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Félix TM, Oliveira BMD, Horovitz DDG. Building a National Policy for Rare Disease in Brazil. J Community Genet 2024:10.1007/s12687-024-00732-9. [PMID: 39325316 DOI: 10.1007/s12687-024-00732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 09/04/2024] [Indexed: 09/27/2024] Open
Abstract
Rare diseases (RD) are individually rare, although encompass a significant proportion of the population, affecting not only the individuals but also their families. In Brazil RD is defined by the Ministry of Health as a disorder that affects up to 65 individuals in 100,000, or 1.3 individuals in every 2,000. In this review the environment that led to the publication of a National Policy for Comprehensive Care for People of Rare Disease in 2014, a national plan with the aim to decrease morbidity and mortality of RD, improving the care of people with RD in the public health system are described. The process that finally led to such policy took over a decade, moving forward not only due to technical needs, but having patient organizations as essential actors and advocates. Specialized centers in RD were licensed and, since its publication, 33 centers have been accredited; such process, however, has been slow and concentrated in specific regions and larger cities of the country. Despite the incorporation of genetic tests in 2014 and exome sequencing later in 2020, many genetic tests are not offered by specialized centers, with unequal availability across the country. Public health system in Brazil uses ICD-10 for disease coding, preventing appropriate epidemiologic knowledge of RD in Brazil. Incorporation of new technologies as orphan drugs has been in place and regulation for expedite licensing for new RD drugs were issued, although high cost and availability to RD population has been a challenge.
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Affiliation(s)
- Têmis Maria Félix
- Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-903, Brazil.
| | - Bibiana Mello de Oliveira
- Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Dafne Dain Gandelman Horovitz
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Rabello F, Celestino MLS, Carneiro NCR, Reis-Oliveira J, Prado HV, Abreu MHNGD, Borges-Oliveira AC. Oral Problems in Brazilian Individuals with Rare Genetic Diseases That Affect Skeletal Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1227. [PMID: 39338110 PMCID: PMC11431253 DOI: 10.3390/ijerph21091227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/10/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024]
Abstract
The present study aimed to compare the prevalence of oral problems between individuals with rare genetic diseases that affect skeletal development and individuals without rare diseases. A cross-sectional study was conducted with 210 individuals between two and fifty-four years of age: 105 with rare genetic diseases (27 with mucopolysaccharidosis [MPS] and 78 with osteogenesis imperfecta [OI]) and 105 without rare diseases. The rare genetic disease group was recruited from hospital units that provide care for patients with MPS and OI in five states of Brazil, and the other group was recruited from the same location. The participants were examined with regards to malocclusion, dental anomalies, dental caries, and gingivitis. A questionnaire was administered addressing individual, sociodemographic, and behavioral characteristics as well as dental history. A descriptive analysis was performed, followed by unadjusted and adjusted binary logistic regression analyses. The mean age was 14.1 ± 12.2 years. Individuals with a rare disease were 12.9-fold more likely to have some type of oral problem (95% CI: 3.7-44.7) compared to the group without rare diseases. The prevalence of oral problems was higher among Brazilians with MPS and OI compared to normotypical individuals.
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Affiliation(s)
- Flavia Rabello
- Undergraduate Course in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte 30535-500, Brazil
| | - Mariana Laís Silva Celestino
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-800, Brazil
| | - Natália Cristina Ruy Carneiro
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-800, Brazil
| | - Jennifer Reis-Oliveira
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-800, Brazil
| | - Heloísa Vieira Prado
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-800, Brazil
| | | | - Ana Cristina Borges-Oliveira
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-800, Brazil
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Horovitz DDG, Félix TM, Ferraz VEDF. Medical Genetics in Brazil in the 21st Century: A Thriving Specialty and Its Incorporation in Public Health Policies. Genes (Basel) 2024; 15:973. [PMID: 39202336 PMCID: PMC11353425 DOI: 10.3390/genes15080973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 09/03/2024] Open
Abstract
Brazil is a continent-size country with 203 million inhabitants, classified as a developing upper-middle-income country, although inequities remain significant. Most of the population is assisted by the public Unified Health System (SUS), along with a thriving private health sector. Congenital malformations are the second leading cause of infant mortality and chronic/genetic disorders and a significant burden in hospital admissions. The past two decades have been crucial for formalizing medical genetics as a recognized medical specialty in the SUS, as well as for implementing a new health policy by the Ministry of Health for comprehensive care for rare diseases. These public health policies had the broad support of the Brazilian Society of Medical Genetics and Genomics and patient organizations. Most comprehensive genetic services are concentrated in large urban centers in the South and Southeast regions of Brazil; with this new policy, new services throughout the country are progressively being integrated. The number of medical geneticists increased by 103% in a decade. Details on the policy and an overview of the availability of services, testing, human resources, newborn screening, research projects, patient organizations, and relevant issues regarding medical genetics in this vast and diverse country are presented.
