Feasibility of using death certificates for studying place of death in Latin America.

OBJECTIVE: This paper assesses the availability and quality of death certificate data in Latin America and the feasibility of using these data to study place of death and associated factors. METHODS: In this comparative study, we collected examples of current official death certificates and digital data files containing information about all deaths that occurred during 1 year in 19 Latin American countries. Data were collected from June 2019 to May 2020. The records for place of death and associated variables were studied. The criteria for data quality were completeness, number of ill-defined causes of death and timeliness. RESULTS: All 19 countries provided copies of current official death certificates and 18 of these registered the place of death. Distinguishing among hospital or other health care institution, home and other was possible for all countries. Digital data files with death certificate data were available from 12 countries and 1 region. Three countries had data considered to be of high quality and seven had data considered to be of medium quality. Categories for place of death and most of the predetermined factors possibly associated with place of death were included in the data files. CONCLUSIONS: The quality of data sets was rated medium to high in 10 countries. Hence, death certificate data make it feasible to conduct an international comparative study on place of death and the associated factors in Latin America.

Perception of Curability Among Advanced Cancer Patients: An International Collaborative Study.

BACKGROUND: There are limited data on illness understanding and perception of cure among advanced cancer patients around the world. The aim of the study was to determine the frequency and factors associated with inaccurate perception of curability among advanced cancer patients receiving palliative care across the globe. MATERIALS AND METHODS: Secondary analysis of a study to understand the core concepts in end-of-life care among advanced cancer patients receiving palliative care from 11 countries across the world. Advanced cancer patients were surveyed using a Patient Illness Understanding survey and Control Preference Scale. Descriptive statistics and multicovariate logistic regression analysis were performed. RESULTS: Fifty-five percent (763/1,390) of patients receiving palliative care inaccurately reported that their cancer is curable. The median age was 58, 55% were female, 59% were married or had a partner, 48% were Catholic, and 35% were college educated. Sixty-eight percent perceived that the goal of therapy was "to get rid of their cancer," and 47% perceived themselves as "seriously ill." Multicovariate logistic regression analysis shows that accurate perception of curability was associated with female gender (odds ratio [OR] 0.73, p = .027), higher education (OR 0.37, p < .0001), unemployment status (OR 0.69, p = .02), and being from France (OR 0.26, p < .0001) and South Africa (OR 0.52, p = .034); inaccurate perception of curability was associated with better Karnofsky performance status (OR 1.02 per point, p = .0005), and being from Philippines (OR 15.49, p < .0001), Jordan (OR 8.43, p < .0001), Brazil (OR 2.17, p = .0037), and India (OR 2.47, p = .039). CONCLUSION: Inaccurate perception of curability in advanced cancer patients is 55% and significantly differs by gender, education, performance status, employment status, and country of origin. Further studies are needed to develop strategies to reduce this misperception of curability in advanced cancer patients. IMPLICATIONS FOR PRACTICE: The findings of this study indicate that inaccurate perception of curability among advanced cancer patients is 55%. Inaccurate perception of curability significantly differs by gender, education, performance status, employment status, and country of origin. There is great need to facilitate improved patient-physician communication so as to improve health care outcomes and patient satisfaction.

Decisional control preferences among patients with advanced cancer: An international multicenter cross-sectional survey.

BACKGROUND: Understanding patients' decision control preferences is important in providing quality cancer care. Patients' decisional control preference can be either active (patients prefer to make decisions themselves), shared (collaborative between patient, their physician, and/or family), or passive (patients prefer that the decisions are made by either the physician and/or their family). AIM: To determine the frequency and predictors of passive decision control preferences among advanced cancer patients. We also determined the concordance between actual decision-making and decision control preferences and its association with patient satisfaction. DESIGN: In this cross-sectional survey of advanced cancer patients referred to palliative care across 11 countries, we evaluated sociodemographic variables, Control Preference Scale, and satisfaction with the decisions and care. RESULTS: A total of 1490 participants were evaluable. Shared, active, and passive decision control preferences were 33%, 44%, and 23%, respectively. Passive decision control preferences (odds ratio, p value) was more frequent in India (4.34, <0.001), Jordan (3.41, <0.001), and France (3.27, <0.001). Concordance between the actual decision-making and decision control preferences was highest in the United States ( k = 0.74) and lowest in Brazil (0.34). Passive decision control preference was significantly associated with (odds ratio per point, p value) better performance status (0.99/point, 0.017), higher education (0.64, 0.001), and country of origin (Brazil (0.26, <0.0001), Singapore (0.25, 0.0003), South Africa (0.32, 0.0002), and Jordan (2.33, 0.0037)). CONCLUSION: Passive decision control preferences were less common (23%) than shared and active decision control preference even among developing countries. Significant predictors of passive decision control preferences were performance status, education, and country of origin.

