Correlation of serological and molecular markers in the screening for hepatitis B virus in blood bank in northern Brazil

ABSTRACT Introduction: In Brazil, the blood donor screening for hepatitis B virus (HBV) includes laboratory testing for serological (HBsAg and Anti-HBc) and molecular (HBV DNA) markers. This study aims to correlate serology reactive results with HBV DNA detection among blood donors with at least one HBV infection marker detected in a blood bank in northern Brazil. Method: A retrospective search for HBV reactive blood donor data from January 2017 to December 2019 was performed. Serological screening was performed by chemiluminescent microparticle immunoassays Architect HBsAg and Architect Anti-HBc, whereas molecular screening was performed by the HBV nucleic acid test (HBV NAT). Main results: A total of 556 HBsAg reactive results were detected, between positive (47.66%) and inconclusive (52.34%). A total of 3,658 Anti-HBc reactive results were detected, between positive (83.71%) and inconclusive (16.29%). None of the inconclusive results were associated with HBV DNA detection. The HBV DNA detection rates were 47.55% among HBsAg positive samples and 4.08% among Anti-HBc positive samples. The signal-to-cutoff (S/CO) ratio median of HBV NAT positive samples was superior in comparison to HBV NAT negative samples (p < 0.0001). The thresholds found to optimize sensitivity and specificity were 404.15 for Architect HBsAg and 7.77 for Architect Anti-HBc. Three blood donors were in the window period and 1 occult HBV infection case was detected. Conclusion: High S/CO ratios were more predictive of HBV DNA detection. However, a number of HBV NAT positive samples gave low values, while some HBV NAT negative samples showed high values, reaffirming the significance of molecular testing to enhance transfusion safety.

Human T-lymphotropic virus 2 (HTLV-2) prevalence of blood donors in the state of Pará, Brazil.

INTRODUCTION: The present study had the objective to describe the molecular prevalence and epidemiological aspects of the human T-lymphotropic virus 2 (HTLV-2) infection in the blood donor population of the Pará state. METHODS: The present study is a descriptive, retrospective, and cross-sectional review of epidemiological, serological, and molecular data on inapt blood donors in the State Center for Hematology and Hemotherapy from January 2015 to December 2021. The data were digitalized to create a database using the Statistical Package for Social Sciences program. The prevalence of HTLV-2 was calculated based on the total number of donations during the study period. Descriptive frequency was used to analyze the qualitative data. RESULTS: A total of 665,568 blood donations were made. Out of these, 1884 (0.2%) samples presented serological detection to HTLV and further were evaluated using molecular confirmatory tests. Out of these, 36 samples were positive for HTLV-2 using qPCR Taqman assay based on pol gene region (0.005%). The HTLV-2 was found to be more prevalent in women (63.9%); aged between 39 and 59 years (55.6%); residents of the metropolitan region of Belém (80.6%); with self-declared race as brown (80.6%); individuals who had completed high school (58.6%); and first-time donors (58.3%) CONCLUSION: The present study identified the presence of HTLV-2 (1 HTLV-2 case/20,000 donations; 0.005%) in the specific population of blood donors in Pará state. These findings can contribute to the existing literature on the subject both for specific population groups under study and for understanding the prevalence of HTLV-2 in the general population.

Seroprevalence of Trypanosoma cruzi infection among blood donors in the state of Pará, Brazil.

INTRODUCTION: Chagas disease (CD) is a neglected pathology worldwide, considered a public health problem due to the high morbidity and mortality rate and its social impact. Thus, the objective was to estimate the prevalence of reactive serology for T. cruzi in blood donors in the units of the public blood network in the state of Pará (Brazil), as well as to describe the epidemiological profile of these donors. METHODS: This is a retrospective and descriptive study carried out at the Pará State Center for Hematology and Hemotherapy (HEMOPA) between 2016 and 2021, with analysis of secondary data (epidemiological and serological) of inapt blood donors for CD. RESULTS: Among the 533,674 screened samples, the reactivity for anti-T. cruzi was detected in 0.1% (548), of which 0.03% (166) were inconclusive and 0.07% (382) were positive. The hemonucleus of the city of Abaetetuba had the highest seroprevalence (0.6%). Regarding epidemiological characteristics, most blood donors were men (63.7%), aged between 31 and 45 (44.7%), racially mixed (79.2%), high school graduate (45.8%), single/widowed/divorced (62%), first-time donors (69%), spontaneous donations (58%) and from the state's countryside (69.9%). CONCLUSION: Over the years analyzed, we observed an increase in seroprevalence for T. cruzi emphasizing the need to maintain epidemiological control in the region and the application of more accurate serological tests in the screening of donor blood bags.

Correlation of serological and molecular markers in the screening for hepatitis B virus in blood bank in northern Brazil.

