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Migowski A, Nadanovsky P, Manso de Mello Vianna C. Harms and benefits of mammographic screening for breast cancer in Brazil. PLoS One 2024; 19:e0297048. [PMID: 38271392 PMCID: PMC10810469 DOI: 10.1371/journal.pone.0297048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION In the absence of evidence on the effect of mammographic screening on overall mortality, comparing the number of deaths avoided with the number of deaths caused by screening would be ideal, but the only existing models of this type adopt a very narrow definition of harms. The objective of the present study was to estimate the number of deaths prevented and induced by various mammography screening protocols in Brazil. METHODS A simulation study of cohorts of Brazilian women screened, considering various age groups and screening interval protocols, was performed based on life tables. The number of deaths avoided and caused by screening was estimated, as was the absolute risk reduction, the number needed to invite for screening-NNS, the net benefit of screening, and the ratio of "lives saved" to "lives lost". Nine possible combinations of balances between benefits and harms were performed for each protocol, in addition to other sensitivity analyses. RESULTS AND CONCLUSIONS The most efficient protocol was biennial screening from 60 to 69 years of age, with almost three times more deaths avoided than biennial screening from 50 to 59 years of age, with a similar number of deaths avoided by biennial screening from 50 to 69 years of age and with the greatest net benefit. Compared with the best scenario of annual screening from 40 to 49 years of age, the NNS of the protocol with biennial screening from 60 to 69 years of age was three-fold lower. Even in its best scenario, the addition of annual screening from 40 to 49 years of age to biennial screening from 50 to 69 years of age results in a decreased net benefit. However, even in the 50-69 year age group, the estimated reduction in breast cancer mortality for Brazil was half that estimated for the United Kingdom.
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Affiliation(s)
- Arn Migowski
- Professional Master’s Program in Health Technology Assessment, Teaching and Research Coordination, Instituto Nacional de Cardiologia (INC), Ministry of Health, Rio de Janeiro, Brazil
- Division of Clinical Research and Technological Development, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Escola Nacional de Saúde Pública (ENSP), FIOCRUZ, Rio de Janeiro, Brazil
| | - Cid Manso de Mello Vianna
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Icanervilia AV, van der Schans J, Cao Q, de Carvalho AC, Cordova-Pozo K, At Thobari J, Postma MJ, van Asselt ADI. Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review. J Glob Health 2022; 12:04048. [PMID: 35837900 PMCID: PMC9284087 DOI: 10.7189/jogh.12.04048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) have limited resources compared to high-income countries (HICs). Therefore, it is critical that LMICs implement cost-effective strategies to reduce the burden of breast cancer. This study aimed to answer the question of whether mammography is a cost-effective breast cancer screening method in LMICs. Methods A systematic article search was conducted through Medline, Embase, Web of Science, and Econlit. Studies were included only if they conducted a full economic evaluation and focused on mammography screening in LMICs. Two reviewers screened through the title and abstract of each article and continued with full-text selection. Data were extracted and synthesized narratively. Quality assessment for each included study was conducted using the Consensus Health Economic Criteria (CHEC) extended checklist. Results This review identified 21 studies economically evaluating mammography as a breast cancer screening method in LMICs. Eighteen of these studies concluded that mammography screening was a cost-effective strategy. Most studies (71%) were conducted in upper-middle-income countries (Upper MICs). The quality of the studies varied from low to good. Important factors determining cost-effectiveness are the target age group (eg, 50-59 years), the screening interval (eg, biennial or triennial), as well as any combination with other breast cancer control strategies (eg, combination with treatment strategy for breast cancer patients). Conclusions Mammography screening appeared to be a cost-effective strategy in LMICs, particularly in Upper MICs. More studies conducted in lower-middle-income and low-income countries are needed to better understand the cost-effectiveness of mammography screening in these regions.
