Programa de Pós-graduação em Assistência e Avaliação em Saúde
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Item Perfil epidemiológico e fatores associados à síndrome respiratória aguda grave em Goiás, no período de 2013-2018(Universidade Federal de Goiás, 2020-09-02) Araujo, Kamilla Lelis Rodrigues de; Silva, Lara Lívia Santos da; http://lattes.cnpq.br/3374527511007494; Ternes, Yves Mauro Fernando; http://lattes.cnpq.br/3417780592064501; Silva, Lara Lívia Santos da; Reis, Angela Adamski da Silva; Siqueira Júnior, João BoscoSevere Acute Respiratory Syndrome (SARS) is a condition that, in addition to classic symptoms of influenza, shows signs of worsening with high morbidity and mortality. Thus, is a major concern for public health, being a disease of epidemiological importance, thatmust be notified and investigated. Therefore, the aim of this study was analyze the epidemiological profile and associated factors of SARS reported in the state of Goiás, between 2013 to 2018. This is a retrospective cohort study, with data obtained from the National disease notification system - Influenza Web. Logistic regression analysis was performed to verify the association between death and ICU admission and exposure variables by using the SPSS 25.0 statistical package program. Between 2013 and 2018, 4,832 cases of SARS were reported in Goiás. During the analyzed period, the majority of cases was attributed to Influenza virus (A or B), mainly Influenza A (22.3%), with predominance of pandemic H1N1 Influenza 2009 subtype H1N1pdm09 (17,9%). Among the variablesrelated to ICU admission, longer time to start antiviral treatment in days wasassociated with an increase in hospitalization while the absence of previousinfluenza vaccination, longer time to start antiviral treatment and older age wereassociated with deaths. Thus, this study showed a high frequency of SARS in the state of Goiás between the years 2013 and 2018, with the Influenza A virus(H1N1pdm09) being the main etiological agent. Among the factors related toadmission to the ICU and death, the time of initiation of treatment with antiviral, vaccination status and age of the patientwere observed, which highlights theneed for constant monitoring of the epidemiological situation of this disease, inorder to adopt public health measures for prevention and control.Item Avaliação da eficácia do nusinersena (Spinraza®) no tratamento de atrofia muscular espinhal: uma revisão sistemática(Universidade Federal de Goiás, 2019-11-01) Borges, Stéfani Sousa; Itria, Alexander; http://lattes.cnpq.br/7278290457268315; Itria, Alexander; Reis, Angela Adamski da Silva; D’Alessandro, Walmirton Bezerra; Suzuki, Karina; Tobias, Gabriela CamargoSpinal muscular atrophy (SMA) is an autosomal recessive neurodegenerative disease characterized by mutations or deletions of the survival motor neuron 1 (SMN1) gene, which leads to degeneration of motor neurons of the spinal cord. Nusinersen, commercially known as Spinraza®, has been approved and incorporated into the Brazilian health system as the first pharmacological treatment for SMA, however, a number of ethical issues have been raised, indicating the need for further studies to confirm the drug’s efficacy. In view of this, the objectives of this study were to assess the efficacy of nusinersen (Spinraza®) in SMA’s treatment through a systematic review of randomized controlled trials (RCTs) and cohort studies, and to evaluate the methodological quality of the included studies. The identification and selection of the studies were conducted by two reviewers, blinded and independent in following databases: Cochrane Library, Embase, Lilacs (via Virtual Health Library) and Medline (via Pubmed). An additional search in references of the included articles and in the international database Clinical Trials was conducted to capture as many publications as possible. As inclusion criteria, were selected the full published full articles of human studies whose objective(s) was to evaluate the efficacy of nusinersena in SMA’s treatment. For quality assessment and bias identification, included RCTs were assessed according to the CONSORT (Consolidated Standards of Reporting Trials) Recommendation and cohort studies in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) Recommendation. The search in the databases returned 427 publications, of which 112 were removed by duplication and 309 excluded because they did not meet any of the inclusion criteria, totalizing six publications included in this review, of which two RCTs and four cohort studies. The total population of the analyzed articles yielded 461 both sexes individuals and diagnosed SMA Types I, II or III. The most used motor function improvement rating scales among the studies were HINE-2 and CHOP INTEND. The efficacy of nusinersen (Spinraza®) was compared between studies taking into account the research design, population included, and outcomes identified based on the progress of motor scale scores. The validity of the outcomes was discussed according to the quality of each publication and the risks of biases identified under the CONSORT and STROBE Recommendations. Financial support from the drug-producing industry was identified as the main bias in some of the studies. Scientific evidence has shown a significant improvement in motor function in patients