INTRODUCTION: In Brazil, the blood donor screening for hepatitis B virus (HBV) includes laboratory testing for serological (HBsAg and Anti-HBc) and molecular (HBV DNA) markers. This study aims to correlate serology reactive results with HBV DNA detection among blood donors with at least one HBV infection marker detected in a blood bank in northern Brazil. METHOD: A retrospective search for HBV reactive blood donor data from January 2017 to December 2019 was performed. Serological screening was performed by chemiluminescent microparticle immunoassays Architect HBsAg and Architect Anti-HBc, whereas molecular screening was performed by the HBV nucleic acid test (HBV NAT). MAIN RESULTS: A total of 556 HBsAg reactive results were detected, between positive (47.66%) and inconclusive (52.34%). A total of 3,658 Anti-HBc reactive results were detected, between positive (83.71%) and inconclusive (16.29%). None of the inconclusive results were associated with HBV DNA detection. The HBV DNA detection rates were 47.55% among HBsAg positive samples and 4.08% among Anti-HBc positive samples. The signal-to-cutoff (S/CO) ratio median of HBV NAT positive samples was superior in comparison to HBV NAT negative samples (p < 0.0001). The thresholds found to optimize sensitivity and specificity were 404.15 for Architect HBsAg and 7.77 for Architect Anti-HBc. Three blood donors were in the window period and 1 occult HBV infection case was detected. CONCLUSION: High S/CO ratios were more predictive of HBV DNA detection. However, a number of HBV NAT positive samples gave low values, while some HBV NAT negative samples showed high values, reaffirming the significance of molecular testing to enhance transfusion safety.

Frequency of antigen Dia on the blood donor population of the Hemocenter coordinator of the Hemopa Foundation

ABSTRACT Introduction: Erythrocyte phenotyping is a very important test in the adoption of prophylactic measures to reduce transfusion reactions/alloimmunizations in polytransfused patients. The blood group Diego, in its current, form has 22 antigens, of which 4 are immunogenic, being Dia/Dib and Wra/Wrb, while the others are less expressive. The antigen Dia is of low incidence among whites and blacks, however, it is common in the South American indigenous and Asian Mongolian populations. It is also considered a system of clinical importance for its immunogenicity. Method: The present study aimed to carry out a retrospective and descriptive survey of the frequency of the Dia antigen in the blood donor population at the HEMOPA Foundation Coordinating Blood Center from 12/2018 to 1/2000. The data obtained were from the HEMOPA Foundation SBS Progress and SBS WEB Systems databases. Results: During this period, 941,744 blood bags were collected and, of these, 930 bags were phenotyped for the Dia antigen, of which 842 were negative and 88 (9.7%) positive. The research showed that, among the positive donors for the antigen Dia, 88.6% were brown, 3.4%, black and 8%, white. In the statistical analysis, the frequency observed was higher in browns. Conclusion: In the present investigation, we concluded that our region has a relatively higher frequency of the Dia antigen, when compared to the rest of Brazil, and it occurs more often in browns.

O impacto da automação da fenotipagem eritrocitária estendida na rotina de um serviço de hemoterapia / The impact of automation of extended erythrocyte phenotyping in the routine of a blood transfusion center

Objetivos. Avaliar o impacto da automação na fenotipagem eritrocitária expandida e o nível de concordância dessa com a metodologia manual em amostras de doadores de sangue atendidos no hemocentro coordenador da Fundação HEMOPA no período de janeiro a dezembro de 2019. Material e Métodos. Foram analisadas 2.700 fenotipagens eritrocitárias realizadas por metodologia manual e automatizada através do equipamento IH500 da BioRad®. Os resultados foram testados quanto ao nível de concordância através do teste de Coeficiente Kappa. Resultados. Das amostras fenotipadas 98,6% (2.662/2.700) foram concordantes em ambas as metodologias e apenas 1,4% (38/2700) foram discordantes. Das 38 amostras discordantes 31,6% referiram-se ao fenótipo Lu(b); 15,8% ao fenótipo Lu(a); 13,1% ao fenótipo Fy(b); 7,9% aos fenótipos Le(b), E, c; 5,3% aos fenótipos N, S, s, Kp(a), P1; e 2,6% aos fenótipos M, Jk(a), Jk(b), Fy(a). Conclusões. O nível de concordância entre os dados obtidos através das técnicas de fenotipagem eritrocitária manual e automatizada foi de 98,6%. Já a implantação dessa metodologia teve um impacto positivo com o aumento em 1.649 amostras processadas a mais em relação ao mesmo período do ano anterior. [au]

Objective. Evaluate the impact of automation on expanded erythrocyte phenotyping and the level of agreement between it and the manual methodology in samples from blood donors treated at the blood center coordinating the Fundação HEMOPA from january to december 2019. Material and Methods. 2,700 erythrocyte phenotyping performed by manual and automated methodology using BioRad® IH500 equipment was analyzed. The results were tested for the level of agreement using the Kappa Coefficient test. Results. Of the phenotyped samples, 98,6% (2,662 / 2,700) were in agreement in both methodologies and only 1,4% (38/2700) were in disagreement. Of the 38 discordant samples, 31,6% referred to the Lu(b) phenotype; 15,8% to the Lu(a) phenotype; 13,1% to the Fy phenotype (b); 7,9% to Le(b), E, c phenotypes; 5,3% to N, S, s, Kp (a), P1 phenotypes; and 2,6% for phenotypes M, Jk(a), Jk(b), Fy(a). Conclusions. The level of agreement between data obtained through manual and automated erythrocyte phenotyping techniques was 98.6%. The implementation of this methodology had a positive impact, with an increase of 1,649 more processed samples compared to the same period of the previous year. [au]

Results of a sample-to-cutoff ratio using Abbott Architect rHTLV-I/II assay allow to predict detection of HTLV-1 and HTLV-2 proviral DNA by real-time PCR / Resultados da razão sinal da amostra sobre o cutoff da reação no ensaio Abbott Architect rHTLV-I/II permite prever a detecção de DNA proviral por PCR em tempo real