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Affiliation(s)
- Ajeng V Icanervilia
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jurjen van der Schans
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands
| | - Qi Cao
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adriana C de Carvalho
- Regenerative Medicine Center Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kathya Cordova-Pozo
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Institute of Management Research, Radboud University, the Netherlands
| | - Jarir At Thobari
- Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands.,Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Antoinette DI van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Dare AJ, Knapp GC, Romanoff A, Olasehinde O, Famurewa OC, Komolafe AO, Olatoke S, Katung A, Alatise OI, Kingham TP. High-burden Cancers in Middle-income Countries: A Review of Prevention and Early Detection Strategies Targeting At-risk Populations. Cancer Prev Res (Phila) 2021; 14:1061-1074. [PMID: 34507972 DOI: 10.1158/1940-6207.capr-20-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system-related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory C Knapp
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anya Romanoff
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Akinwumi O Komolafe
- Department of Morbid Anatomy and Forensic Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical College - Owo, Owo, Nigeria
| | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
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Palacios A, Rojas-Roque C, González L, Bardach A, Ciapponi A, Peckaitis C, Pichon-Riviere A, Augustovski F. Direct Medical Costs, Productivity Loss Costs and Out-Of-Pocket Expenditures in Women with Breast Cancer in Latin America and the Caribbean: A Systematic Review. PHARMACOECONOMICS 2021; 39:485-502. [PMID: 33782865 DOI: 10.1007/s40273-021-01014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Our objective was to conduct a systematic review of the literature to identify, categorise, assess, and synthesise the healthcare costs of patients with breast cancer (BC) and their relatives in Latin America and the Caribbean (LAC). METHODS In December 2020, we searched for published data in PubMed, LILACS, EMBASE, and other sources, including the grey literature. Studies were eligible if they were conducted in LAC and reported the direct medical costs, productivity loss costs, out-of-pocket expenditure, and other costs to patients with BC and their relatives. No restrictions were imposed on the type of BC population (metastatic BC or human epidermal growth factor receptor 2-positive/negative BC, among others). We summarised the characteristics and methodological approach of each study and the healthcare costs by cancer stage. We also developed and applied an original ad hoc instrument to assess the quality of the cost estimation studies. RESULTS We identified 2725 references and 63 included studies. In total, 79.3% of the studies solely reported direct medical costs and five solely reported costs to patients and their relatives. Only 14.3% of the studies were classified as of high quality. The pooled weighted average direct medical cost per patient-year (year 2020 international dollars [I$]) by BC stage was I$13,179 for stage I, I$15,556 for stage II, I$23,444 for stage III, and I$28,910 for stage IV. CONCLUSION This review provides the first synthesis of BC costs in LAC. Our findings show few high-quality costing studies in BC and a gap in the literature measuring costs to patients and their relatives. The high costs associated with the advanced stages of BC call into question the affordability of treatments and their accessibility for patients. Registered in PROSPERO (CRD42018106835).
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Affiliation(s)
- Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina.
- Facultad de Ciencias Económicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Lucas González
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Ariel Bardach
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Claudia Peckaitis
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Federico Augustovski
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
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Bezerra HDS, Melo TFVD, Barbosa JV, Feitosa EELC, Sousa LCM. Evaluation of access to mammographies in Brazil and socioeconomic indicators: a space study. ACTA ACUST UNITED AC 2018; 39:e20180014. [PMID: 30365759 DOI: 10.1590/1983-1447.2018.20180014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the correlation between mammography screening coverage in women from 50 to 69 years old and the socioeconomic indicators Human Development Index (HDI) and Gini Index. METHODS Epidemiological, retrospective and ecological study carried out in Brazil with secondary data. The sample is made up of 5565 municipalities in Brazil. As a dependent variable: the ratio of screening mammography examinations performed in women aged 50 to 69 years, from 2008 to 2015, and as independent variables: The Human Development Index (HDI) and the Gini Index. Descriptive analysis, univariate and bivariate spatial analysis were performed. RESULTS North, Northeast and Center-West are regions that are more propitious for breast cancer, due to the low access for mammograms. CONCLUSION The HDI and the Gini index, determinants of inequalities, directly influence the mammography numbers in Brazil, highlighting the importance of evaluating public policies.