Palliative care: pathway in primary health care in Brazil. / Cuidados paliativos: percurso na atenção básica no Brasil.

In 2022, an important international report was published on the "value of death" not only in the field of health, but in relation to human societies in general. This report proposed to reimagine systems related to end of life in which death is understood not only as a physiological event but also as a relational and spiritual phenomenon with a value of its own and inseparable from life. It identifies the low priority given by most governments worldwide to the issue of alleviating suffering and supporting bereavement, evidenced by the low investment in palliative care. At the same time, we are witnessing in Brazil changes that threaten the feasibility of palliative care policies in primary health care. The denial of finitude within health systems is reflected in global indicators such as the quality of death index of The Economist magazine, in which Brazil ranks 42nd, the global atlas of palliative care of the World Hospice and Palliative Care Alliance, where Brazil is in level 3b, and the global trends in opioid consumption of International Narcotics Control Board of the World Health Organization, in which opioid consumption in Brazil is in the hundreds of doses per million inhabitants per day. Despite notable advances in the legislative and executive fields with regard to palliative care, the Brazilian Unified National Health System (SUS) and primary health care have suffered important structural setbacks that will impact the design of public policy for palliative care. The goal of this article is to undertake an initial analysis of the impacts of current policies within this context and their repercussions in the construction of a solid policy for palliative care.

Em 2022, foi publicado um importante relatório internacional acerca do "valor da morte" não apenas no campo da saúde, mas nas sociedades humanas de forma geral. Este relatório se propôs a reimaginar sistemas relacionados ao fim da vida nos quais a morte seja compreendida não apenas como um fenômeno fisiológico, mas também relacional e espiritual, com valor próprio e inseparável da vida. Identifica-se a baixa prioridade dada pela maior parte dos governos ao redor do mundo para a questão do alívio do sofrimento e dos cuidados com o luto, representada pelo baixo investimento em cuidados paliativos. Ao mesmo tempo, assistimos no Brasil a modificações ameaçadoras à exequibilidade de políticas de cuidados paliativos na atenção básica. A negação da finitude no âmbito dos sistemas de saúde se reflete em alguns indicadores mundiais, como o ranking de qualidade de morte da revista The Economist, em que o Brasil se encontra na 42ª posição, o mapeamento mundial de cuidados paliativos da Aliança Mundial de Cuidados Paliativos em Hospitais, no qual o Brasil se encontra no nível 3b, e o consumo mundial de opioides pelo Órgão Internacional de Controle de Entorpecentes, da Organização Mundial da Saúde, no qual o consumo dessas substâncias em nosso país está na casa das centenas de doses por milhão de habitantes por dia. Apesar de avanços notáveis nos campos legislativo e executivo no que se refere à temática dos cuidados paliativos, o Sistema Único de Saúde (SUS) e a atenção básica vêm sofrendo reveses importantes a nível estrutural que irão causar impacto na estruturação de uma política pública de cuidados paliativos. Este artigo procura fazer uma análise inicial dos impactos das políticas atuais dentro desse cenário e suas repercussões na construção de uma política de cuidados paliativos sólida.

En 2022 se publicó un importante informe internacional sobre el "valor de la muerte" no solo en el campo de la salud, sino en las sociedades humanas en general. Este informe se propuso reimaginar sistemas relacionados con el fin de la vida en los que la muerte se comprenda no solo como un fenómeno fisiológico, sino también relacional y espiritual, con un valor propio e inseparable de la vida. Se identifica la baja prioridad dada por la mayor parte de los gobiernos en todo el mundo para la cuestión del alivio del sufrimiento y de los cuidados con el duelo, representados por la baja inversión en cuidados paliativos. Al mismo tiempo, asistimos en Brasil a modificaciones amenazadoras a la viabilidad de políticas de cuidados paliativos en la atención básica. La negación de la finitud en el ámbito de los sistemas de salud se refleja en algunos indicadores mundiales como el ranking de calidad de la muerte de la revista The Economist en que Brasil está en la posición 42; el mapeo mundial de cuidados paliativos de la Alianza Mundial de Cuidados Paliativos y Hospicio donde Brasil se encuentra en el nivel 3b y el consumo mundial de opioides por la Junta Internacional de Fiscalización de Estupefacientes de la Organización Mundial de la Salud en el que nuestro consumo de opioides está en los cientos de dosis por millón de habitantes por día. A pesar de los notables avances en los ámbitos legislativo y ejecutivo en lo que se refiere a la temática de los cuidados paliativos, por otro lado, el Sistema Único de Salud brasileño (SUS) y la atención básica vienen sufriendo importantes retrocesos a nivel estructural que repercutirán en la estructuración de una política pública de cuidados paliativos. Este artículo pretende hacer un primer análisis de los impactos de las políticas actuales, dentro de este escenario, y sus repercusiones en la construcción de una política sólida de cuidados paliativos.