The present study aims to correlate the sample-to-cutoff ratios (S/CO) distributions of reactive results for HTLV-1/2 antibodies with the detection of proviral DNA in a population of blood donor candidates. It was carried out a retrospective data search of 632 HTLV-1/2 reactive samples, submitted to confirmatory testing from January 2015 to December 2019. Serological screening was performed by chemiluminescent microparticle immunoassay Architect rHTLV-I/II, whereas confirmatory testing was performed by in-house real-time polymerase chain reaction method. 496 out of 632 samples (78%) had undetectable HTLV-1/2 proviral DNA and 136 (22%) had detectable proviral DNA. HTLV infection was not confirmed in any individual for whom the S/CO ratio value was <4, and proviral DNA detection rates gradually escalated as S/CO ratio values increased. The sensitivity and predictive positive value found for the Architect rHTLV-I/II was 100% and 22%, respectively. The receiver operating characteristic (ROC) curve analysis showed that the optimal S/CO ratio value for predicting the presence of HTLV-1/2 was 18.11. High S/CO ratios were more associated with the detection of proviral DNA. The S/CO ratio value <4 suggests excluding true HTLV infection and the risk of blood transmission (AU).

O estudo tem como objetivo correlacionar às distribuições das razões sample-to-cutoff (S/CO) de resultados reagentes para anticorpos HTLV-1/2 com a detecção de DNA proviral em uma população de candidatos à doação de sangue. Realizou-se uma busca retrospectiva de dados de 632 amostras reagentes para HTLV-1/2 submetidas à testagem confirmatória entre janeiro de 2015 a dezembro de 2019. A triagem sorológica foi realizada pelo imunoensaio quimioluminescente de micropartículas Architect rHTLV-I/II, enquanto o teste confirmatório foi realizado pelo método de PCR em tempo real in-house. 496 de 632 amostras (78%) apresentaram DNA proviral indetectável e 136 (22%) apresentaram DNA proviral detectável. A infecção por HTLV não foi confirmada em nenhum indivíduo com valor de S/CO <4 e as taxas de detecção de DNA proviral escalonaram gradualmente à medida que as razões S/CO aumentaram. A sensibilidade e valor preditivo positivo encontrados para o Architect rHTLV-I/II foram 100% e 22%, respectivamente. Utilizando análise de curva ROC, o valor de razão S/CO ideal para predizer a presença de DNA proviral foi de 18,11. Razões S/CO elevadas foram mais associadas à detecção de DNA proviral. Em suma, o valor de S/CO <4 sugere a exclusão de infecção por HTLV e o risco de transmissão pelo sangue (AU).

Frequency of antigen Dia on the blood donor population of the Hemocenter coordinator of the Hemopa Foundation.

INTRODUCTION: Erythrocyte phenotyping is a very important test in the adoption of prophylactic measures to reduce transfusion reactions/alloimmunizations in polytransfused patients. The blood group Diego, in its current, form has 22 antigens, of which 4 are immunogenic, being Diª/Dib and Wra/Wrb, while the others are less expressive. The antigen Diª is of low incidence among whites and blacks, however, it is common in the South American indigenous and Asian Mongolian populations. It is also considered a system of clinical importance for its immunogenicity. METHOD: The present study aimed to carry out a retrospective and descriptive survey of the frequency of the Diª antigen in the blood donor population at the HEMOPA Foundation Coordinating Blood Center from 12/2018 to 1/2000. The data obtained were from the HEMOPA Foundation SBS Progress and SBS WEB Systems databases. RESULTS: During this period, 941,744 blood bags were collected and, of these, 930 bags were phenotyped for the Diª antigen, of which 842 were negative and 88 (9.7%) positive. The research showed that, among the positive donors for the antigen Diª, 88.6% were brown, 3.4%, black and 8%, white. In the statistical analysis, the frequency observed was higher in browns. CONCLUSION: In the present investigation, we concluded that our region has a relatively higher frequency of the Diª antigen, when compared to the rest of Brazil, and it occurs more often in browns.

Prevalence of Dengue, Chikungunya and Zika Viruses in Blood Donors in the State of Pará, Northern Brazil: 2018-2020.

Arboviruses have been reported over the years as constant threats to blood transfusion recipients, given the high occurrence of asymptomatic cases and the fact that the presence of viremia precedes the onset of symptoms, making it possible that infected blood from donors act as a source of dissemination. This work aims to identify the prevalence of dengue virus (DENV), Zika virus (ZIKV) and Chikungunya virus (CHIKV) infection in blood donors during epidemic and non-epidemic periods; classify the donor as symptomatic or asymptomatic; and verify the need to include DENV, CHIKV and ZIKV in the nucleic acid test (NAT) platform in northern Brazil. We investigated 36,133 thousand donations in two years of collection in Northern Brazil. One donor was positive for DENV and one for CHIKV (0.002% prevalence). As the prevalence for arboviruses was low in this study, it would not justify the individual screening of samples from donors in a blood bank. Thus, DENV- and CHIKV-positive samples were simulated in different amounts of sample pools, and both were safely detected by molecular biology even in a pool of 14 samples, which would meet the need to include these three viruses in the routine of blood centers in endemic countries such as Brazil.

Epidemiological and molecular profile of blood donors infected with HTLV-1/2 in the state of Pará, northern Brazil.

