Teses de doutorado

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Navegando Teses de doutorado por Autor "Abreu, Luiz Carlos de"

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    Estudo de base hospitalar sobre gastrosquise no Espírito Santo, Brasil entre 2000 e 2018
    (Universidade Federal do Espírito Santo, 2021-08-06) Muniz, Virginia Maria; Zandonade, Eliana; https://orcid.org/0000-0001-5160-3280; http://lattes.cnpq.br/0983533134908583; https://orcid.org/0000-0003-4131-4658; http://lattes.cnpq.br/4372684474884667; Santos Neto, Edson Theodoro dos; https://orcid.org/0000000273517719; http://lattes.cnpq.br/5430137427291413; Ruschi, Gustavo Enrico Cabral; https://orcid.org/0000-0002-0854-4905; http://lattes.cnpq.br/9589990222614381; Sadovsky, Ana Daniela Izoton de; https://orcid.org/0000-0002-3787-4217; http://lattes.cnpq.br/9062782022903431; Abreu, Luiz Carlos de; https://orcid.org/0000000276182109; http://lattes.cnpq.br/6796970691432850
    Introduction: Gastroschisis is subject matter to several health care workers, due to controversies regarding its pathogenesis, temporal increase in prevalence, risk factors not yet fully understood and progress in treatment techniques. Objectives: To verify the health care profile and risk factors to mortality of newborns with gastroschisis admitid in three public hospitals in Vitória, Espírito Santo, Brazil. Methodology: Retrospective multicenter cohort study with gastroschisis patients admitted to neonatal intensive care unit of Hospital Estadual Infantil Nossa Senhora da Glória (HEINSG), Hospital Estadual Infantil e Maternidade Alzir Bernardino Alves (HEIMABA) and Hospital Estadual Dr. Jayme Santos Neves (HEJSN) in period between January 2000 and December 2018. Patients were compared by groups of born in a referral center or outside, and groups of deaths or survivors. Statistical tests were carried out and statistical significance was considered when p-value < 0.05. Results: A total of 144 newborns were investigated. The group of patients born outside reference centers had higher rates of absence of antenatal diagnosis (p = 0.001), vaginal delivery ( p = 0.001), longer time between delivery and abdominal wall closure surgery (p = 0.001), until silo removal (p = 0.001), until first enteral feeding (p = 0.008), to weaning from mechanical ventilation (p = 0.034), used less peripherally inserted central catheter (PICC) and had a lower mean of serum sodium (p = 0.015) when compared with group of neonates born in reference centers. The mean maternal age (p = 0.040), gestational age (p = 0.001) and birth weight (p = 0.000) were lower in group of deaths. Unfavorable clinical conditions during hospitalization (p = 0.005), complex gastroschisis (p = 0.001), abdominal wall closure with silo placement (p = 0.001), use of blood products (p = 0.022), surgical complications (p = 0.001) and short bowel syndrome were more frequent in group of deaths (p = 0.001). Complex gastroschisis (OR = 3.74; 95%CI = 1.274 -11.019) and short bowel syndrome adjusted (OR = 7.55; 95%CI = 2.177 – 26.225) increased risk of death. The increase of birth weight inversely reduced the risk for mortality adjusted (OR = 0.99; 95%CI = 0.997-1000). Conclusion: Although this result may suggest that not all neonates with gastroschisis should be born in a tertiary referral center, it should be noted that faster and more specialized transport is needed for patients born outside the referral centers, and beds are guaranteed in neonatal care reference units, with aim of reducing time between delivery and first surgical intervention. These findings can contribute to formulation of protocols to improve quality and safety of care to gastroschisis patients. In another sphere, it presents elements for management of public policies to reduce neonatal mortality by congenital anomalies that can be avoided by surgical treatment, such as gastroschisis.