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Affiliation(s)
- Héllyda de Souza Bezerra
- Universidade Federal do Rio Grande do Norte (UFRN). Faculdade de Ciências da Saúde do Trairí (FACISA). Santa Cruz, Rio Grande do Norte, Brasil
| | | | - Joyce Viana Barbosa
- Universidade Federal do Rio Grande do Norte (UFRN). Diretoria de Atenção à Saúde do Servidor (DAS). Natal, Rio Grande do Norte, Brasil
| | | | - Layanne Cristini Martin Sousa
- Universidade Federal do Rio Grande do Norte (UFRN). Faculdade de Ciências da Saúde do Trairí (FACISA). Santa Cruz, Rio Grande do Norte, Brasil
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Borges ZDS, Wehrmeister FC, Gomes AP, Gonçalves H. Clinical breast examination and mammography: inequalities in Southern and Northeast Brazilian regions. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 19:1-13. [PMID: 27167644 DOI: 10.1590/1980-5497201600010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 09/18/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence and associated factors of doing clinical breast examinations (CBE) and mammogram (MMG) in the Southern and Northeast Brazilian regions, focusing on some social inequalities. METHODS This is a cross-sectional study using data from the 2008 National Household Sampling Survey (PNAD). We evaluated the prevalence of CBE during the last year and of the MMG in the last two years, which were analyzed based on demographic (age, skin color, and marital status) and socioeconomic (income and schooling) variables. Gross and adjusted prevalence ratios were obtained using Poisson regression models. All analyses were stratified by region. RESULTS The sample comprised 27,718 women aged 40 to 69 years. Less than a half of the women followed the recommendation of annual CBE performance in both the regions. The MMG prevalence during the last two years was 58.6 and 45.5% for the Southern and Northeast regions, respectively. More than a quarter of the women had never had a MMG (26.5% in the Southern and 40.6% in the Northeast regions). Not having performed both examinations was almost two times higher in the Northeast region (29.7%) when compared with the Southern (15.9%). The risk for not having performed both examinations was greater among nonwhite women, aged 60 to 69 years, with lower schooling level and family income. CONCLUSION Important inequalities were seen between the Southern and Northeast regions for CBE and MMG. Health public policies should prioritize the most vulnerable groups to reduce these inequalities.
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Moraz G, Garcez ADS, de Assis EM, dos Santos JP, Barcellos NT, Kroeff LR. [Cost-effectiveness in health in Brazil: a systematic review]. CIENCIA & SAUDE COLETIVA 2017; 20:3211-29. [PMID: 26465862 DOI: 10.1590/1413-812320152010.00962015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 05/30/2015] [Indexed: 12/13/2022] Open
Abstract
A systematic review was performed with the aim of describing the landscape and evolution of cost-effectiveness studies in health in Brazil. The search for articles on cost-effectiveness was performed in the main electronic health databases. The review identified 83 cost-effectiveness studies conducted nationwide. Between the years 1990-2005 there were few studies published on cost-effectiveness, though between 2006 and 2014 there was a significant increase in the number of publications. As for the themes and objectives of the studies, the chronic degenerative diseases and infectious/contagious diseases reflect the epidemiological diversity of Brazil. A predominance of studies on health intervention/treatment was identified. Thus, this review reveals a compatible Brazilian epidemiological reality scenario, indicating a need to increase research and investment of funds in the area of preventive health.