Cuidados paliativos: percurso na atenção básica no Brasil / Cuidados paliativos: camino en la atención primaria en Brasil / Palliative care: pathway in primary health care in Brazil

Em 2022, foi publicado um importante relatório internacional acerca do "valor da morte" não apenas no campo da saúde, mas nas sociedades humanas de forma geral. Este relatório se propôs a reimaginar sistemas relacionados ao fim da vida nos quais a morte seja compreendida não apenas como um fenômeno fisiológico, mas também relacional e espiritual, com valor próprio e inseparável da vida. Identifica-se a baixa prioridade dada pela maior parte dos governos ao redor do mundo para a questão do alívio do sofrimento e dos cuidados com o luto, representada pelo baixo investimento em cuidados paliativos. Ao mesmo tempo, assistimos no Brasil a modificações ameaçadoras à exequibilidade de políticas de cuidados paliativos na atenção básica. A negação da finitude no âmbito dos sistemas de saúde se reflete em alguns indicadores mundiais, como o ranking de qualidade de morte da revista The Economist, em que o Brasil se encontra na 42ª posição, o mapeamento mundial de cuidados paliativos da Aliança Mundial de Cuidados Paliativos em Hospitais, no qual o Brasil se encontra no nível 3b, e o consumo mundial de opioides pelo Órgão Internacional de Controle de Entorpecentes, da Organização Mundial da Saúde, no qual o consumo dessas substâncias em nosso país está na casa das centenas de doses por milhão de habitantes por dia. Apesar de avanços notáveis nos campos legislativo e executivo no que se refere à temática dos cuidados paliativos, o Sistema Único de Saúde (SUS) e a atenção básica vêm sofrendo reveses importantes a nível estrutural que irão causar impacto na estruturação de uma política pública de cuidados paliativos. Este artigo procura fazer uma análise inicial dos impactos das políticas atuais dentro desse cenário e suas repercussões na construção de uma política de cuidados paliativos sólida.

En 2022 se publicó un importante informe internacional sobre el "valor de la muerte" no solo en el campo de la salud, sino en las sociedades humanas en general. Este informe se propuso reimaginar sistemas relacionados con el fin de la vida en los que la muerte se comprenda no solo como un fenómeno fisiológico, sino también relacional y espiritual, con un valor propio e inseparable de la vida. Se identifica la baja prioridad dada por la mayor parte de los gobiernos en todo el mundo para la cuestión del alivio del sufrimiento y de los cuidados con el duelo, representados por la baja inversión en cuidados paliativos. Al mismo tiempo, asistimos en Brasil a modificaciones amenazadoras a la viabilidad de políticas de cuidados paliativos en la atención básica. La negación de la finitud en el ámbito de los sistemas de salud se refleja en algunos indicadores mundiales como el ranking de calidad de la muerte de la revista The Economist en que Brasil está en la posición 42; el mapeo mundial de cuidados paliativos de la Alianza Mundial de Cuidados Paliativos y Hospicio donde Brasil se encuentra en el nivel 3b y el consumo mundial de opioides por la Junta Internacional de Fiscalización de Estupefacientes de la Organización Mundial de la Salud en el que nuestro consumo de opioides está en los cientos de dosis por millón de habitantes por día. A pesar de los notables avances en los ámbitos legislativo y ejecutivo en lo que se refiere a la temática de los cuidados paliativos, por otro lado, el Sistema Único de Salud brasileño (SUS) y la atención básica vienen sufriendo importantes retrocesos a nivel estructural que repercutirán en la estructuración de una política pública de cuidados paliativos. Este artículo pretende hacer un primer análisis de los impactos de las políticas actuales, dentro de este escenario, y sus repercusiones en la construcción de una política sólida de cuidados paliativos.