treated with nusinersena, although the combination of the outcomes discussed in this review are not considered sufficient to confirm an increase in patient survival. It was identified that an improvement in the patterns of conduct and reporting of studies included in the review are important attitudes to be adopted.Item Impacto da implementação da qualidade na fase pré-analítica em um laboratório clínico prestador de serviço para o Sistema Único de Saúde(Universidade Federal de Goiás, 2017-12-07) Pedreira, Samira Mariana Naciff; Costa, Sérgio Henrique Nascente; http://lattes.cnpq.br/1104711925118993; Amaral, Rita Goreti; http://lattes.cnpq.br/3665611660713029; Amaral, Rita Goreti; Silva, Rita de Cassia Pereira da Costa e; Tavares, Suelene de Brito do Nascimento; Feres, Valéria Christina de Rezende; Silva, Karlla Greick Batista da Costa eObjective: To evaluate the impact of the implementation of quality in the preanalytical phase in a clinical laboratory providing services for the Brazilian public healthcare system. Method: This study was carried out in three distinct stages. The first stage, before the intervention, was held between June and November 2015, summing up 7,058 consultations. The second stage or stage of interventions was carried out between December 2015 and May 2016. The interventions were carried out through permanent education actions to the professionals involved and implementation of standard operating procedures and forms (POPs, in Portuguese). After the interventions, the third stage began, evaluating the quality indicators in the first semester (between June and November 2016), in a total of 6,317 visits, and in the second semester after the interventions (between January and June 2017), in a total of 6,698 visits. The variables studied were the indicators of nonconformities of registry, nonconformities of collection, hemolysis and recollection and indicators of productivity of receptionists and phlebotomists. Stata 12® was used for statistical analysis. In order to verify the impact of the implementation of the quality, the Chi-square test was used, with a significance level of 5%, and Fisher's exact test. Results In the first semester after the interventions, a reduction of nonconformities related to the reception before the interventions was observed 9.7% after 7.4% (p <0.01) and to the collection before the intervention 1.0% after 0.4% (p <0.01) and increase in nonconformities related to screening before 0.7% after 1.2% (p = 0.003). However, there was no reduction in emissions at 5.1% (p <0.01), collection at 0.3% (p <0.01), and at 0.6% (p = 0.05) . In the first half of the year after the interventions, a significant increase of productivity of the reception desk before 36.4% after 39.30% (p<0.01) and of phlebotomists one before 21.5% after 34.8% and of the two before 14.2% and after 26.7% (p<0.01). In the second semester after the interventions the booth one maintained the productivity, the booth two increased before 31.2% after 6 months 38.4% and the booth three reduced before 32.4% after 6 months 24.7%. Phlebotomists increased productivity in relation to the period before interventions.. Conclusion: There was a positive impact in the implementation of the internal quality control in the preanalytical phase. After intervention, there was a decrease in nonconformities related to reception and collection and an increase of phlebotomist productivity. The reduction of nonconformities may reflect positively on the quality of the service provided to the patient.Item Disposição a pagar por um serviço de dispensação de medicamentos: perspectiva da população do município de Goiânia, Goiás, Brasil(Universidade Federal de Goiás, 2019-10-02) Rocha filho, César Ramos; Dewulf, Nathalie de Lourdes Souza; http://lattes.cnpq.br/1244479719591748; Dewulf, Nathalie de Lourdes Souza; Vieira, Fabiola Sulpino; Cardoso, Larissa Barbosa; Lopes, Angela Ferreira; Provin, Mercia PandolfoObjective: To evaluate the Willingness to Pay (WTP) for a pharmacists’ dispensing service, as strategy to contribute with the debate and to provide subsidies for the optimization of the service in the planning of public health policies in Brazil. Methods: A cross-sectional survey was conducted among residents of Goiânia, Brazil. We applied the contingent valuation method, with dichotomous choice question. Furthermore, Qui-square test and multiple logistic regression model were used to assess the relationship of the participants’ opinions and characteristics with “real” WTP. Results: A sample of 327 interviewed were statically analyzed. More than half (55.96%) were certainty that they would pay 14 BRL for a dispensing service. Moreover, in a context of gratuity, 92.05% of the participants would seek for the service. Characteristics such as education level, family income, respondents’ perception of pharmacists’ abilities, not having used the service, no history with Drug-Related Problems, perceived health status, and recent use of medicines demonstrated to contribute significantly to the prediction of WTP. Conclusion: It was observed a feasibility of implementation and incorporation of the service from society’ perspective. Additionally, we noted some limitations and biases in the WTP study design, which should be carefully considered as the methodology development progresses.