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Affiliation(s)
- Dafne Dain Gandelman Horovitz
- Centro de Genetica Medica, Instituto Nacional de Saude da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, RJ, Brazil
| | - Têmis Maria Félix
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil;
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da Fonseca LLCG, Rocha DN, Cintra HA, de Araújo LL, dos Santos GLM, de Faria LL, Salú MDS, Leite SHDS, Rocha AD, Lopes MDCB, Ferreira IR, Gomes LHF, Guida LC. Establishing a Standardized DNA Extraction Method Using NaCl from Oral Mucosa Cells for Its Application in Imprinting Diseases Such as Prader-Willi and Angelman Syndromes: A Preliminary Investigation. Genes (Basel) 2024; 15:641. [PMID: 38790270 PMCID: PMC11120874 DOI: 10.3390/genes15050641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/11/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Diagnosing imprinting defects in neonates and young children presents challenges, often necessitating molecular analysis for a conclusive diagnosis. The isolation of genetic material from oral swabs becomes crucial, especially in settings where blood sample collection is impractical or for vulnerable populations like newborns, who possess limited blood volumes and are often too fragile for invasive procedures. Oral swab samples emerge as an excellent source of DNA, effectively overcoming obstacles associated with rare diseases. METHODS In our study, we specifically addressed the determination of the quality and quantity of DNA extracted from oral swab samples using NaCl procedures. RESULTS We compared these results with extractions performed using a commercial kit. Subsequently, the obtained material underwent MS-HRM analysis for loci associated with imprinting diseases such as Prader-Willi and Angelman syndromes. CONCLUSIONS Our study emphasizes the significance of oral swab samples as a reliable source for obtaining DNA for MS-HRM analysis. NaCl extraction stands out as a practical and cost-effective method for genetic studies, contributing to a molecular diagnosis that proves particularly beneficial for patients facing delays in characterization, ultimately influencing their treatment.
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Affiliation(s)
- Letícia Lopes Cabral Guimarães da Fonseca
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Danielle Nascimento Rocha
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Hiago Azevedo Cintra
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Luiza Loureiro de Araújo
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Gabrielle Leal Monteiro dos Santos
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Leonardo Lima de Faria
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Margarida dos Santos Salú
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Silvia Helena dos Santos Leite
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Adriana Duarte Rocha
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Maria da Conceição Borges Lopes
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Igor Ribeiro Ferreira
- Rural and Remote Support Services, Department of Health, Integrated Cardiovascular Clinical Network SA, Adelaide 5042, Australia
| | - Leonardo Henrique Ferreira Gomes
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
| | - Letícia Cunha Guida
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil (H.A.C.); (L.L.d.A.); (L.L.d.F.)
