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Walters S, Aldous C, Malherbe H. Knowledge, attitudes, and practices of primary healthcare practitioners in low- and middle-income countries: a scoping review on genetics. J Community Genet 2024:10.1007/s12687-024-00721-y. [PMID: 39120782 DOI: 10.1007/s12687-024-00721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Individualised treatment, including genetic services, calls for an increased role of primary healthcare practitioners (pHCPs) in diagnosing and caring for individuals with genetic conditions. PHCPs' genetics knowledge and practices must be current to ensure adequate care. A scoping review was conducted to explore peer-reviewed articles on the knowledge, attitudes, and practices (KAPs) of pHCPs concerning genetics, genetic testing, and genetic services. English-language human genetics/genomics articles published between January 1990 and April 2022 in low- and middle-income countries (LMICs) were included. Twenty-eight articles from 16 LMICs in five World Health Organisation (WHO)-defined regions met the inclusion criteria and showed a steady increase in publications, with varied contributions by region. The Eastern Mediterranean Region (EMR) contributed the most articles (n = 8), while the Western Pacific Region (WPR) had the least (n = 2). Brazil published the most articles (n = 6), while ten countries contributed one article each. Fifteen articles included knowledge, 19 included attitudes towards genetics, and eight included genetic practices. The findings indicate that pHCPs in LMICs lack knowledge of genetics and its applications despite their positive outlook towards genetic services. Barriers such as limited resources, financial constraints, and cultural or religious beliefs hinder access to genetic services. Enhancing pHCPs' genetics education is vital for improving care for those affected by genetic conditions. The scarcity of literature in LMICs emphasises the need for research on educational interventions to improve patient outcomes and family support.
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Affiliation(s)
- Sarah Walters
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Colleen Aldous
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Helen Malherbe
- Director of Research and Epidemiology, Rare Diseases South Africa, NPC, Bryanston, Sandton, Gauteng, South Africa
- Centre for Human Metabolomics, North-West University, Potchefstroom, South Africa
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Jaramillo-Aguilar DS, Simbaña-Rivera K. Genetic knowledge and attitudes towards genetic testing among final-year medical students at a public university in Ecuador. Front Med (Lausanne) 2024; 11:1363552. [PMID: 38962733 PMCID: PMC11219587 DOI: 10.3389/fmed.2024.1363552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/29/2024] [Indexed: 07/05/2024] Open
Abstract
Background Genetics plays a crucial role in the field of medicine, offering numerous applications. However, health professionals often have insufficient knowledge in this area. Therefore, it is essential to provide appropriate genetics education during university studies. Aim This study aimed to assess the knowledge and attitudes towards genetic testing among final-year medical students at a public university in Ecuador. Methods A cross-sectional study was conducted involving final-year medical students from a public university in Ecuador. The third version of the Genetic Literacy and Attitudes Survey was administered between April and May 2022. The study examined sociodemographic characteristics, genetic knowledge, and attitudes towards genetic testing. Results The study included 153 medical students, of which 58.2% identified as female. Most participants fell within the age range of 22 to 25 years old (85.0%). Regarding genetic knowledge, three-quarters of the participants (75.2%) demonstrated intermediate proficiency, while only 9.80% possessed a high level of knowledge. Attitudes towards the clinical and therapeutic applications of genetics, scientific advancements, access to conventional medicine, and other related topics were found to be appropriate. Conclusion The findings suggest that most final-year medical students at a public university in Ecuador have intermediate genetic knowledge and hold appropriate attitudes towards genetic testing. However, higher education institutions should conduct a comprehensive analysis and restructure their curricula to better prepare students for the medical and technological challenges of the 21st century.
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Affiliation(s)
| | - Katherine Simbaña-Rivera
- Centro de Investigación para la Salud en América Latina (CISeAL), Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
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Pedrini DB, da Silva LP, Vieira TA, Giugliani R. Training of community health agents - a strategy for earlier recognition of mucopolysaccharidoses. J Community Genet 2024; 15:129-135. [PMID: 38114745 PMCID: PMC11031509 DOI: 10.1007/s12687-023-00691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023] Open
Abstract
Primary Health Care (PHC) is the gateway for patients in the Brazilian unified health system (Sistema Único de Saúde-SUS), playing an extremely important role in the identification of potential patients with genetic diseases, and referral to specialized and tertiary health services. The PHC is composed of a multidisciplinary team, including the Community Health Agent, who is in direct contact with the community. To implement an educational program aimed at community health agents working in several municipalities in the state of Rio Grande do Sul (RS), Brazil. The training was focused on genetic diseases in general, with a special focus on identifying patients with Mucopolysaccharidosis (MPS). Tests were applied before and after the educational intervention, in order to assess the participants' knowledge on the topic at these two moments. The study covered a total of ten training sessions carried out in eight municipalities in the RS state, training 374 community health agents. The number of correct answers in the pre-test (n = 339) was 8,4 (SD 1.2), while in the post-test (n = 361) it was 9,2 (SD 0.8). Statistical analysis showed that the educational intervention effectively provided information about genetic diseases to the participants. Considering that community health agents are of fundamental importance in the identification and prevention of diseases and in the better navigation of the patients on the SUS, these professionals play a key role in the field of rare genetic diseases, and continuous training strategies should be taken.