BACKGROUND: The Human T-lymphotropic virus (HTLV) is a retrovirus of the genus Deltaretrovirus, which belongs to the family Retroviridae. The most important types are HTLV-1 and HTLV-2. It is estimated that between five and 10 million individuals are infected with HTLV-1, worldwide. Studies in the state of Pará indicate that it has the third highest prevalence of HTLV infections of any Brazilian state. The present study describes the epidemiological, serological, and molecular profile of blood donors from the state of Pará that were classified as unfit due to infection by HTLV-1 and 2. METHODS: The present study is based on a descriptive, retrospective, and cross-sectional review of the epidemiological, serological, and molecular data on blood donations, between January 2015 and December 2019. The data were obtained from the blood bank system and were digitalized to form a database in the Statistical Package for Social Sciences program, version 20. Descriptive statistics were used to determine the absolute and relative frequencies of the qualitative variables. For the quantitative variables, the mean, standard deviation, and minimum and maximum values were calculated. A p < 0.05 significance level was adopted for all analyses. RESULTS: A total of 632 samples were analyzed, of which 496 (78%) had no detectable proviral DNA and 136 (22%) had detectable HTLV. The HTLV-1 was detected in most (78%; 106/136) of these samples, while only 30 (22%) were detected for HTLV-2. The HTLV proviral DNA was detected primarily in females (69.1%), with a mean age of 40 years, with the highest frequencies of detection being recorded in single individuals (66.2%), first-time donors (74.3%), and individuals that had graduated high school (44.1%). The molecular confirmation of HTLV showed that three-quarters (78%) of the serologically reactive individuals were negative for either types 1 or 2, so the epidemiological profile of these individuals was significantly different from their detectable profile. CONCLUSIONS: The HTLV is neglected in Brazil; there is thus a clear need for further research in the area of regional hemotherapy and hematology services, in order to contribute to the definition of regional infection profiles, that will be fundamental to the development of effective prophylactic practices for the prevention of the infection and the dissemination of knowledge on the dangers of HTLV in the community.

Correlação entre os métodos sorológico e molecular para detecção do HIV na triagem de doadores de sangue na Fundação HEMOPA / Correlation between sorological and molecular methods for HIV detection in blood donor screening in HEMOPA Foundation

Objetivo: Buscar a correlação entre os métodos sorológico e molecular para detecção do HIV na triagem de doadores de sangue na Fundação HEMOPA. Métodos: Realizou-se a busca das amostras reagentes para HIV, referente aos anos de 2015 a 2019 no Sistema de Banco de Sangue da Fundação HEMOPA. Para análise estatística, utilizou-se o programa SPSS para a comparação das medianas dos valores de S/CO com NAT detectável e indetectável. O teste de X² foi utilizado para apontar a correlação dos valores de S/CO com a presença do RNA viral. Resultados: Obtiveram-se para o estudo 910 amostras reagentes, na qual 75,60% (688/910) positivas (S/CO >1,2) e 24,40% (222/910) inconclusivas (S/CO 0,8-1,2). A mediana de S/CO das amostras detectáveis foi de 503,93 e das indetectáveis foi de 1,22 no NAT. Conclusão: Estabelecemos que na triagem sorológica-molecular há uma correlação estatisticamente significante, na qual a presença de anticorpos e/ou antígenos no teste ARCHITECH HIV Ag/Ab Combo orienta a predição de viremia no NAT.

Objective: Search for the correlation between serological and molecular methods of HIV detection in screening blood donors at the HEMOPA Foundation. Methods: The HIV reagent samples were searched for the years 2015 to 2019 in the Blood Bank System of the HEMOPA Foundation. For statistical analysis, the SPSS program was used to compare the medians of the S / CO values with detectable and undetectable NAT. The X² test was used to point out the correlation between S / CO values and the presence of viral RNA. Results: 910 reagent samples were obtained for the study, in which 75.60% (688/910) positive (S / CO> 1.2) and 24.40% (222/910) inconclusive (S / CO 0.8) -1.2). The median S / CO of the detectable samples was 503.93 and the undetectable was 1.22 in NAT. Conclusion: We established that in serological-molecular screening there is a statistically significant correlation, in which the presence of antibodies and / or antigens in the ARCHITECH HIV Ag / Ab Combo test guides the prediction of viremia in NAT.

[Mental healthcare in Brazil: a multifaceted study in four large cities]. / Assistência à saúde mental no Brasil: estudo multifacetado em quatro grandes cidades.

This study aimed to assess characteristics of healthcare networks in four large Brazilian cities (Campinas, Fortaleza, Porto Alegre, and São Paulo), in the provision of mental healthcare. The following outcomes were used: (i) place of identification of the mental health problem; (ii) mental healthcare in primary care; (iii) pharmaceutical care in mental health; and (iv) social rehabilitation. This is a mixed-methods study with a concurrent and sequential approach, conducted with 10 administrators and 1,642 users of Centers for Psychosocial Care (CAPS, in Portuguese) in the four cities. The study showed the persistence of high-complexity services such as hospitals as the site for initial identification of mental health problems in Campinas (40% of users) and Fortaleza (37%); low proportion of mental health treatment in primary care (Fortaleza, 23%); differences between cities in psychotropic medication prescription in primary care (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%) and in shortages of prescribed medication (higher in Fortaleza, 58%; lower in Campinas, 28%); and overall frailty in enabling return to work (lower in São Paulo, 17%; higher in Campinas, 39%), with better overall results regarding religion and leisure activities (higher in São Paulo, 53% and 56%, respectively). The study contributes to the discussion of the Brazilian scenario of mental healthcare, with evidence of persistent inequalities in the national context, pointing to gaps in some mental healthcare network configurations with the potential for better performance and longitudinal follow-up.