In 2022, an important international report was published on the "value of death" not only in the field of health, but in relation to human societies in general. This report proposed to reimagine systems related to end of life in which death is understood not only as a physiological event but also as a relational and spiritual phenomenon with a value of its own and inseparable from life. It identifies the low priority given by most governments worldwide to the issue of alleviating suffering and supporting bereavement, evidenced by the low investment in palliative care. At the same time, we are witnessing in Brazil changes that threaten the feasibility of palliative care policies in primary health care. The denial of finitude within health systems is reflected in global indicators such as the quality of death index of The Economist magazine, in which Brazil ranks 42nd, the global atlas of palliative care of the World Hospice and Palliative Care Alliance, where Brazil is in level 3b, and the global trends in opioid consumption of International Narcotics Control Board of the World Health Organization, in which opioid consumption in Brazil is in the hundreds of doses per million inhabitants per day. Despite notable advances in the legislative and executive fields with regard to palliative care, the Brazilian Unified National Health System (SUS) and primary health care have suffered important structural setbacks that will impact the design of public policy for palliative care. The goal of this article is to undertake an initial analysis of the impacts of current policies within this context and their repercussions in the construction of a solid policy for palliative care.

Influence of a Brazilian wild green propolis on the enamel mineral loss and Streptococcus mutans' count in dental biofilm.

OBJECTIVE: This study investigated the anti-demineralizing and antibacterial effects of a propolis ethanolic extract (EEP) against Streptococcus mutans dental biofilm. DESIGN: Blocks of sound bovine enamel (n=24) were fixed on polystyrene plates. S. mutans inoculum (ATCC 25175) and culture media were added (48 h-37 °C) to form biofilm. Blocks with biofilm received daily treatment (30 µL/1 min), for 5 days, as following: G1 (EEP 33.3%); G2 (chlorhexidine digluconate 0.12%); G3 (ethanol 80%); and G4 (Milli-Q water). G5 and G6 were blocks without biofilm that received only EEP and Milli-Q water, respectively. Final surface hardness was evaluated and the percentage of hardness loss (%HL) was calculated. The EEP extract pH and total solids were determined. S. mutans count was expressed by log10 scale of Colony-Forming Units (CFU/mL). One way ANOVA was used to compare results which differed at a 95% significance level. RESULTS: G2 presented the lowest average %HL value (68.44% ± 12.98) (p=0.010), while G4 presented the highest (90.49% ± 5.38%HL) (p=0.007). G1 showed %HL (84.41% ± 2.77) similar to G3 (87.80% ± 6.89) (p=0.477). Groups G5 and G6 presented %HL=16.11% ± 7.92 and 20.55% ± 10.65; respectively (p=0.952). G1 and G4 differed as regards to S. mutans count: 7.26 ± 0.08 and 8.29 ± 0.17 CFU/mL, respectively (p=0.001). The lowest bacterial count was observed in chlorhexidine group (G2=6.79 ± 0.10 CFU/mL) (p=0.043). There was no difference between S. mutans count of G3 and G4 (p=0.435). The EEP showed pH 4.8 and total soluble solids content=25.9 Brix. CONCLUSION: The EEP seems to be a potent antibacterial substance against S. mutans dental biofilm, but presented no inhibitory action on the de-remineralization of caries process.

Feasibility of using death certificates for studying place of death in Latin America

Objective: this paper assesses the availability and quality of death certificate data in Latin America and the feasibility of using these data to study place of death and associated factors. Methods: in this comparative study, we collected examples of current official death certificates and digital data files containing information about all deaths that occurred during 1 year in 19 Latin American countries. Data were collected from June 2019 to May 2020. The records for place of death and associated variables were studied. The criteria for data quality were completeness, number of ill-defined causes of death and timeliness. Results: all 19 countries provided copies of current official death certificates and 18 of these registered the place of death. Distinguishing among hospital or other health care institution, home and other was possible for all countries. Digital data files with death certificate data were available from 12 countries and 1 region. Three countries had data considered to be of high quality and seven had data considered to be of medium quality. Categories for place of death and most of the predetermined factors possibly associated with place of death were included in the data files. Conclusions: the quality of data sets was rated medium to high in 10 countries. Hence, death certificate data make it feasible to conduct an international comparative study on place of death and the associated factors in Latin America.