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Affiliation(s)
- Diane Bressan Pedrini
- Medical Genetics Service Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Child and Adolescent Health, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Larissa Pozzebon da Silva
- Brazilian Research Group On Rare Diseases (DR Brasil), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Casa Dos Raros, Porto Alegre, Brazil
- Clinical Research Group in Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Taiane Alves Vieira
- Medical Genetics Service Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- Brazilian Research Group On Rare Diseases (DR Brasil), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- Casa Dos Raros, Porto Alegre, Brazil.
| | - Roberto Giugliani
- Medical Genetics Service Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Child and Adolescent Health, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
- Casa Dos Raros, Porto Alegre, Brazil
- Clinical Research Group in Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- National Institute of Population Medical Genetics, INAGEMP, Porto Alegre, Brazil
- Dasa Genomics, São Paulo, Brazil
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Thomas J, Keels J, Calzone KA, Badzek L, Dewell S, Patch C, Tonkin ET, Dwyer AA. Current State of Genomics in Nursing: A Scoping Review of Healthcare Provider Oriented (Clinical and Educational) Outcomes (2012-2022). Genes (Basel) 2023; 14:2013. [PMID: 38002957 PMCID: PMC10671121 DOI: 10.3390/genes14112013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
In the 20 years since the initial sequencing of the human genome, genomics has become increasingly relevant to nursing. We sought to chart the current state of genomics in nursing by conducting a systematic scoping review of the literature in four databases (2012-2022). The included articles were categorized according to the Cochrane Collaboration outcome domains/sub-domains, and thematic analysis was employed to identify key topical areas to summarize the state of the science. Of 8532 retrieved articles, we identified 232 eligible articles. The articles primarily reported descriptive studies from the United States and other high-income countries (191/232, 82%). More than half (126/232, 54.3%) aligned with the "healthcare provider oriented outcomes" outcome domain. Three times as many articles related to the "knowledge and understanding" sub-domain compared to the "consultation process" subdomain (96 vs. 30). Five key areas of focus were identified, including "nursing practice" (50/126, 40%), "genetic counseling and screening" (29/126, 23%), "specialist nursing" (21/126, 17%), "nurse preparatory education" (17/126, 13%), and "pharmacogenomics" (9/126, 7%). Only 42/126 (33%) articles reported interventional studies. To further integrate genomics into nursing, study findings indicate there is a need to move beyond descriptive work on knowledge and understanding to focus on interventional studies and implementation of genomics into nursing practice.
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Affiliation(s)
- Joanne Thomas
- Genomics Policy Unit, Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK;
| | - Jordan Keels
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02476, USA;
| | - Kathleen A. Calzone
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- National Institutes of Health, National Cancer Institute, Center for Cancer Research, Genetics Branch, Bethesda, MD 20892, USA
| | - Laurie Badzek
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- Ross and Carol Nese College of Nursing, Penn State University, University Park, PA 16802, USA
| | - Sarah Dewell
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- School of Nursing, Thompson Rivers University, Kamloops, BC V2C 0C8, Canada
| | - Christine Patch
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- Engagement and Society, Wellcome Connecting Science, Hinxton CB10 1RQ, UK
| | - Emma T. Tonkin
- Genomics Policy Unit, Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK;
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
| | - Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02476, USA;
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
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Ferreira RL, do Nascimento IJB, de Almeida VIA, de Oliveira VRL, Marangne LG, dos Santos Gameleira F, Dutra TRC, de Oliveira Santos D, Dias Afonso MP, dos Santos PEA, de Oliveira HN, Vilhena Dias FM. The utilisation of primary health care system concepts positively impacts the assistance of patients with rare diseases despite limited knowledge and experience by health care professionals: A qualitative synopsis of the evidence including approximately 78 000 individuals. J Glob Health 2023; 13:04030. [PMID: 37539555 PMCID: PMC10401310 DOI: 10.7189/jogh.13.04030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background Individuals with rare diseases (RD) have been historically understudied. Previous publications reported that existing primary health care (PHC) workforces and associated infrastructure had been shown to improve their access and health-related outcomes in low- and middle-income countries (LMICs). As current evidence about the impact of PHC on patients diagnosed with RD is yet highly dispersed, this scoping review aimed to collate available evidence of the impact of PHC on patients with RD and summarize published information from multiple stakeholders about the perceived usefulness and barriers to effective use of the PHC system. Methods We searched Embase, Health System Evidence, PubMed, LILACS / BVS, and The Cochrane Library, from inception to September 1, 2022, for publications providing clear expert- or experience-based insights or data from patients living with RD at the PHC level of care. We included publications highlighting barriers to integrated care of patients with RD, reported by multiple social actors involved in caring for patients with RD. Two investigators screened publications, extracted data, and clustered information among records deemed eligible for inclusion. Data synthesis was performed using narrative and thematic-based analysis. Major findings identified and coded through a semantic-driven analysis were processed in vosViewer software and reported using descriptive statistics. Findings Eighty publications were included in this review. Quali-quantitative analyses evidenced that the PHC level is essential for approaching patients with RD, mainly due to its longitudinal, multidisciplinary, and coordinated care delivery. In addition, several publications highlighted that the medical curriculum is inappropriate for preparing health care providers to deal with patients presenting unusual signs and symptoms and being diagnosed with RD. PHC teams are essential in orienting patients and families on emergency events. Technology-related concepts were reported in 19 publications, emphasizing their effectiveness on early diagnosis, optimal treatment definition, improvement of quality of life, and long-lasting follow-up. Conclusions We provided valuable information on the effectiveness of the PHC in fostering a creative, integrative, and supportive environment for patients living with RD. Our results can be helpful to several stakeholders in deciding what actions are still pending to achieve a solid and positive experience for patients with RD in the PHC. Registration PROSPERO (CRD42022332347).
