began to decline in August and remained falling until the last month of available data.(Table). Conclusions: This study is the first one that analyzes RWD of breast cancer screening, diagnosis and treatment in Brazil as a result of the COVID-19 pandemic. The impact of the decrease observed in screening and diagnosis is already evident in the number of women undergoing chemotherapy. These data will continue to be monitored in the coming months when only then will data be available for staging at diagnosis.[Table: see text]

scholarly journals Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

2017 ◽  
Vol 54 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Elinton Adami CHAIM ◽  
José Carlos PAREJA ◽  
Martinho Antonio GESTIC ◽  
Murillo Pimentel UTRINI ◽  
Everton CAZZO
Keyword(s):  
Public Health ◽  
Bariatric Surgery ◽  
Health System ◽  
Public Health System ◽  
Wound Dehiscence ◽  
Pulmonary Complications ◽  
Multidisciplinary Program ◽  
The Impact ◽  
Access To Surgery

ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.

Prevalence of germline testing criteria in breast cancer patients in the Brazilian public health system: A retrospective study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10597-10597
Author(s):  
Robson dos Santos dos Santos Borges ◽  
Laisa Gabrielle Silva ◽  
Mariana do Nascimento Vilaca ◽  
Alexandre Ribas De Carvalho ◽  
João Paulo Solar Vasconcelos ◽  
...  
Keyword(s):  
Public Health ◽  
Breast Cancer ◽  
Overall Survival ◽  
Health System ◽  
Triple Negative ◽  
Public Health System ◽  
Significant Difference ◽  
Epidemiological Characteristics ◽  
Germline Testing ◽  
Testing Criteria

10597 Background: Identification of a germline mutation in a breast cancer predisposition gene has implications for the patients and their families. The National Comprehensive Cancer Network (NCCN) has published guidelines for genetic testing. In Brazil, this assessment is covered by health insurance in accordance with criteria defined by the National Supplementary Health Agency (ANS). For the majority of the population, served by the public health system (SUS), the assessment is not routinely available. Methods: In order to determine the prevalence rates of NCCN and ANS criteria for germline testing in breast cancer (primary outcome) we retrospectively analyzed data from patients treated at two SUS oncology centers in Belo Horizonte, Minas Gerais, Brazil, between 01/01/18 and 12/31/19. The secondary outcomes were comparisons between the groups with and without germline testing criteria (NCCN and ANS) regarding overall survival, clinical and epidemiological characteristics. The association between qualitative variables was calculated using the Chi-square and Fisher tests. The Kaplan-Meier method was used to analyse the survival data and the differences between the groups were tested using the log-rank test. The level of significance was 5%. Results: A total of 357 patients were included in the final analysis. The presence of germline testing criteria were found in 126 patients (35%) according to NCCN guidelines and in 82 patients (23%) according to ANS guidelines. None of them were tested for germline mutations. The most common criteria were women up to 60 years old with triple negative tumors (n = 43, 12% of all patients) and diagnosis of cancer up to 45 years old (n = 75, 21% of all patients) according to ANS and NCCN criteria, respectively. When the group of patients who met at least one criterion for germline testing were compared with the group who did not met any criteria, we found in the first group: more ductal carcinomas and less lobular tumors (p = 0.009), more grade 3 tumors (p = 0.002), more triple negative tumors (p < 0.001), more neoadjuvant treatments (p = 0.008) and less hormonal therapies (p = 0.011). After a median follow up of 13.5 months there were 22 deaths in the cohort, 7 in the group with testing criteria (5.7%) and 15 in the group without testing criteria (6.4%). There was no statistical significant difference between the groups in terms of overall survival (p = 0.77). Conclusions: To our knowledge this is the first study to evaluate the prevalence of NCCN and ANS criteria for germline testing in patients with breast cancer treated in the Brazilian public health system. Our results show that more than a third of those patients are candidates for germline testing. Moreover, the data highlight a serious shortcoming in the management of breast cancer and must be considered in the development of public health policies for routine germline testing in that population.