O objetivo deste estudo foi avaliar as características das redes de saúde de quatro grandes municípios brasileiros (Campinas, Fortaleza, Porto Alegre e São Paulo) no que diz respeito à prestação de cuidados em saúde mental. Foram usados como desfechos: (i) local de identificação do problema de saúde mental; (ii) atendimento em saúde mental na atenção básica; (iii) assistência farmacêutica em saúde mental; e (iv) reinserção social. Trata-se de um estudo analítico de métodos mistos, de abordagem concomitante e sequencial, conduzido com 10 gestores e 1.642 usuários de Centros de Atenção Psicossocial (CAPS) dos municípios citados. Observou-se a persistência de serviços de alta complexidade, tais como os hospitais, como locais de identificação inicial dos problemas de saúde mental em Campinas (40% dos usuários) e Fortaleza (37%); baixa proporção de tratamento de saúde mental na atenção básica (Fortaleza, 23%); diferenças entre os municípios no que diz respeito à prescrição de medicamentos psicotrópicos na atenção básica (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%), bem como na falta dos medicamentos prescritos (maior em Fortaleza, 58%; menor em Campinas, 28%); e fragilidade em geral na retomada de atividades laborais (menor em São Paulo, 17%; maior em Campinas, 39%), havendo melhores resultados em geral em relação a atividades religiosas e de lazer (maiores em São Paulo, 53% e 56%, respectivamente). É um estudo que contribui para a discussão do panorama brasileiro da assistência à saúde mental, com evidências da persistência de desigualdades no contexto nacional, e aponta lacunas em algumas configurações das redes de saúde mental com potenciais para melhor desempenho e seguimento longitudinal.

El objetivo de este estudio fue evaluar características de las redes de salud en cuatro grandes municipios brasileños (Campinas, Fortaleza, Porto Alegre y São Paulo), en lo que se refiere prestación de cuidados en salud mental. Se utilizaron como resultados: (i) lugar de identificación del problema de salud mental; (ii) atención en salud mental en la atención básica; (iii) asistencia farmacéutica en salud mental; y (iv) reinserción social. Se trata de un estudio analítico con métodos mixtos, de enfoque concomitante y secuencial, realizado con 10 gestores y 1.642 usuarios de Centros de Atención Psicosocial (CAPS) de los municipios citados. Se observó la persistencia de servicios de alta complejidad, tales como hospitales, respecto al lugar de identificación inicial del problema de salud mental en Campinas (40% de los usuarios) y Fortaleza (37%); baja proporción de tratamiento de salud mental en la atención básica (Fortaleza, 23%); hubo diferencias entre los municipios en lo que se refiere a la prescripción de medicamentos psicotrópicos en la atención básica (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%), así como en la falta de medicamentos prescritos (mayor en Fortaleza, 58%; menor en Campinas, 28%); y fragilidad en general en el retorno al trabajo (menor en São Paulo, 17%; mayor en Campinas, 39%), existiendo mejores resultados en general, en relación con la religión y ocio (mayores en São Paulo, 53% y 56%, respectivamente). Se trata de un estudio que contribuye a la discusión del panorama brasileño de la asistencia en salud mental, con evidencias de la persistencia de desigualdades en el contexto nacional, además apunta lagunas en algunas configuraciones de las redes de salud mental con potencial para un mejor desempeño y seguimiento longitudinal.

Assistência à saúde mental no Brasil: estudo multifacetado em quatro grandes cidades / Mental healthcare in Brazil: a multifaceted study in four large cities / Asistencia en salud mental en Brasil: estudio multifacético en cuatro grandes ciudades

O objetivo deste estudo foi avaliar as características das redes de saúde de quatro grandes municípios brasileiros (Campinas, Fortaleza, Porto Alegre e São Paulo) no que diz respeito à prestação de cuidados em saúde mental. Foram usados como desfechos: (i) local de identificação do problema de saúde mental; (ii) atendimento em saúde mental na atenção básica; (iii) assistência farmacêutica em saúde mental; e (iv) reinserção social. Trata-se de um estudo analítico de métodos mistos, de abordagem concomitante e sequencial, conduzido com 10 gestores e 1.642 usuários de Centros de Atenção Psicossocial (CAPS) dos municípios citados. Observou-se a persistência de serviços de alta complexidade, tais como os hospitais, como locais de identificação inicial dos problemas de saúde mental em Campinas (40% dos usuários) e Fortaleza (37%); baixa proporção de tratamento de saúde mental na atenção básica (Fortaleza, 23%); diferenças entre os municípios no que diz respeito à prescrição de medicamentos psicotrópicos na atenção básica (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%), bem como na falta dos medicamentos prescritos (maior em Fortaleza, 58%; menor em Campinas, 28%); e fragilidade em geral na retomada de atividades laborais (menor em São Paulo, 17%; maior em Campinas, 39%), havendo melhores resultados em geral em relação a atividades religiosas e de lazer (maiores em São Paulo, 53% e 56%, respectivamente). É um estudo que contribui para a discussão do panorama brasileiro da assistência à saúde mental, com evidências da persistência de desigualdades no contexto nacional, e aponta lacunas em algumas configurações das redes de saúde mental com potenciais para melhor desempenho e seguimento longitudinal.