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Affiliation(s)
- Raquel Lemos Ferreira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Israel Júnior Borges do Nascimento
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Victor Izidro Alves de Almeida
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vanuza Regina Lommez de Oliveira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Gomes Marangne
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Flávia dos Santos Gameleira
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tárcia Regina Coura Dutra
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniela de Oliveira Santos
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Pellizzaro Dias Afonso
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Programa de Pós Graduação em Saúde Pública, da Faculdade de Medicina, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Paula Eduarda Alves dos Santos
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helian Nunes de Oliveira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, UFMG, Minas Gerais, Brazil
- Programa de Promoção de Saúde e Prevenção da Violência, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG, Minas Gerais, Brazil
| | - Fernando Machado Vilhena Dias
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Promoção de Saúde e Prevenção da Violência, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG, Minas Gerais, Brazil
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de Oliveira BM, Neiva MB, Carvalho I, Schwartz IVD, Alves D, Félix TM. Availability of Genetic Tests in Public Health Services in Brazil: Data from the Brazilian Rare Diseases Network. Public Health Genomics 2023; 26:145-158. [PMID: 37356424 PMCID: PMC10614440 DOI: 10.1159/000531547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023] Open
Abstract
INTRODUCTION The Brazilian Policy for Comprehensive Care for People with Rare Diseases (BPCCPRD) was published in 2014, accrediting several reference centers and incorporating many genetic tests for the diagnosis of rare diseases (RDs). The Brazilian Network of Rare Diseases (RARAS) comprises more than 40 institutions that offer diagnosis and treatment for RDs in Brazil. This network includes Reference Services for Rare Diseases (RDRS), Reference Services for Newborn Screening (NSRS), and University Hospitals distributed in all Brazilian regions. OBJECTIVE The aim of the study was to map the availability and distribution of the BPCCPRD diagnostic procedures in the Brazilian Unified Health System through RARAS. METHOD Data were collected through a questionnaire on the Research Electronic Data Capture platform, with 22 questions regarding the availability of procedures. Thirty-seven coordinators from RARAS participating centers received the questionnaire link for participation by email from August/2020 to March/2021. All participating institutions ethically approved this project. RESULTS Of the 37 institutions, 23 (62.16%) offered cytogenetic tests, 20 (54.05%) offered molecular procedures, and 22 (59.46%) offered inborn errors of metabolism diagnostic tests. The Southern blot analysis, enzyme assays on cultured tissue and urinary organic acid tests had the highest outsourcing rate. On the other hand, the procedures most frequently performed on-site were bone marrow karyotype and long-term cultured karyotype. It was observed that 10 of the 37 centers (27%) did not provide access to investigated procedures (on-site or outsourced). The North and Midwest regions stood out in terms of the unavailability of such techniques in at least 40% of the evaluated institutions. DISCUSSION AND CONCLUSION This study reveals large discrepancies in the supply of diagnostic procedures in the Brazilian territory. Moreover, there is a broad collaboration between services through the outsourcing of multiple diagnostic techniques to address this issue. Finally, this work corroborates the importance of mapping services for the diagnosis and treatment of individuals with RDs to propose actions for the better supply and distribution of these procedures.
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Affiliation(s)
- Bibiana Mello de Oliveira
- Medical Genetics Service, Hospital de Clínicas
de Porto Alegre, Porto Alegre, Brazil
- Postgraduation Program in Genetics and Molecular
Biology, Federal University of Rio Grande do Sul, Porto Alegre,
Brazil
| | - Mariane Barros Neiva
- Institute of Mathematical and Computer Sciences,
University of Sao Paulo, Sao Paulo, Brazil
| | - Isabelle Carvalho
- Institute of Mathematical and Computer Sciences,
University of Sao Paulo, Sao Paulo, Brazil
| | - Ida Vanessa Doederlein Schwartz
- Medical Genetics Service, Hospital de Clínicas
de Porto Alegre, Porto Alegre, Brazil
- Postgraduation Program in Genetics and Molecular
Biology, Federal University of Rio Grande do Sul, Porto Alegre,
Brazil
| | - Domingos Alves
- Ribeirao Preto Medical School, University of Sao
Paulo, Sao Paulo, Brazil
| | - Temis Maria Félix
- Medical Genetics Service, Hospital de Clínicas
de Porto Alegre, Porto Alegre, Brazil
| | - Raras Network Group
- Medical Genetics Service, Hospital de Clínicas
de Porto Alegre, Porto Alegre, Brazil
- Postgraduation Program in Genetics and Molecular
Biology, Federal University of Rio Grande do Sul, Porto Alegre,
Brazil
- Institute of Mathematical and Computer Sciences,
University of Sao Paulo, Sao Paulo, Brazil
- Ribeirao Preto Medical School, University of Sao
Paulo, Sao Paulo, Brazil
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Advancing rare disease policy in Latin America: a call to action. LANCET REGIONAL HEALTH. AMERICAS 2023; 18:100434. [PMID: 36844013 PMCID: PMC9950655 DOI: 10.1016/j.lana.2023.100434] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Abstract
People living with a rare disease are amongst the most vulnerable groups in society. They have been historically marginalised and systematically stigmatised. It is estimated that 300 million people worldwide live with a rare disease. Despite that, many countries today, especially in Latin America, still lack consideration of rare diseases in public policies and national laws. Based on interviews with patient advocacy groups in Latin America, we aim to provide recommendations for lawmakers and policymakers in Brazil, Peru, and Colombia on how to improve public policies and national legislation for persons living with rare diseases in these three countries.