scholarly journals Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System

2017 ◽  
Vol 3 (3) ◽  
pp. 201-207 ◽  
Author(s):  
Márcio Debiasi ◽  
Tomás Reinert ◽  
Rafael Kaliks ◽  
Gilberto Amorim ◽  
Maira Caleffi ◽  
...  
Keyword(s):  
Public Health ◽  
Breast Cancer ◽  
Health System ◽  
Advanced Breast Cancer ◽  
Public Health System ◽  
Her2 Positive ◽  
The Public ◽  
Premature Deaths ◽  
Number Of Patients ◽  
Positive Breast Cancer

Purpose Patients with human epidermal growth factor receptor 2 (HER2) -positive metastatic tumors treated in the public health system in Brazil do not have access to trastuzumab. This study aimed to estimate the impact of the lack of access to anti-HER2 therapies on the mortality of these patients. Methods On the basis of published data, the number of patients with HER2-positive advanced breast cancer in 2016 who should receive anti-HER2 targeted therapy was estimated. Three different treatment groups were considered for this hypothetical cohort: chemotherapy alone, chemotherapy plus trastuzumab, and chemotherapy plus trastuzumab and pertuzumab. The number of patients alive after 2 years of follow-up was estimated on the basis of the efficacy results of the pivotal trials considering these interventions. Results It was calculated that 2,008 women will be diagnosed with advanced HER2-positive breast cancer in Brazil in 2016. It was estimated that only 808 women would be alive in 2018 if they receive only chemotherapy (which is the treatment offered by the public health system). On the other hand, the bar rises to 1,408 women alive in 2018 if they receive chemotherapy plus trastuzumab and 1,576 women alive in 2018 if they receive the gold standard of chemotherapy plus trastuzumab and pertuzumab. Conclusion Trastuzumab is included in the WHO’s list of essential medications, but the Brazilian public health system does not yet provide this treatment to its population with advanced disease. The introduction of trastuzumab and pertuzumab would have a positive effect, preventing premature deaths in women with metastatic HER2-positive breast cancer in Brazil.

PP155 The Impact Of Lawsuits In The Brazilian Public Health System

2017 ◽  
Vol 33 (S1) ◽  
pp. 141-141
Author(s):  
Carla Biella ◽  
Viviane Pereira ◽  
Fabiana Raynal ◽  
Jorge Barreto ◽  
Vania Canuto ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Public Health System ◽  
Scientific Evidence ◽  
Health Technology ◽  
Health Technologies ◽  
Access To Health ◽  
The Right ◽  
The Impact

INTRODUCTION:The increase of litigation in Brazil on the right to health, and the Brazilian Public Health System (SUS) targets of litigation, are phenomena that generate discussions both in the judiciary, and among researchers and managers of health. The lawsuits are based on the integrality that includes the right to any health technology. Our aim was to gather information on the use of scientific evidence by judges and other law professionals to support their decisions in lawsuits involving health care in Brazil.METHODS:A narrative review by literature search using key terms of legalization in specific databases was conducted.RESULTS:Twenty-five studies showed litigation matters relating to health care which were focused on legal claims about drugs. In general, law operators used the scientific evidences in a limited way when making decisions, by considering the medical report and medication label indications and disregarding therapeutic alternatives contemplated in the SUS list. The access to health technologies, by litigation, reveals that the gap between scientific knowledge and legal practice are similar to those found between science and decision-making in the formulation and implementation of health policies. The Health Technology Assessment studies have high potential for use by the judiciary as a reference source to support technical and scientific decisions in lawsuits on health care.CONCLUSIONS:For the judiciary to ensure not only access to health technologies, but also the efficacy and safety of technologies to system users, their decisions must be substantiated by scientific evidence. The National Committee for Health Technology Incorporation (CONITEC) in SUS has established actions in conjunction with law operators and society, such as a communication using e-mail, aiding the decision for the injunction and elaboration of technical reports and a policy brief, with the intention that the decisions are taken with the greatest possible knowledge about technologies provided by SUS, and based on scientific evidence.

scholarly journals Breast Feeding in Pandemic Situation. How Does Sri Lanka Face the Challenge?