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Affiliation(s)
- Gabriele Moraz
- Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil,
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Mendes ACR, Toscano CM, Barcellos RMDS, Ribeiro ALP, Ritzel JB, Cunha VDS, Duncan BB. Costs of the Smoking Cessation Program in Brazil. Rev Saude Publica 2016; 50:66. [PMID: 27849293 PMCID: PMC5117528 DOI: 10.1590/s1518-8787.2016050006303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/11/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the costs of the Smoking Cessation Program in the Brazilian Unified Health System and estimate the cost of its full implementation in a Brazilian municipality. METHODS The intensive behavioral therapy and treatment for smoking cessation includes consultations, cognitive-behavioral group therapy sessions, and use of medicines. The costs of care and management of the program were estimated using micro-costing methods. The full implementation of the program in the municipality of Goiania, Goias was set as its expansion to meet the demand of all smokers motivated to quit in the municipality that would seek care at Brazilian Unified Health System. We considered direct medical and non-medical costs: human resources, medicines, consumables, general expenses, transport, travels, events, and capital costs. We included costs of federal, state, and municipal levels. The perspective of the analysis was that from the Brazilian Unified Health System. Sensitivity analysis was performed by varying parameters concerning the amount of activities and resources used. Data sources included a sample of primary care health units, municipal and state secretariats of health, and the Brazilian Ministry of Health. The costs were estimated in Brazilian Real (R$) for the year of 2010. RESULTS The cost of the program in Goiania was R$429,079, with 78.0% regarding behavioral therapy and treatment of smoking. The cost per patient was R$534, and, per quitter, R$1,435. The full implementation of the program in the municipality of Goiania would generate a cost of R$20.28 million to attend 35,323 smokers. CONCLUSIONS The Smoking Cessation Program has good performance in terms of cost per patient that quit smoking. In view of the burden of smoking in Brazil, the treatment for smoking cessation must be considered as a priority in allocating health resources. OBJETIVO Analisar os custos do Programa de Tratamento do Tabagismo no Sistema Único de Saúde e estimar o custo de sua implementação plena em um município brasileiro. MÉTODOS A abordagem intensiva e tratamento do tabagismo engloba consultas, sessões de terapia cognitivo-comportamental em grupo e uso de medicamentos. Os custos do atendimento e gerenciamento do programa foram estimados utilizando a metodologia do microcusteio. A implementação plena do programa no município de Goiânia, Goiás, foi definida como sua expansão para suprir a demanda de todos os fumantes motivados a parar de fumar no município que seriam atendidos pelo Sistema Único de Saúde. Foram considerados custos médicos e não médicos diretos: recursos humanos, medicamentos, material de consumo, despesas gerais, transporte, viagens, eventos e custos de capital. Foram incluídos custos dos níveis federal, estadual e municipal de gestão. A perspectiva da análise foi a do Sistema Único de Saúde. Análise de sensibilidade foi realizada variando parâmetros referentes à quantidade de atividades e aos recursos utilizados. As fontes de dados incluíram uma amostra de unidades de saúde da Atenção Primária, secretarias de saúde municipal e estadual e Ministério da Saúde. Os custos foram estimados em reais (R$) para o ano de 2010. RESULTADOS O custo do programa em Goiânia foi de R$429.079, sendo 78,0% referentes à abordagem e tratamento do tabagismo. O custo por paciente foi de R$534 e, por paciente que deixou de fumar, de R$1.435. A implementação plena do programa no município de Goiânia geraria custo de R$20,28 milhões, para atender 35.323 fumantes. CONCLUSÕES O Programa de Tratamento do Tabagismo tem bom desempenho em termos de custo por paciente que deixa de fumar. Tendo em vista a carga do tabagismo no Brasil, o tratamento para cessação de fumar deve ser considerado prioritário ao se programar a alocação de recursos de saúde.
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Affiliation(s)
- Andréa Cristina Rosa Mendes
- Departamento de Economia da Saúde, Investimentos e Desenvolvimento. Ministério da Saúde. Brasília, DF, Brasil
| | - Cristiana Maria Toscano
- Departamento de Saúde Coletiva. Instituto de Patologia Tropical e Saúde Pública. Universidade Federal de Goiás. Goiânia, GO, Brasil
| | | | - Alvaro Luis Pereira Ribeiro
- Departamento de Economia da Saúde, Investimentos e Desenvolvimento. Ministério da Saúde. Brasília, DF, Brasil
| | - Jonas Bohn Ritzel
- Departamento de Economia da Saúde, Investimentos e Desenvolvimento. Ministério da Saúde. Brasília, DF, Brasil
| | - Valéria de Souza Cunha
- Instituto Nacional de Câncer José Alencar Gomes da Silva. Ministério da Saúde. Rio de Janeiro, RJ, Brasil
| | - Bruce Bartholow Duncan
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Effect of the “Spiritual Support” Intervention on Spirituality and the Clinical Parameters of Women Who Have Undergone Mastectomy: A Pilot Study. RELIGIONS 2016. [DOI: 10.3390/rel7030026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Incidental diffuse low-grade gliomas: from early detection to preventive neuro-oncological surgery. Neurosurg Rev 2015; 39:377-84. [DOI: 10.1007/s10143-015-0675-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 03/05/2015] [Accepted: 08/09/2015] [Indexed: 10/22/2022]
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