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Lopes-Júnior LC, Ferraz VEF, Lima RAG, Schuab SIPC, Pessanha RM, Luz GS, Laignier MR, Nunes KZ, Lopes AB, Grassi J, Moreira JA, Jardim FA, Leite FMC, Freitas PDSS, Bertolini SR. Health Policies for Rare Disease Patients: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15174. [PMID: 36429893 PMCID: PMC9690117 DOI: 10.3390/ijerph192215174] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To identify and map the available evidence on the implementation of public health policies directed at individuals with rare diseases, and to compare the implementation of these health policies between Brazil and other countries. METHOD A scoping review guided by the PRISMA-ScR and JBI checklists. The search for articles was conducted in eight electronic databases, MEDLINE/Pubmed, Embase, Cochrane Library, Web of Science, Scopus, CINAHL, PsycINFO, and LILACS, using controlled descriptors, synonyms, and keywords combined with Boolean operators. All steps of this review were independently conducted by two researchers. The selected studies were classified by evidence hierarchy, and a generic quantitative tool was used for the assessment of the studies. RESULTS A total of 473 studies were identified, of which 13 which met all the inclusion criteria were selected and analyzed. Of these studies, 61.5% (n = 8) had final scores equal to or greater than 70%, i.e., they were classified by this tool as being well-reported. The comparative analysis of international rare diseases demonstrates that public authorities' priorities and recommendations regarding this topic also permeate and apply to the Brazilian context. CONCLUSIONS The evaluation and monitoring of public policies directed at rare disease patients are urgent and necessary to improve and implement such policies with less bureaucracy and more determination for this unique population that requires timely and high-quality care.
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Affiliation(s)
- Luís Carlos Lopes-Júnior
- Health Sciences Center, Graduate Program in Public Health, Federal University of Espírito Santo (UFES), Vitoria 29047-105, ES, Brazil
| | | | | | | | - Raphael Manhães Pessanha
- Health Sciences Center, Graduate Program in Public Health, Federal University of Espírito Santo (UFES), Vitoria 29047-105, ES, Brazil
| | - Geisa Santos Luz
- Hospital de Clínicas da Faculdade de Medicina de Marília (HCFAMEMA), Marília 17519-080, SP, Brazil
| | | | - Karolini Zuqui Nunes
- Department of Integrated Health Education, Graduate Program in Nutrition and Health, Federal University of Espírito Santo (UFES), Vitoria 29043-213, ES, Brazil
| | - Andressa Bolsoni Lopes
- Department of Integrated Health Education, Graduate Program in Nutrition and Health, Federal University of Espírito Santo (UFES), Vitoria 29043-213, ES, Brazil
| | - Jonathan Grassi
- Health Sciences Center, Graduate Program in Public Health, Federal University of Espírito Santo (UFES), Vitoria 29047-105, ES, Brazil
| | - Juliana Almeida Moreira
- Department of Integrated Health Education, Graduate Program in Nutrition and Health, Federal University of Espírito Santo (UFES), Vitoria 29043-213, ES, Brazil
| | - Fabrine Aguilar Jardim
- Ribeirão Preto College of Nursing (USP), University of São Paulo, Ribeirão Preto 14040-902, SP, Brazil
| | - Franciéle Marabotti Costa Leite
- Health Sciences Center, Graduate Program in Public Health, Federal University of Espírito Santo (UFES), Vitoria 29047-105, ES, Brazil
| | | | - Silvia Regina Bertolini
- Department of Management and Health Care, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, SP, Brazil
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Bonilla C, Albuquerque Sortica V, Schuler-Faccini L, Matijasevich A, Scheffer MC. Medical geneticists, genetic diseases and services in Brazil in the age of personalized medicine. Per Med 2022; 19:549-563. [DOI: 10.2217/pme-2021-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aim: In anticipation of the implementation of personalized medicine in Brazil the authors assessed the characteristics of its medical genetics workforce together with the distribution of genetic diseases and services across the country. Materials & methods: The authors used demographic data on medical specialties, and summarized data from the public and private healthcare systems on live births, hospitalization and mortality, for the years 2019 and 2020. Results: The distribution of medical geneticists (MGs) overlapped the country-wide distribution of genetic diseases and services examined, indicating that ∼30% of the patient population has access to a MG specialist. Graduate specialism in medical genetics, registered MGs and suitable workplaces were concentrated in the south and southeast regions, leaving the north and northeast deeply underserved. Conclusion: MGs are concentrated in the wealthiest and most populated areas, while other regions have very limited services. These inequalities should be addressed for a successful transition to personalized medicine.