This study aimed to assess characteristics of healthcare networks in four large Brazilian cities (Campinas, Fortaleza, Porto Alegre, and São Paulo), in the provision of mental healthcare. The following outcomes were used: (i) place of identification of the mental health problem; (ii) mental healthcare in primary care; (iii) pharmaceutical care in mental health; and (iv) social rehabilitation. This is a mixed-methods study with a concurrent and sequential approach, conducted with 10 administrators and 1,642 users of Centers for Psychosocial Care (CAPS, in Portuguese) in the four cities. The study showed the persistence of high-complexity services such as hospitals as the site for initial identification of mental health problems in Campinas (40% of users) and Fortaleza (37%); low proportion of mental health treatment in primary care (Fortaleza, 23%); differences between cities in psychotropic medication prescription in primary care (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%) and in shortages of prescribed medication (higher in Fortaleza, 58%; lower in Campinas, 28%); and overall frailty in enabling return to work (lower in São Paulo, 17%; higher in Campinas, 39%), with better overall results regarding religion and leisure activities (higher in São Paulo, 53% and 56%, respectively). The study contributes to the discussion of the Brazilian scenario of mental healthcare, with evidence of persistent inequalities in the national context, pointing to gaps in some mental healthcare network configurations with the potential for better performance and longitudinal follow-up.

El objetivo de este estudio fue evaluar características de las redes de salud en cuatro grandes municipios brasileños (Campinas, Fortaleza, Porto Alegre y São Paulo), en lo que se refiere prestación de cuidados en salud mental. Se utilizaron como resultados: (i) lugar de identificación del problema de salud mental; (ii) atención en salud mental en la atención básica; (iii) asistencia farmacéutica en salud mental; y (iv) reinserción social. Se trata de un estudio analítico con métodos mixtos, de enfoque concomitante y secuencial, realizado con 10 gestores y 1.642 usuarios de Centros de Atención Psicosocial (CAPS) de los municipios citados. Se observó la persistencia de servicios de alta complejidad, tales como hospitales, respecto al lugar de identificación inicial del problema de salud mental en Campinas (40% de los usuarios) y Fortaleza (37%); baja proporción de tratamiento de salud mental en la atención básica (Fortaleza, 23%); hubo diferencias entre los municipios en lo que se refiere a la prescripción de medicamentos psicotrópicos en la atención básica (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%), así como en la falta de medicamentos prescritos (mayor en Fortaleza, 58%; menor en Campinas, 28%); y fragilidad en general en el retorno al trabajo (menor en São Paulo, 17%; mayor en Campinas, 39%), existiendo mejores resultados en general, en relación con la religión y ocio (mayores en São Paulo, 53% y 56%, respectivamente). Se trata de un estudio que contribuye a la discusión del panorama brasileño de la asistencia en salud mental, con evidencias de la persistencia de desigualdades en el contexto nacional, además apunta lagunas en algunas configuraciones de las redes de salud mental con potencial para un mejor desempeño y seguimiento longitudinal.

Mental Health Studies published in the last 25 years in the Journal Ciência & Saúde Coletiva. / Estudos de Saúde Mental publicados nos últimos 25 anos na Revista Ciência & Saúde Coletiva.

A systematic review of the 25-year Mental Health production of Journal Ciência & Saúde Coletiva was performed to identify whether this production had changed over time. We investigated whether these changes would have any relationship with the implementation of a new regulatory and legal framework for this field and the expansion of public services and the promotion of public funding agencies' investigation on the subject. A total of 278 original papers were analyzed from the following categories: sociocultural transformations related to madness and its approach; legislative changes; implantation, coverage range and operation of the network of substitute services; clinic/care developed in substitute services; the role and possibilities of primary care; drug use-related problems; mental health of children and adolescents; epidemiological studies/psychiatric categories; and others - which included ethnic-racial issues, violence, about the elderly population, suicide, bullying, and migration. A chronological relationship can be observed between the increase in publications and research notices and the expansion of services, not seemingly in the same way concerning care for people with alcohol and other drug problems.

Realizou-se revisão sistemática de 25 anos de produção da Revista Ciência & Saúde Coletiva sobre a temática de Saúde Mental buscando responder se essa produção tinha se modificado ao longo do tempo. Perguntou-se se essas mudanças guardariam alguma relação com a implementação de um novo marco regulatório e legal para essa área assim como com a expansão de serviços públicos e com os estímulos à investigação do tema por Agencias Públicas de financiamento. Analisaram-se 278 artigos originais, apresentados a partir das categorias: transformações socioculturais relacionadas à loucura e sua abordagem; mudanças legislativas; implantação, capilaridade e funcionamento da rede de serviços substitutivos; clínica/cuidado desenvolvido nos serviços substitutivos; o papel e as possibilidades da atenção básica; problemas relacionados ao uso de drogas; saúde mental de crianças e adolescentes; estudos epidemiológicos/categorias psiquiátricas; e outros - nas quais foram incluídas as questões étnico-raciais, de violência, acerca da população idosa, suicídio, bullying e migração. Pode ser observada relação cronológica entre o aumento de publicações e os editais de pesquisa e a expansão de serviços, não parecendo ser da mesma forma em relação ao tema dos cuidados a pessoas com problemas com álcool e outras drogas.

