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[en] Objective: This study aimed to explore the patterns of radioactive iodine (RAI) use for differentiated thyroid cancer (DTC) in Brazil over the past 20 years. Materials and methods: A retrospective analysis of the DTC-related RAI prescriptions, from 2000 to 2018, retrieved from the Department of Informatics of the Unified Health System (Datasus) and National Supplementary Health Agency (ANS) database was performed. RAI activities prescriptions were re-classified as low (30-50 mCi), intermediate (100 mCi), or high activities (>100 mCi). Results: The number of DTC-related RAI prescriptions increased from 0.45 to 2.28/100,000 inhabitants from 2000 to 2015, declining onwards, closing 2018 at 1.87/100,000. In 2018, population-adjusted RAI prescriptions by state ranged from 0.07 to 4.74/100,000 inhabitants. Regarding RAI activities, in the 2000 to 2008 period, the proportion of high-activities among all RAI prescriptions increased from 51.2% to 74.1%. From 2009 onwards, there was a progressive reduction in high-activity prescriptions in the country, closing 2018 at 50.1%. In 2018, the practice of requesting high-activities varied from 16% to 82% between Brazilian states. Interestingly, variability of RAI use do not seem to be related to RAI referral center volume nor state socio-economic indicators. Conclusion: In recent years, there has been a trend towards the lower prescription of RAI, and a reduction of high-activity RAI prescriptions for DTC in Brazil. Also, significative inter-state and inter-institutional variability on RAI use was documented. These results suggest that actions to advance DTC healthcare quality surveillance should be prioritized. (author)
[en] Background: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. Objective: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. Design and setting: Diagnostic test study performed in a tertiary care hospital. Methods: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. Results: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. Conclusion: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall. (author)
[en] Objectives: To report the impact of the COVID-19 pandemic on patient attendance at a radiotherapy department two months after the implementation of specific policies regarding the pandemic. Methods: The proposed treatment schemes, favoring hypofractionated schedules, and COVID-19 management strategies regarding irradiation are presented. Attendance after two months of implementation of these policies was measured and compared with that during the same period in 2019. Results: A 10% reduction in the number of treated patients and a 26% reduction in the number of sessions was observed. The main impact was a decrease in the treatment of benign diseases and gastrointestinal tumors, with a general increase in breast cancer treatments. Eighteen (1.7%) patients were confirmed as having COVID-19 during radiotherapy in April and May 2020, three of whom were hospitalized, and one patient died because of COVID-19. Among the 18 patients, 12 had their treatments interrupted for at least 15 days from symptom appearance. Conclusion: There was a decrease in the number of treated patients in our radiotherapy department, with a greater decrease in the total number of sessions. This indicated, overall, a smaller number of fractions/patients treated, despite our efforts to maintain the treatment routine. We had several patients who were infected with COVID-19 and one related death during treatment in the first few months of the pandemic in Saão Paulo Brazil. (author)
[en] Objectives: To evaluate the economic impact of the new form of radiotherapy remuneration published by the Ministry of Health. Methods: We design a simulated group of seventy patients from a database of a public institution. We compare the remuneration from SUS old payment methodology (SOPM), with the new form entitled of the diagnosis-related groups (DRG). A comparison between the DRG with the SOPM corrected by four economic indexes was also performed. We tested if hypofractionation replace or equilibrate the absence of readjustment according to the economic indexes. A p-value <0.05 significant. Results: The remuneration of sixty CIDs using the SOPM and the DRG were done to simulate the group of patients. Evaluating the sixty CIDs, the DRG had a mean readjustment of 33.2% (-29.5% to 258%). However, evaluating the readjustment in the group, the ten most frequent tumor sites responsible per 85% of the remuneration had a readjustment < 5% (0.4-4.5%). The total of remuneration by the DRG or by the old table had a difference of R$18.700,00 (p=0.821). The difference was influenced by the breast cancer readjustment, and when breast cancer was the second or third most frequent, SOPM remunerated better than DRG. All indexes had a significant difference for the remuneration by DRG (p<0.0001). The hypofractionation improved the remuneration per fraction (p=0.001). The number need to treat with a hypofractionated schedule to equilibrate the difference for the economic indexes would be 31.2, 32, 60, and 58, for IPCA, IGPM, Dollar and minimum wage. Conclusion: The remuneration by DRG produced a non-significant difference compared with SOPM; the correction was < 5% for the most frequent tumors. The hypofractionation improves the ticket per fraction, but it does not exclude the need of a readjustment. (author)
[en] The technological development applied to statistical data collection processes, that has taken place in recent years, and the increasing availability of alternative statistical sources, notably administrative and so-called “sensor”, is leading to a profound revision of the role of direct surveys, also in the context of Official Statistics. The objective of this article, based on the experiences in progress in ISTAT (Italian National Statistical Institute) is to evaluate the status of the transition towards a more modern, efficient and sustainable way of conducting direct surveys, in a set of specific areas, providing examples and targeted analysis. This analysis will help to build a general framework towards which the collection of Official Statistics data will converge in the next years. In the above mentioned framework the analysis will mainly involve three converging macro areas: a) individuation of efficient management set-up of data collection processes; b) application of innovative techniques in the data collection of traditional direct surveys; c) aspects related to the availability of new alternative sources to those currently used in the production of official statistics.