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Affiliation(s)
- Carolina Bonilla
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, 01246-903, Brazil
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, United Kingdom
| | - Vinicius Albuquerque Sortica
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, 01246-903, Brazil
| | - Lavinia Schuler-Faccini
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 91501-970, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-903, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, 01246-903, Brazil
| | - Mário C Scheffer
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, 01246-903, Brazil
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10
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Valentim RAM, de Oliveira CAP, Oliveira ESG, Ribeiro EL, da Costa SM, Morais IRD, Fernandes FRDS, Caitano AR, Gusmão CMG, Cunha-Oliveira A, Rêgo MCFD, Coutinho KD, Barros DMS, Ceccim RB. Virtual Learning Environment of the Brazilian Health System (AVASUS): Efficiency of Results, Impacts, and Contributions. Front Med (Lausanne) 2022; 9:896208. [PMID: 35721078 PMCID: PMC9201943 DOI: 10.3389/fmed.2022.896208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
The Virtual Learning Environment of the Brazilian Health System (AVASUS) is a free and open distance education platform of the Ministry of Health (MS). AVASUS is a scalable virtual learning environment that has surpassed 800,000 users, 2 million enrollments, and 310 courses in its catalog. The objective of this paper was to assess the impacts of the educational offerings on health services and AVASUS course participants' professional practice. This study analyzed data from AVASUS, the Brazilian National Registry of Health Care Facilities (CNES), the Brazilian Occupational Classification (CBO), and a questionnaire applied to 720-course participants from five regions of Brazil. After acquiring and extracting data, computational methods were used for the evaluation process. Only the responses of 462 participants were considered for data analysis, as they had a formal link to CNES. The results showed that respondents recommended 76.2% of AVASUS courses to peers. Accordingly, the quality of educational offerings motivated 81.3% of such recommendations. In addition, 75.6% of course participants who answered the questionnaire also indicated that AVASUS course contents contribute to enhancing existing health services in the health facilities where they work. Finally, 24.6% of all responses mentioned that courses available in AVASUS were essential in offering new health services in such facilities.
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Affiliation(s)
- Ricardo A. M. Valentim
- Laboratory for Technological Innovation in Health, Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Carlos A. P. de Oliveira
- Multidisciplinary Institute of Human Development With Technologies, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eloiza S. G. Oliveira
- Multidisciplinary Institute of Human Development With Technologies, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo L. Ribeiro
- Laboratory for Technological Innovation in Health, Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Soneide M. da Costa
- Department of Distance Education of the Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Ione R. D. Morais
- Department of Distance Education of the Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Felipe R. dos S. Fernandes
- Laboratory for Technological Innovation in Health, Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Alexandre R. Caitano
- Laboratory for Technological Innovation in Health, Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Cristine M. G. Gusmão
- Department of Biomedical Engineering, Federal University of Pernambuco, Recife, Brazil
| | - Aliete Cunha-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E) and Nursing School of Coimbra (ESEnfC), Portugal and CEIS-20 da Universidade de Coimbra, Coimbra, Portugal
| | - Maria C. F. D. Rêgo
- Department of Distance Education of the Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Karilany D. Coutinho
- Laboratory for Technological Innovation in Health, Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Daniele M. S. Barros
- Laboratory for Technological Innovation in Health, Federal University of Rio Grande Do Norte, Natal, Brazil
| | - Ricardo B. Ceccim
- Graduate Program in Education, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
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Santos CSD, Kishi RGB, Costa DLGD, Silva DSDD, Narciso TRF, Avó LRDSD, Germano CMR, Sandes KA, Acosta AX, Melo DG. Identificação de doenças genéticas na Atenção Primária à Saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Problema: Embora individualmente raras, somadas, as doenças genéticas têm prevalência global estimada de 31,5 a 73,0 por 1.000 indivíduos. Além disto, doenças genéticas e defeitos congênitos representam a segunda causa de mortalidade infantil no Brasil. Diante deste cenário, foi instituída a Política Nacional de Atenção Integral às Pessoas com Doenças Raras no Sistema Único de Saúde. Esta política prevê funções específicas para Atenção Primária à Saúde (APS) que incluem diagnóstico precoce e mapeamento de pessoas com ou sob-risco de desenvolver doenças genéticas raras e/ou defeitos congênitos para encaminhamento regulado. Essa experiência objetivou colaborar com o desenvolvimento de métodos para o reconhecimento de indivíduos com ou sob-risco de desenvolver doenças genéticas na APS. Métodos: Através de visitas domiciliares e por meio do preenchimento de uma ficha específica, realizou-se busca ativa de casos de doença genética e/ou defeito congênito em uma amostra probabilística aleatória, representativa de uma Unidade de Saúde da Família de um município brasileiro de porte médio. Resultados: Foram investigados 295 domicílios, totalizando 1.160 indivíduos e 238 casais. A média de filhos por casal foi de 2,7, a frequência de consanguinidade foi 3,8% e de abortamento espontâneo foi 8,7%. Foram identificadas 29 pessoas (2,5%) com doenças congênitas, 11 (0,9%) com deficiências auditivas, 10 (0,9%) com deficiência mental e 6 (0,5%) com déficits visuais importantes. Atraso no desenvolvimento neuropsicomotor foi relatado em 8,8% das crianças e adolescentes. Doze indivíduos (1%) possuíam câncer e 9,6% relataram história familiar positiva para câncer. Conclusão: Os profissionais da APS estão em posição privilegiada para identificar e organizar uma rede de cuidados para indivíduos com doenças genéticas e/ou defeitos congênitos. A utilização sistemática de instrumentos que facilitem o reconhecimento de fatores de risco e de situações suspeitas pode ser uma estratégia útil a ser incorporada pela APS.