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    Lacunas assistenciais no tratamento de transtornos mentais na região metropolitana de São Paulo, Brasil
    (Universidade Federal do Espírito Santo, 2022-05-25) Franca, Mariane Henriques; Viana, Maria Carmen Moldes; https://orcid.org/0000-0002-0464-4845; http://lattes.cnpq.br/4338126917250074; https://orcid.org/0000000348055839; http://lattes.cnpq.br/3739284059672135; Santos Neto, Edson Theodoro dos; https://orcid.org/0000000273517719; http://lattes.cnpq.br/5430137427291413; Abreu, Luiz Carlos de; https://orcid.org/0000000276182109; http://lattes.cnpq.br/6796970691432850; Razzouk, Denise; https://orcid.org/0000-0003-4228-8949; http://lattes.cnpq.br/2570757108117687; Pang, Wang Yuan
    Backgroud: The prevalence of mental disorders (MD) in the general population is high. Mood and anxiety disorders are the most prevalent MD in the general population. The high prevalence of MD, with the fact that they are chronic, results as the main cause of disability and social cost in the world, causing a high social burden and overburdening the health services systems. Early therapeutic interventions can play a crucial role in the prognosis of MD, preventing chronicity and disability. Therefore, it can contribute with a decrease in the time between early contact with treatment after the initiation of MD - a crucial step to increase the chances of recovery through the availability of cost-effective treatment. The aims of this thesis are: 1) to analyze the gaps in treatment coverage among individuals with TM common in the metropolitan region of São Paulo, Brazil, 2) to estimate the treatment delay after the first onset of MD and to analyze the sociodemographic predictors, and in addition; 3) to analyze the gaps related to effective treatment coverage among individuals diagnosed with major depressive disorder (MDD), and its predictors, developing the theoretical model of “Cascade of effective coverage” for Brazil, identifying critical quality gaps adjusted to user adherence, and pharmacological and psychotherapeutic care. Methodology: The São Paulo Megacity is a cross-sectional, population-based epidemiological study designed to assess psychiatric morbidity in a representative sample of individuals residents in the São Paulo metropolitan area (SPMA), with 81.3% overall response rate. Data were collected between May/2005 and April/2007 using the World Mental Health Survey, Composite International Diagnostic Interview (CIDI 3.0). The first study considered a total sample survey (n=5,037). The second and the thrird study considered a sample of respondents that fulfilled DSM-IV criteria for MDD over the past 12-months (n=491). Retrospective information about the age of onset of MD was obtained through questions that considered the respondent's memory bias for the first treatment. Effective treatment coverage was considered as the adequate combination of pharmacotherapy and psychotherapy. The “Contact Coverage” framework included adjustments for quality of care and user adherence. The correlation between contact coverage and effective treatment was analyzed through the survival analysis. The association of socioeconomic and demographic characteristics, health insurance, and clinical severity with contact coverage and its components, including type of treatment, quality of treatment, and adherence were analyzed as well. Results: Mostly of individuals with lifetime MD had health contact coverage. The contact coverage was more frequent among those being treated for mood disorders (94.4%) than with anxiety disorders (63.6%), and substance use disorders (46.6%). The average delay among those who eventually made contact with health treatment ranged from 3 to 13 years for mood disorders, 1 to 36 years for anxiety, and 8 to 14 for substance use disorders. The early age onset of MD was associated with lower contact coverage odds. The low contact coverage after the first disorder onset of the MD was associated to the type of coverage, accessibility, adherence, socio demographics predictors. Among those with MDD (n=491), 164 individuals (33.3%) had contact with health services. Among them, only 25.2% received effective treatment coverage, which represents 8.5% of those in need. The critical bottlenecks identified were related to the use of psychotropic medication (12.2 percentage points), use of antidepressants (6.5), adequate medication control (6.8), and receiving psychotherapy (19.8). Older age, having private health insurance, and having a moderately severe MDD episode were predictors for health services contact. Conclusions: This study demonstrated the low proportion and huge delay of treatment contact after the first onset of MD in Brazil. Furthemore, this study shown the enormous treatment gaps for MDD, considering not only contact coverage, but also identifying specific quality- and user-adjusted bottlenecks in providing pharmacological and psychotherapeutic care. This thesis highlights the importance of looking beyond the traditional focus of assessing the treatment gap of mental disorders, which has been typically based on low rates of seeking and accessing treatment. Effective coverage should be the added in the public health policies agenda not only to reduce the treatment gap, but mainly to reduce the delays between the onset of mental disorders, and the first contact with treatment.