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 214-214
Author(s):  
Neerodha Dharmasoma
Keyword(s):  
Public Health ◽  
Sri Lanka ◽  
Health System ◽  
Breast Feeding ◽  
Public Health System ◽  
Feeding Practices ◽  
Health Staff ◽  
Emergency Situations ◽  
Public Health Staff ◽  
The Impact

Abstract Objectives Sri Lanka has been awarded the first-ever ‘Green’ breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020 (1) with the support of public health system. But, deviating attention of health services towards emergency pandemic situation has resulted in strained health systems and interruptions in humanitarian response leading to eroding access to essential and often life-saving nutrition services. Therefore, optimal breast feeding practices are at risk due to infected mothers’ isolation practices, exhausted public health system and misbeliefs among the community (2). This finds out how Sri Lanka plans to maintain high standards of breast feeding in pandemic situation. Methods We searched for the publications on breast feeding, Sri Lanka in pandemic situation from January 2020 to date. Results As a low and middle income country with an unbeatable public health system, Sri Lanka has already issued an interim guideline for public health staff in continuation maternal and child care services (3). It ensures domiciliary visits by public health midwives (PHMs), although the clinic based teaching sessions on breast feeding have been cancelled. Community awareness has been created that no evidence of transmission of SARS COV-2 via breast milk is available and how the benefits of breast feeding outweigh the risk of infection (4). It is recommended that breast feeding shouldn't be interrupted at all and hand hygienic practices before touching the baby are ideal. Infected mothers can wear a protective mask and rooming in, and kangaroo mother care should be practiced. Sri Lanka already had guidelines on ensuring adequate and appropriate infant feeding guidelines in emergency situations (5). Conclusions Despite the challenges faced by community and public health staff, Sri Lanka make efforts to maintain the achieved breast feeding standards. Further studies are needed to assess the impact of the pandemic on breast feeding practices in near future. Funding Sources None

scholarly journals OPEN VS LAPAROSCOPIC HERNIA REPAIR IN THE BRAZILIAN PUBLIC HEALTH SYSTEM. AN 11-YEAR NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 57 (4) ◽  
pp. 484-490
Author(s):  
Eduardo Morais EVERLING ◽  
Daniela Santos BANDEIRA ◽  
Felipe Melloto GALLOTTI ◽  
Priscila BOSSARDI ◽  
Antoninho José TONATTO-FILHO ◽  
...  
Keyword(s):  
Public Health ◽  
Minimally Invasive ◽  
Hernia Repair ◽  
Health System ◽  
Public Health System ◽  
Laparoscopic Hernia Repair ◽  
Dominant Group ◽  
The Public ◽  
Early Return ◽  
The Impact

ABSTRACT BACKGROUND: Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE: To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS: Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS: 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION: This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.

Equestrian-related injuries, predictors of fatalities, and the impact on the public health system in Sweden

Public Health ◽  
2019 ◽  
Vol 168 ◽  
pp. 67-75 ◽  
Author(s):  
L. Meredith ◽  
R. Thomson ◽  
R. Ekman ◽  
J. Kovaceva ◽  
H. Ekbrand ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
The Public ◽  
The Impact

Analysis of the Challenges and Problems in the Development of Public Health System in Beijing, China

2020 ◽  
Author(s):  
Ayan Mao ◽  
Cordia Chu ◽  
Yujie Yang ◽  
Yueli Meng ◽  
Wuqi Qiu
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Municipal Government ◽  
Legal Framework ◽  
System Capacity ◽  
Health Staff ◽  
The Public ◽  
Information Strategies ◽  
The Impact

Abstract Background: To discern the main problems of Beijing’s public health service system, in order to provide suggestions to modernize the public health system and to enforce the implementation of the “Health Beijing 2030” plan. Methods: We carried out a quantitative study mostly based on interviews. There are over 40 directors and scholars who came from public health institutions and government sectors or organization that related to the public health work in Beijing were interviewed. The interview records were summary analyzed on key issues in accordance with the interview outline. Results: The challenges for the system include the change of structure of the population, the impact of the changing spectrum of diseases and changing environmental factors, and macro-institutional changes. The main problems include structure of the public health system, capacity of public health staff, systems for information management and legal framework for public health. On this basis, several relevant policy recommendations are put forward. Conclusion: To improve the public health system, the Beijing municipal government should design and construction of a system planning and perfecting their investment mechanism on public health. Stability of personnel and encouragement of innovation in scientific research and reliable health information strategies are also urgent needed.

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