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12
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Selič P, Klemenc-Ketiš Z, Zelko E, Kravos A, Rifel J, Makivić I, Poplas Susič A, Tevžič Š, Cerovič M, Peterlin B, Kopčavar Guček N. Development of an Algorithm for Determining of Genetic Risk at the Primary Healthcare Level - A New Tool for Primary Prevention: A Study Protocol. Zdr Varst 2020; 59:27-32. [PMID: 32952700 PMCID: PMC7478082 DOI: 10.2478/sjph-2020-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/21/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Family history (FH) is an important part of the patients' medical history during preventive management at model family medicine practices (MFMP). It currently includes a one (or two) generational inquiry, predominately in terms of cardiovascular diseases, arterial hypertension, and diabetes, but not of other diseases with a probable genetic aetiology. Beside family history, no application-based algorithm is available to determine the risk level for specific chronic diseases in Slovenia. METHODS A web application-based algorithm aimed at determining the risk level for selected monogenic and polygenic diseases will be developed. The data will be collected in MFMP; approximately 40 overall with a sample including healthy preventive examination attendees (approximately 1,000). Demographic data, a three-generational FH, a medical history of acquired and congenital risk factors for the selected diseases, and other important clinical factors will be documented. RESULTS The results will be validated by a clinical genetic approach based on family pedigrees and the next-generation genetic sequencing method. After the risk of genetic diseases in the Slovenian population has been determined, clinical pathways for acting according to the assessed risk level will be prepared. CONCLUSION By means of a public health tool providing an assessment of family predisposition, a contribution to the effective identification of people at increased risk of the selected monogenic and polygenic diseases is expected, lessening a significant public health burden.
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Affiliation(s)
- Polona Selič
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
| | - Erika Zelko
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
| | - Andrej Kravos
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
| | - Janez Rifel
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
| | - Irena Makivić
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
| | | | - Špela Tevžič
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
| | - Metka Cerovič
- Community Health Centre dr. Adolfa Drolca Maribor, Ulica talcev 9, 2000Maribor, Slovenia
| | - Borut Peterlin
- University Medical Centre Ljubljana, Clinical Institute of Medical Genetics, Šlajmerjeva 4, 1000Ljubljana, Slovenia
| | - Nena Kopčavar Guček
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
- Community Health Centre Ljubljana, Metelkova 9, 1000Ljubljana, Slovenia
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13
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Frenetic, under-Challenged, and Worn-out Burnout Subtypes among Brazilian Primary Care Personnel: Validation of the Brazilian "Burnout Clinical Subtype Questionnaire" (BCSQ-36/BCSQ-12). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031081. [PMID: 32046282 PMCID: PMC7036968 DOI: 10.3390/ijerph17031081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/16/2022]
Abstract
Primary healthcare personnel show high levels of burnout. A new model of burnout has been developed to distinguish three subtypes: frenetic, under-challenged, and worn-out, which are characterized as overwhelmed, under-stimulated, and disengaged at work, respectively. The aim of this study was to assess the psychometric properties of the long/short Brazilian versions of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-36/BCSQ-12) among Brazilian primary healthcare staff and its possible associations with other psychological health-related outcomes. An online cross-sectional study conducted among 407 Brazilian primary healthcare personnel was developed. Participants answered a Brazil-specific survey including the BCSQ-36/BCSQ-12, "Maslach Burnout Inventory-General Survey", "Utrecht Work Engagement Scale", "Hospital Anxiety/Depression Scale", "Positive-Negative Affect Schedule", and a Visual Analogue Scale of guilt at work. The bifactor was the model with the best fit to the data using the BCSQ-36, which allowed a general factor for each subtype. The three-correlated factors model fit better to the BCSQ-12. Internal consistence was appropriate, and the convergence between the long-short versions was high. The pattern of relationships between the burnout subtypes and the psychological outcomes suggested a progressive deterioration from the frenetic to the under-challenged and worn-out. In sum, the Brazilian BCSQ-36/BCSQ-12 showed appropriate psychometrics to be used in primary healthcare personnel.
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14
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Franciscatto LHG, Silva MRSD, Santos AMD, Oliveira AMND, Salvador K. Genetic disease in the family: trajectories and experiences in public health services. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify the trajectories and experiences of families of children with genetic diseases in health services. Method: A qualitative study, with data collected through interviews with 15 families and caregivers of children with Genetic Disease, living in the northern region of Rio Grande do Sul. Interviews were conducted from March to May 2018. Data analysis was based on thematic analysis. Results: A genetic disease diagnosis led to families' changes due to the demands of treatment, and also the needs of the child for being met by health services. To access specialized services, some families needed to travel to referral centers in larger cities. Families experienced difficulties such as unprepared health professionals, lack of organization of services, judicialization of resources, and need for structured Health Care Networks. Conclusion: The professional has the fundamental role of providing families with access to information and are responsible for decision making and for the organization and management of health and nursing services to meet the demands imposed on the individual and the family by the genetic disease.
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Affiliation(s)
| | | | | | | | - Keterlin Salvador
- Universidade Regional Integrada do Alto Uruguai e das Missões, Brasil
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15
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Mandrell BN, Hines-Dowell S, Nishigaki M. Genetics and Genomics: Precision Health in Pediatric Oncology. PEDIATRIC ONCOLOGY 2020. [DOI: 10.1007/978-3-030-25804-7_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Sousa MSAD, Gallian DMC, Maciel RMDB. From ‘Me’ to ‘Us’: solidarity and biocitizenship in the Brazilian cancer precision medicine innovation system. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT As biotechnology innovations move from the bench to the bedside and, recently, also to the Internet, a myriad of emanating challenges and potentials may rise under distinct sociocultural and political economic contexts. Using a grounded-theory-inspired case study focused on the Brazilian research consortium for Medullary Endocrine Neoplasia type 2 (BrasMEN) – an inherited syndrome where genetic tests define cost-effective interventions – we outline facilitators and barriers to both development and implementation of a ‘public health genomics’ strategy under a developing country scenario. The study is based on participant observation at three centres and interviews with all who might hold an interest in MEN2 around Brazil. We discuss how a ‘solidarity’-based motivation for individual and collective ‘biocitizenship’ is driving people’s pre-emptive actions for accessing and making personalised healthcare available at Brazil’s Unified Health System (SUS) via the ‘co-production’ of science, technology and the culture for precision medicine – termed Brazil’s ‘hidden’ biomedical innovation system. Given the establishment of BrasMEN as ‘solidarity networks’ – promoting and supporting the cancer precision medicine’s rationale – our data illustrates how a series of new bioethical challenges raise from such engagement with familial cancer genomics under Brazil’s developing country scenario and how this social/soft technology constitute a solution for Euro/North American societies.