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Cunico C, Vicente G, Leite SN. Initiatives to promote access to medicines after publication of the Brazilian Policy on the Comprehensive Care of People with Rare Diseases. Orphanet J Rare Dis 2023; 18:259. [PMID: 37653461 PMCID: PMC10472611 DOI: 10.1186/s13023-023-02881-5] [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: 04/12/2022] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Rare diseases affect a small number of people compared to prevalent diseases. The vast majority of these diseases are of genetic origin, have no cure, are chronic and can lead to death. Although the right to access medicines is included in the constitutionally guaranteed right to health in Brazil, problems in the supply of medicines for rare diseases are reported in the country. This study aimed to describe and analyse the initiatives to promote access to medicines for treating rare diseases in the Unified Health System, Brazil, after the publication of the Brazilian Policy on the Comprehensive Care of People with Rare Diseases. Based on the model published by the WHO Regional Office for Europe, which described access to medicines in prelaunch, perilaunch and postlaunch policies, the initiatives referring to each category were summarized based on documentary research searched in online databases from January 2014 to December 2020. RESULTS Different actions and policy interventions were identified, which went through the expansion of resources for research and development, health regulations, incorporation of new drugs, review and publication of clinical guidelines, and expansion of the network of care facilities by the Ministry of Health. On the other hand, aspects related to care policies, pricing methods, technological development, and development of pharmaceutical service processes were not implemented. CONCLUSIONS Although it is impossible to determine the explicit motivation of such actions concerning the Policy, its publication certainly was a landmark in Brazilian society, allowing greater recognition of the needs of rare disease patients and the specificities of treatment'. However, this study suggests that the steps that make up the life cycle of medicines are not linked, lacking articulation and integration of the care network, and consequently, there is no evidence that rare disease policy publication has generated a broad impact on the promotion of access to medicines to treat rare diseases in Brazil.
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Affiliation(s)
- Cássia Cunico
- Graduate Program in Pharmaceutical Policy and Services PPGASFAR, Universidade Federal de Santa Catarina - Campus Trindade, Florianópolis, Santa Catarina, CEP 88.040-000, Brazil.
| | - Geison Vicente
- Graduate Program in Pharmacy, Universidade Federal de Santa Catarina - Campus Trindade, Florianópolis, Santa Catarina, CEP 88.040-000, Brazil
| | - Silvana Nair Leite
- Graduate Program in Pharmaceutical Policy and Services, PPGASFAR, Universidade Federal de Santa Catarina - Campus Trindade, Florianópolis, Santa Catarina, CEP 88.040-000, Brazil
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Dos Santos TR, Carlucci NSS, de Avó LRDS, Barbato IT, Pinto LLDC, Pilotto RF, Germano CMR, Melo DG. Quality of life of Brazilian families who have children with Fragile X syndrome: a descriptive study. J Community Genet 2023; 14:407-418. [PMID: 37594660 PMCID: PMC10444934 DOI: 10.1007/s12687-023-00660-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Abstract
This study aimed to assess the Family Quality of Life (FQoL) of Brazilian families with male children with Fragile X syndrome (FXS). Data from 53 families were collected using forms that included sociodemographic and clinical information, as well as the Beach Center Family Quality of Life Scale, a 5-point Likert scale ranging from "very dissatisfied" (1) to "very satisfied" (5). The mean overall FQoL score was 3.56 ± 0.79; the emotional well-being domain had the lowest score (2.98 ± 1.11) and showed significant differences between the other domains: family interaction (3.81 ± 0.89; p < 0.001), parenting (3.66 ± 0.89; p < 0.001), physical and material well-being (3.48 ± 0.83; p < 0.001), and disability-related support (3.75 ± 0.98; p < 0.001). Physical and material well-being was the second-lowest domain and was statistically different from the family interaction domain (p = 0.013). Lower FQoL satisfaction ratings were found in families with children who had difficulty getting along with people of the same age (t(51) = -3.193, p = 0.002; d = 1.019) and difficulty in living together on a day-to-day basis (t(51) = -3.060, p = 0.004; d = 0.888). These results highlight the importance of proper emotional support for the family, emphasizing the need to provide assistance not only for individuals with FXS but also for other family members. Besides, we advocate for the adoption of public policies that provide financial assistance to families and the implementation of the Brazilian Policy of Comprehensive Care for People with Rare Diseases.