Estudo Observacional Retrospectivo sobre o Perfil de pacientes que Receberam Terapia de Sedação Paliativa em Unidade de Cuidados Paliativos de Hospital de Câncer no Brasil / Retrospective Observational Study about Patient's Profile who Reveived Palliative Sedation Therapy at the Palliative Care Unit in a Brazilian Cancer Hospital / Estudio Observacional Retrospectivo sobre el Perfil de Pacientes que Recibieron Terapia de Sedación Paliativa en Unidad de Cuidados Paliativos de Hospital de Cáncer en Brasil

Introdução: A Organização Mundial da Saúde estima que até 2030 ocorrerão 27 milhões de novos casos de câncer no mundo. Em 2017, esperava-se em torno de 597 mil novos casos no Brasil com letalidade de 70%. Os cuidados paliativos incluem os cuidados de final de vida, e o controle dos sintomas físicos é um dos focos de suas ações. Eventualmente, os sintomas podem se tornar refratários. Para esses casos, existe a opção da terapia de sedação paliativa (TSP), que é o uso de fármacos para reduzir ou abolir a consciência do paciente com o objetivo de aliviar o sofrimento. Estudos demonstram que o uso da técnica adequada do procedimento não encurta a vida do paciente. Objetivo: Identificar o perfil dos pacientes que receberam TSP no final da vida. Método: Estudo observacional retrospectivo com coleta de dados em prontuário dos pacientes falecidos na unidade de cuidados paliativos de um hospital de câncer no ano de 2015. Foram coletados dados demográficos, proporção de pacientes que necessitaram de TSP, indicações mais frequentes, drogas mais utilizadas, doses médias usadas, se discussões com família e/ou equipe foram realizadas, duração da TSP em dias e sobrevida do paciente até o óbito. Resultados: Em 2015, ocorreram 919 óbitos; 198 (21,5%) receberam TSP; 55,1% do sexo feminino; média de idade de 55 anos. Os sintomas mais frequentes no momento da indicação foram dispneia (64,1%), dor (36,3%) e outros sintomas (30,3%). A droga mais utilizada foi o midazolam (98%) e a modalidade mais utilizada foi de sedação contínua (75,8%).

Introduction: The World Health Organization estimates that 27 million new cases of cancer will occur until 2030 around the world. In 2017, 597.000 new cases were expected to occur in Brazil with 70% of lethality rate. Palliative Care comprises end of life care, and physical symptom control is one of the aims of its actions. Eventually, the symptoms can be refractory. For such cases, the Palliative Sedation Therapy (PST) is an option, that is the use of drugs to reduce or abolish patient's consciousness to relieve suffering. Studies have demonstrated that using suitable techniques does not shorten patient's life. Objective: To identify patient's profile that received PST at the end of life. Method: Cross-sectional observational study collecting data from patients records who died at a palliative care unit of a cancer hospital in 2015. Data was collected regarding demographics, proportion of patients who received PST, what were the more frequent symptoms, the more used drugs, the average dose used, if any discussion with the Family or the team occurred, the length of PST in days, and the survivorship until death. Results: In 2015 there were 919 deaths, 198 (21.5%) received PST, 55.1% were female, the average age was 55 years-old. The most frequent symptoms at the time of indication were dyspnoea (64.1%), pain (36.3%), and other symptoms (30.3%). The most frequent used drug was midazolam (98%) and the most frequent modality used was continuous sedation (75.8%).

Introducción: La Organización Mundial de la Salud estima que hast 2030 deberán ocurrir 27 milhones de nuevos casos de cáncer em el mundo. En 2017, se esperaba alrededor de 597 mil nuevos casos em Brasil, com 70% de letalidad. Los Cuidados Paliativos incluyem los cuidados de fin de vida y el control de los sintomas es uno de los focos de sus acciones. Eventualmente, los síntomas puedem se tornar refractarios. Para esos casos, existe la opción de la Terapia de Sedación Paliativa (TSP), que es el uso de fármacos para reducir ou abolir la conciencia del paciente con el objetivo de aliviar el sufrimiento. Los estudios demuestram que el uso de la técnica adecuada del procedimento no acorta la vida del paciente. Objetivo: Identificar el perfil de los pacientes que recibieron la TSP al final de la vida. Método: Estudio observacional retrospectivo con recolección de datos en prontuario de los pacientes fallecidos en la unidad de cuidados paliativos de un hospital de cáncer en el año 2015. Se recolectaran datos demográficos, proporción de pacientes que necesitaron TSP, indicaciones más frecuentes, drogas más utilizadas, dosis medias, se utilizaron las discusiones con la familia y / o el equipo, la duración de la TSP en días y la supervivencia del paciente hasta la muerte. Resultados:En 2015 ocurrieron 919 muertes, 198 (21,5%) recibieron TSP, 55,1% del sexo femenino, promedio de edad de 55 años. Los síntomas más frecuentes en el momento de la indicación fueron disnea (64,1%), dolor (36,3%) y otros sintomas (30,3%). La droga más utilizada fue el midazolam (98%) y la modalidad más utilizada fue sedación continua (75,8%).