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Affiliation(s)
- Maria Sharmila Alina de Sousa
- Universidade Federal de São Paulo, Brasil; Fundação Oswaldo Cruz, Brasil; Pontifícia Universidade Católica de São Paulo, Brasil
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17
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Chong HY, Allotey PA, Chaiyakunapruk N. Current landscape of personalized medicine adoption and implementation in Southeast Asia. BMC Med Genomics 2018; 11:94. [PMID: 30367635 PMCID: PMC6203971 DOI: 10.1186/s12920-018-0420-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/11/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The emergence of personalized medicine (PM) has raised some tensions in healthcare systems. PM is expensive and health budgets are constrained - efficient healthcare delivery is therefore critical. Notwithstanding the cost, many countries have started to adopt this novel technology, including resource-limited Southeast Asia (SEA) countries. This study aimed to describe the status of PM adoption in SEA, highlight the challenges and to propose strategies for future development. METHODS The study included scoping review and key stakeholder interviews in four focus countries - Indonesia, Malaysia, Singapore, and Thailand. The current landscape of PM adoption was evaluated based on an assessment framework of six key themes - healthcare system, governance, access, awareness, implementation, and data. Six PM programs were evaluated for their financing and implementation mechanisms. RESULTS The findings revealed SEA has progressed in adopting PM especially Singapore and Thailand. A regional pharmacogenomics research network has been established. However, PM policies and programs vary significantly. As most PM programs are champion-driven and the available funding is limited, the current PM distribution has the potential to widen existing health disparities. Low PM awareness in the society and the absence of political support with financial investment are fundamental barriers. There is a clear need to broaden opportunities for critical discourse about PM especially for policymakers. Multi-stakeholder, multi-country strategies need to be prioritized in order to leverage resources and expertise. CONCLUSIONS Adopting PM remains in its infancy in SEA. To achieve an effective PM adoption, it is imperative to balance equity issues across diverse populations while improving efficiency in healthcare.
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Affiliation(s)
- Huey Yi Chong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor Malaysia
| | - Pascale A. Allotey
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor Malaysia
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, USA
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia
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18
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Rodrigues SA, Fontanella BJB, de Avó LRS, Germano CMR, Melo DG. A qualitative study about quality of life in Brazilian families with children who have severe or profound intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:413-426. [PMID: 30353627 DOI: 10.1111/jar.12539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 07/17/2018] [Accepted: 09/21/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study investigated the psychocultural perspectives concerning family quality of life among Brazilian families with children who have severe or profound intellectual disability. METHODS Individual in-depth semi-structured interviews conducted with 15 mothers, selected by convenience, were analysed using a categorical thematic analysis technique. The themes were examined to allow for an interpretative approach of the results. RESULTS Mothers revealed that their children with disabilities had insufficient access to services and support related to health care, transportation and recreation. Family quality of life was negatively affected by financial restrictions and social interaction difficulties. Caring for a child with disabilities seemed to be centred on the mother and religious coping appeared as a common psychological adjustment strategy. CONCLUSIONS Improving emotional and psychological cares, as well as social and practical measures comprising income support and access to appropriate health care, were inferred to be the mothers' priorities to improve their families' quality of life.
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Affiliation(s)
- Stephania A Rodrigues
- Department of Medicine, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Bruno J B Fontanella
- Department of Medicine, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Lucimar R S de Avó
- Department of Medicine, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Carla M R Germano
- Department of Medicine, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Débora G Melo
- Department of Medicine, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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19
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Gibbon S, Aureliano W. Inclusion and exclusion in the globalisation of genomics; the case of rare genetic disease in Brazil. Anthropol Med 2018. [PMID: 29533091 PMCID: PMC5890301 DOI: 10.1080/13648470.2017.1381230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Within the context of a globalising agenda for genetic research where ‘global health’ is increasingly seen as necessarily informed by and having to account for genomics, the focus on rare genetic diseases is becoming prominent. Drawing from ethnographic research carried out separately by both authors in Brazil, this paper examines how an emerging focus on two different arenas of rare genetic disease, cancer genetics and a class of degenerative neurological diseases known as Ataxias, is subject to and a product of the dynamics of inclusion and exclusion as this concerns participation in research and access to health care. It examines how in these different cases ‘rarenesss’ has been diversely situated and differently politicised and how clinicians, patients and their families grapple with the slippery boundaries between research, rights to health and the limits of care, therapy or prevention. It illustrates how attention to rare genetic disease in Brazil emerges at the intersection of a particular history of genetic research and public health infrastructure, densely complicated feedback loops between clinical care and research, patient mobilisation around the ‘judicialisation’ of health and recent state legislation regarding rare disease in Brazil. It highlights the relevance of local configurations in the way rare genetic disease is being made relevant for and by different communities.