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Affiliation(s)
- Thamires Rosa Dos Santos
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brasil
| | | | - Lucimar Retto da Silva de Avó
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brasil
- Instituto Nacional de Genética Médica Populacional, INAGEMP, Porto Alegre, Rio Grande do Sul, Brasil
| | - Ingrid Tremel Barbato
- Laboratório Neurogene, Florianópolis, Santa Catarina, Brasil
- Associação Catarinense da Síndrome do X Frágil, Florianópolis, Santa Catarina, Brasil
| | - Louise Lapagesse de Camargo Pinto
- Serviço de Referência em Doenças Raras do Hospital Infantil Joana de Gusmão, Florianópolis, Santa Catarina, Brasil
- Curso de Medicina, Universidade do Sul de Santa Catarina (UNISUL), Campus Tubarão, Tubarão, Santa Catarina, Brasil
| | - Rui Fernando Pilotto
- Departamento de Genética, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brasil
| | - Carla Maria Ramos Germano
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brasil
- Instituto Nacional de Genética Médica Populacional, INAGEMP, Porto Alegre, Rio Grande do Sul, Brasil
| | - Débora Gusmão Melo
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brasil.
- Instituto Nacional de Genética Médica Populacional, INAGEMP, Porto Alegre, Rio Grande do Sul, Brasil.
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Bernardi FA, Mello de Oliveira B, Bettiol Yamada D, Artifon M, Schmidt AM, Machado Scheibe V, Alves D, Félix TM. The Minimum Data Set for Rare Diseases: Systematic Review. J Med Internet Res 2023; 25:e44641. [PMID: 37498666 PMCID: PMC10415943 DOI: 10.2196/44641] [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: 12/15/2022] [Revised: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The minimum data set (MDS) is a collection of data elements to be grouped using a standard approach to allow the use of data for clinical and research purposes. Health data are typically voluminous, complex, and sometimes too ambiguous to generate indicators that can provide knowledge and information on health. This complexity extends further to the rare disease (RD) domain. MDSs are essential for health surveillance as they help provide services and generate recommended population indicators. There is a bottleneck in international literature that reveals a global problem with data collection, recording, and structuring in RD. OBJECTIVE This study aimed to identify and analyze the MDSs used for RD in health care networks worldwide and compare them with World Health Organization (WHO) guidelines. METHODS The population, concept, and context methodology proposed by the Joanna Briggs Institute was used to define the research question of this systematic review. A total of 4 databases were reviewed, and all the processes were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. The data elements were analyzed, extracted, and organized into 10 categories according to WHO digital health guidelines. The quality assessment used the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. RESULTS We included 20 studies in our review, 70% (n=14) of which focused on a specific health domain and 30% (n=6) of which referred to RD in general. WHO recommends that health systems and networks use standard terminology to exchange data, information, knowledge, and intelligence in health. However, there was a lack of terminological standardization of the concepts in MDSs. Moreover, the selected studies did not follow the same standard structure for classifying the data from their MDSs. All studies presented MDSs with limitations or restrictions because they covered only a specific RD, or their scope of application was restricted to a specific context or geographic region. Data science methods and clinical experience were used to design, structure, and recommend a fundamental global MDS for RD patient records in health care networks. CONCLUSIONS Our study highlights the difficulties in standardizing and categorizing findings from MDSs for RD because of the varying structures used in different studies. The fundamental RD MDS designed in this study comprehensively covers the data needs in the clinical and management sectors. These results can help public policy makers support other aspects of their policies. We highlight the potential of our results to help strategic decisions related to RD. TRIAL REGISTRATION PROSPERO CRD42021221593; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=221593. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.procs.2021.12.034.
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Affiliation(s)
- Filipe Andrade Bernardi
- Health Intelligence Laboratory, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
- Brazilian Rare Disease Network, Porto Alegre, Brazil
| | - Bibiana Mello de Oliveira
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Diego Bettiol Yamada
- Health Intelligence Laboratory, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
- Brazilian Rare Disease Network, Porto Alegre, Brazil
| | - Milena Artifon
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Amanda Maria Schmidt
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Victória Machado Scheibe
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Faculty of Medicine, Lutheran University of Brazil, Canoas, Brazil
| | - Domingos Alves
- Health Intelligence Laboratory, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
- Brazilian Rare Disease Network, Porto Alegre, Brazil
| | - Têmis Maria Félix
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, 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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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: 3] [Impact Index Per Article: 1.5] [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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