[en] This paper presents Hotelling T2 as a procedure for the testing of significance difference between the item response probabilities (Omega/sub ij/S’) of classes in a Latent Class Model (LCM). Parametric bootstrap technique is used in order to generate samples for Omega/sub ij/s’. These samples are based on the estimated parameters of 2-class latent model. The estimation of parameters in either situation is done using the Expectation Maximization (EM) algorithm through Maximum likelihood method. The hypothesis under consideration is whether the response probabilities Greek small letter of Omega/sub ij/’s are equal against each item in both the classes. (H/sub 0/: Omega/sub iI/ = W/sub 12/ against H/sub 1/= Omega/Ii/ ≠ ω/sub 12/). If the test exhibits significant difference between response probabilities in both classes, it will be a clear indication of a presence of latent variable. We consider both training and testing data sets to develop the test. In order to apply Hotelling T/sup 2/ test the basic assumptions of normality and homogeneity of variance are also checked. Chi-square goodness of fit test is used for assessing normal distribution to be good fitted on the hypothesized (bootstrap samples) based on 2-class latent model parameters for each data and Bartlett test to check heterogeneity of variances in omega/sub ij/'s. Moreover, our procedure produces a minimum standard error of estimates as compared to those obtained through the package in R.Gui environment. (author)
[en] In 2017, more than 2.8 million people in Germany worked in a wide variety of occupations and fields in environmental protection. With a share of 6.4 % of all employed persons, environmental protection is thus an important factor for the entire labor market. More than half of the environmental protection workforce, a good 1.5 million people, performed activities for climate protection in 2017. That is 3.4 percent of the total workforce. One in 30 employees therefore owes their job to climate protection. As in previous years, environmental protection service employees accounted for the largest share of environmental protection employment in Germany in 2017, at around 56%.
[de]Im Jahr 2017 waren in Deutschland mehr als 2,8 Millionen Personen in den unterschiedlichsten Berufen und Bereichen für den Umweltschutz tätig. Mit einem Anteil von 6,4 % an allen Erwerbstätigen ist der Umweltschutz damit ein wichtiger Faktor für den gesamten Arbeitsmarkt. Mehr als die Hälfte der Umweltschutzbeschäftigten, gut 1,5 Millionen Personen, führten im Jahr 2017 Tätigkeiten für den Klimaschutz aus. Das sind 3,4 Prozent aller Erwerbstätigen. Jeder 30. Beschäftigte verdankt also seinen Arbeitsplatz dem Klimaschutz. Wie in den Vorjahren machten auch im Jahr 2017 die Umweltschutzdienstleistungsbeschäftigten mit rund 56% den größten Anteil der Umweltschutzbeschäftigung in Deutschland aus.
[en] "Energy-related emissions" are greenhouse gases and air pollutants released by the conversion of energy carriers into electrical and / or thermal energy (electricity and heat production). In this publication, UBA has compiled graphs and tables for the years 1990 to 2018 that show the energy-related emissions for greenhouse gases and selected air pollutants and the amount of fuels used for this purpose, broken down by sector.
[de]"Eergiebedingte Emissionen" sind Treibhausgase und Luftschadstoffe, die durch die Umwandlung von Energieträgern in elektrische und / oder thermische Energie (Strom- und Wärmeproduktion) freigesetzt werden. In dieser Veröffentlichung hat das UBA für die Jahre 1990 bis 2018 Grafiken und Tabellen zusammengestellt, die die energiebedingten Emissionen für Treibhausgase und ausgewählte Luftschadstoffe und die Menge der dafür eingesetzten Brennstoffe nach Sektoren aufgeschlüsselt darstellen.
[en] The work is based on the analysis of data from the literature and the survey of 36 cancer patients who underwent multiorgan thoracic, abdominal, retroperitoneal operative interventions. The severity of patients’ status was assessed using SOFA scale depending on the stage of ESI. The qualitative and quantitative composition of the bacterial flora of intestinal contents was studied. The increase in number of advanced and multi-organ surgery in cancer treatment can be noted. Statistical data showed that in 2018–2019 operative interventions on the chest organs comprised 47 %, and on abdominal cavity — 51 %. Regardless of the localization of surgery on various anatomical and physiological sites, the enteral insufficiency manifests in 39 % of all surgical interventions. The mortality rate due to enteral insufficiency is about 46 %, and SPOI complications are noted in 78 % of cases. Compensated and subcompensated EI in the postoperative period occurs in 95 %. A new method of electrochemical detoxication using sodium hypochlorite was suggested for EI patients treatment in order to reduce the indices of their pathogenic gut microbocenosis. This method allowed to decrease the yield of E. coli by 57,5 %, Enterococcus faecalis — by 72,3 % during the first day. At the end of study the yield of Staphilococcus xylosus dropped by 84,3 %, Candida lusitaniae and Candida spp. — by 98,3 %. Enterobacter aggomerans was reduced by 50,4 %, Staphilococcus haemolyticus and St. aureus — by 56,8 %. Treatment of patients with SEI allowed to decrease the rate of complications 1.4 times, the treatment time in intensive care departmet was shortened 1.7 times, treatment costs were reduced 2.4 times. Thus, it seems reasonable to pay more attention to the enteral insufficiency, particlualrly to disturbances of microbiocenosis as a marker of septic complications, in routine clinical practice. (author)