Frequências fenotípicas dos sistemas de grupos sanguíneos ABO, Rh e Kell em doadores de sangue da região metropolitana de Belém-PA / Phenotype frequencies of ABO, Rh and Kell blood group systems in blood donors in the metropolitan region of Belém-PA

Objetivo: O objetivo deste trabalho foi realizar um estudo das frequências dos principais antígenos e fenótipos dos sistemas de grupo sanguíneo: ABO, Rh, Kell. Métodos: A partir dos dados da fenotipagem estendida disponíveis no Sistema de Banco de Sangue (SBS web) de doadores de sangue da Fundação Hemopa, foram avaliadas as frequências absolutas e relativas. Resultados: Dentre os 1.474 doadores analisados houve predominância do tipo O (62,6%) e quanto ao Rh: D (85,5%). O antígeno mais frequente do sistema Rh foi: e (94,9%), e o fenótipo mais frequente: DCcee (27,5%). O antígeno mais frequente do sistema Kell foi: Kpb (100%), e o fenótipo: k+ K- (95,7%), Kp (a- b+) (99,4%). Conclusão: A identificação das frequências desses antígenos em diferentes populações pode auxiliar na rotina hemoterápica, facilitando a busca por hemocomponentes compatíveis, melhorando a segurança transfusional imunológica.

Objective: To study the frequencies of the major antigens of bloodgroup systems:ABO, Rh, Kell. Methods: From data of extendedphenotyping available in the Blood Bank System (SBS web) in blooddonors of the Hemopa Foundation, were evaluated absolute and relativefrequencies. Results: Among the 1.474 donors analyzed there was apredominance of type O (62.6%) and RhD (85.5%). The most frequentantigen from system Rh was: e (94,9%), and the most commonphenotype: DCcee (27,5%). The most frequent antigen from systemKell was: Kpb (100%), and the most common phenotypes: k + K-(95.7%), Kp (a- b +) (99.4%). Conclusion: Identifying the frequenciesof these antigens in different populations may help in the routine bloodtherapy, facilitating the search for compatible blood components,improving the immunological transfusion safety.

Estudos de Saúde Mental publicados nos últimos 25 anos na Revista Ciência & Saúde Coletiva / Mental Health Studies published in the last 25 years in the Journal Ciência & Saúde Coletiva

Resumo Realizou-se revisão sistemática de 25 anos de produção da Revista Ciência & Saúde Coletiva sobre a temática de Saúde Mental buscando responder se essa produção tinha se modificado ao longo do tempo. Perguntou-se se essas mudanças guardariam alguma relação com a implementação de um novo marco regulatório e legal para essa área assim como com a expansão de serviços públicos e com os estímulos à investigação do tema por Agencias Públicas de financiamento. Analisaram-se 278 artigos originais, apresentados a partir das categorias: transformações socioculturais relacionadas à loucura e sua abordagem; mudanças legislativas; implantação, capilaridade e funcionamento da rede de serviços substitutivos; clínica/cuidado desenvolvido nos serviços substitutivos; o papel e as possibilidades da atenção básica; problemas relacionados ao uso de drogas; saúde mental de crianças e adolescentes; estudos epidemiológicos/categorias psiquiátricas; e outros - nas quais foram incluídas as questões étnico-raciais, de violência, acerca da população idosa, suicídio, bullying e migração. Pode ser observada relação cronológica entre o aumento de publicações e os editais de pesquisa e a expansão de serviços, não parecendo ser da mesma forma em relação ao tema dos cuidados a pessoas com problemas com álcool e outras drogas.

Abstract A systematic review of the 25-year Mental Health production of Journal Ciência & Saúde Coletiva was performed to identify whether this production had changed over time. We investigated whether these changes would have any relationship with the implementation of a new regulatory and legal framework for this field and the expansion of public services and the promotion of public funding agencies' investigation on the subject. A total of 278 original papers were analyzed from the following categories: sociocultural transformations related to madness and its approach; legislative changes; implantation, coverage range and operation of the network of substitute services; clinic/care developed in substitute services; the role and possibilities of primary care; drug use-related problems; mental health of children and adolescents; epidemiological studies/psychiatric categories; and others - which included ethnic-racial issues, violence, about the elderly population, suicide, bullying, and migration. A chronological relationship can be observed between the increase in publications and research notices and the expansion of services, not seemingly in the same way concerning care for people with alcohol and other drug problems.

Notes for the study on health systems: multifaceted analysis and tracer indicators.

OBJECTIVE: To present the methodological approach used in a research that analyzed the use and performance of specialized health care, from primary care access, in four major Brazilian cities: Fortaleza (CE), Campinas (SP), São Paulo (SP) and Porto Alegre (RS). METHODS: Presentation and discussion of the quantitative-qualitative components of the proposed research strategy. RESULTS: Four tracing conditions were studied: systemic arterial hypertension, high-risk pregnancy, breast cancer and severe mental disorder. For each health condition, indicators were constructed based on health information systems data, pointing out frequencies, temporal trends and local differences. This initial contextualization was enriched with a descriptive-qualitative study of the performance of each municipal health service network. Next, a cross-sectional study was conducted through a survey of 7,053 users of specialized services for each health condition. Finally, in-depth interviews were conducted with key actors to complement selected operational aspects of each municipality's network. The results of all these data sources were triangulated, allowing us to explore the variability of SUS implementations in different regional scenarios. CONCLUSIONS: The multifaceted analytical model presented allows us to understand relevant aspects of the Unified Health System performance, paying attention to the singularities, heterogeneities and inequalities that characterize its implementation in Brazil and emphasizing the performance of local networks for the addressed health conditions.