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Affiliation(s)
- Sahra Gibbon
- a Department of Anthropology , University College London , London , UK
| | - Waleska Aureliano
- b Department of Anthropology , Universidade do Estado do Rio de Janeiro , Rio de Janeiro , Brazil
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20
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Melo DG, Germano CMR, Porciúncula CGG, Paiva ISD, Neri JIDCF, Avó LRDSD, Demarzo MMP, Galera MF. Qualificação e provimento de médicos no contexto da Política Nacional de Atenção Integral às Pessoas com Doenças Raras no Sistema Único de Saúde (SUS). ACTA ACUST UNITED AC 2017. [DOI: 10.1590/1807-57622016.0211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Este ensaio teórico reflete sobre a qualificação e o provimento de médicos no contexto da Política Nacional de Atenção Integral às Pessoas com Doenças Raras no SUS. Para isso, apresentamos a Política e suas diretrizes, e situamos a discussão em torno de duas estratégias integradas: o provimento e a fixação de médicos geneticistas; e a capacitação de profissionais da Atenção Primária à Saúde em relação às doenças genéticas e aos defeitos congênitos. Finalmente, considerando as Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina, apresentamos uma proposta de perfil de competência mínimo em Genética, elaborada para instrumentalizar os cursos de graduação da área da Saúde, em particular os cursos de Medicina. Assim, oferecemos um referencial teórico para apoiar o delineamento de programas de educação e formação em Saúde, contribuindo para inclusão do cuidado em Genética no SUS.
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21
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Montero-Marín J, Gaete J, Demarzo M, Rodero B, Lopez LCS, García-Campayo J. Self-Criticism: A Measure of Uncompassionate Behaviors Toward the Self, Based on the Negative Components of the Self-Compassion Scale. Front Psychol 2016; 7:1281. [PMID: 27625618 PMCID: PMC5003888 DOI: 10.3389/fpsyg.2016.01281] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022] Open
Abstract
Background: The use of the Self-Compassion Scale (SCS) as a single measure has been pointed out as problematic by many authors and its originally proposed structure has repeatedly been called into question. The negative facets of this construct are more strongly related to psychopathology than the positive indicators. The aim of this study was to evaluate and compare the different structures proposed for the SCS, including a new measure based only on the negative factors, and to assess the psychometric features of the more plausible solution. Method: The study employed a cross-sectional and cross-cultural design. A sample of Brazilian (n = 406) and Spanish (n = 416) primary care professionals completed the SCS, and other questionnaires to measure psychological health-related variables. The SCS factor structure was estimated using confirmatory factor analysis by the maximum likelihood method. Internal consistency was assessed by squaring the correlation between the latent true variable and the observed variables. The relationships between the SCS and other constructs were analyzed using Spearman's rs. Results: The structure with the best fit was comprised of the three negative first-order factors of “self-judgment”, “isolation” and “over-identification”, and one negative second-order factor, which has been named “self-criticism” [CFI = 0.92; RMSEA = 0.06 (90% CI = 0.05–0.07); SRMR = 0.05]. This solution was supported by both samples, presented partial metric invariance [CFI = 0.91; RMSEA = 0.06 (90% CI = 0.05–0.06); SRMR = 0.06], and showed significant correlations with other health-related psychological constructs. Reliability was adequate for all the dimensions (R ≥ 0.70). Conclusions: The original structure proposed for the SCS was not supported by the data. Self-criticism, comprising only the negative SCS factors, might be a measure of uncompassionate behaviors toward the self, with good psychometric properties and practical implications from a clinical point of view, reaching a stable structure and overcoming possible methodological artifacts.
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Affiliation(s)
- Jesús Montero-Marín
- Faculty of Health and Sport Sciences, Primary Care Prevention and Health Promotion Research Network, Centro de Investigación Biomédica en Red de Salud Mental, University of Zaragoza, Zaragoza, Spain
| | - Jorge Gaete
- Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile,Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marcelo Demarzo
- Department of Preventive Medicine, Mente Aberta – Brazilian Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo, São Paulo, Brazil,Instituto Israelita de Ensino e Pesquisa Do Hospital Albert Einstein, São Paulo, Brazil
| | | | - Luiz C Serrano Lopez
- Department of Preventive Medicine, Mente Aberta – Brazilian Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Javier García-Campayo
- Miguel Servet Hospital and University of Zaragoza, Primary Care Prevention and Health Promotion Research Network, Instituto de Investigación Sanitaria Aragón (IIS Aragon), Centro de Investigación Biomédica en Red de Salud Mental, Zaragoza, Spain
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Quality of Life in Adults with Neurofibromatosis 1 in Brazil. J Genet Couns 2016; 25:1063-74. [PMID: 26944915 DOI: 10.1007/s10897-016-9939-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a neurocutaneous genetic disorder that can be associated with severe complications, and it may shorten patients' lifespan and affect their quality of life negatively. This study aimed to examine quality of life constructs among adults with NF1 in Brazil. It is an exploratory, descriptive and cross-sectional study consisting of two stages, involving thirteen adult patients with NF1. The first stage was developed using a quantitative methodology, namely the WHOQOL-100 questionnaire; responses for the 13 patients were compared to a matched control group. The second stage comprised clinical-qualitative research whereby participants took part in a semi-structured interview; these data were analyzed using the categorical thematic analysis technique. There were no statistically significant differences in the questionnaire domains between the NF1 patients and the control subjects. Eighteen main themes were extracted from the interviews, showing interference of the NF1 visibility principally in psychological aspects and social relationships. Patients mentioned curiosity about NF1 and confusion about the distinctions between NF1 and contagious diseases, which lead to prejudice. They were concerned about the future and how the disease would develop in themselves and their offspring, and emphasized difficulties acquiring proper healthcare. These findings may help in planning healthcare for Brazilian NF1 patients and improving their quality of life.
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