Notes for the study on health systems: multifaceted analysis and tracer indicators / Apontamentos para estudo de sistemas de saúde: análise multifacetada e agravos traçadores

ABSTRACT OBJECTIVE To present the methodological approach used in a research that analyzed the use and performance of specialized health care, from primary care access, in four major Brazilian cities: Fortaleza (CE), Campinas (SP), São Paulo (SP) and Porto Alegre (RS). METHODS Presentation and discussion of the quantitative-qualitative components of the proposed research strategy. RESULTS Four tracing conditions were studied: systemic arterial hypertension, high-risk pregnancy, breast cancer and severe mental disorder. For each health condition, indicators were constructed based on health information systems data, pointing out frequencies, temporal trends and local differences. This initial contextualization was enriched with a descriptive-qualitative study of the performance of each municipal health service network. Next, a cross-sectional study was conducted through a survey of 7,053 users of specialized services for each health condition. Finally, in-depth interviews were conducted with key actors to complement selected operational aspects of each municipality's network. The results of all these data sources were triangulated, allowing us to explore the variability of SUS implementations in different regional scenarios. CONCLUSIONS The multifaceted analytical model presented allows us to understand relevant aspects of the Unified Health System performance, paying attention to the singularities, heterogeneities and inequalities that characterize its implementation in Brazil and emphasizing the performance of local networks for the addressed health conditions.

RESUMO OBJETIVO Apresentar a abordagem metodológica utilizada em pesquisa que analisou a utilização e o funcionamento da atenção especializada, partindo do acesso via atenção básica, em quatro grandes cidades brasileiras: Fortaleza (CE), Campinas (SP), São Paulo (SP) e Porto Alegre (RS). MÉTODOS Apresentação e discussão dos componentes quanti-qualitativos da estratégia de pesquisa proposta. RESULTADOS Foram estudadas quatro condições traçadoras: hipertensão arterial grave, gravidez de alto risco, câncer de mama e transtorno mental grave. Para cada agravo foram construídos indicadores a partir de dados dos sistemas de informação de saúde destacando frequências, tendência temporal e diferenças por localidade. Essa contextualização inicial foi enriquecida com um estudo descritivo-qualitativo do funcionamento de cada rede municipal de serviços. A seguir, realizou-se um estudo transversal por meio de inquérito com 7.053 usuários dos serviços especializados para cada agravo. Por fim, foram realizadas entrevistas em profundidade com atores-chave para complementar aspectos operacionais selecionados da rede de cada município. Os resultados de todas essas fontes de dados foram triangulados, permitindo explorar a variabilidade das implantações do SUS em diferentes cenários regionais. CONCLUSÕES O modelo analítico multifacetado apresentado permite compreender aspectos relevantes do funcionamento do Sistema Único de Saúde, atentando para as singularidades, heterogeneidades e desigualdades que caracterizam sua implantação no Brasil e destacando o funcionamento das redes locais para os agravos estudados.

GBA mutations p.N370S and p.L444P are associated with Parkinson's disease in patients from Northern Brazil.

Mutations of the GBA gene have been reported in patients with Parkinson's disease (PD) from a number of different countries, including Brazil. In order to confirm this pattern in a sample of PD patients from northern Brazil, we conducted a case-control study of the occurrence of the two most common mutations of the GBA gene (c.1226A>G; p.N370S and c.1448T>C; p.L444P) in a group of 81 PD patients and 81 control individuals, using PCR-RFLP, confirmed by the direct sequencing of the PCR products. In the patient group, three patients (3.7%) were heterozygous for the GBA c.1226A>G; p.N370S mutation, and three (3.7%) for GBA c.1448T>C; p.L444P Neither mutation was detected in the control group (p =0.0284). Patients with the c.1448T>C; p.L444P mutation showed a tendency to have an earlier disease onset, but a larger sample number is required to confirm this observation. Our results suggest an association between the GBA c.1226A>G; p.N370S and c.1448T>C; p.L444P mutations and the development of PD in the population of patients from the Northern Brazil.

GBA mutations p.N370S and p. L444P are associated with Parkinson's disease in patients from Northern Brazil / Mutações p.N370S e p. L444P no gene GBA estão associadas com doença de Parkinson em pacientes do norte do Brasil

ABSTRACT Mutations of the GBA gene have been reported in patients with Parkinson's disease (PD) from a number of different countries, including Brazil. In order to confirm this pattern in a sample of PD patients from northern Brazil, we conducted a case-control study of the occurrence of the two most common mutations of the GBA gene (c.1226A>G; p.N370S and c.1448T>C; p.L444P) in a group of 81 PD patients and 81 control individuals, using PCR-RFLP, confirmed by the direct sequencing of the PCR products. In the patient group, three patients (3.7%) were heterozygous for the GBA c.1226A>G; p.N370S mutation, and three (3.7%) for GBA c.1448T>C; p.L444P Neither mutation was detected in the control group (p =0.0284). Patients with the c.1448T>C; p.L444P mutation showed a tendency to have an earlier disease onset, but a larger sample number is required to confirm this observation. Our results suggest an association between the GBA c.1226A>G; p.N370S and c.1448T>C; p.L444P mutations and the development of PD in the population of patients from the Northern Brazil.

RESUMO Mutações no gene GBA têm sido reportadas em pacientes com doença de Parkinson (DP) em diferentes países, incluindo o Brasil. Com o objetivo de confirmar esse padrão em uma amostra de pacientes com DP provenientes do Norte brasileiro, foi conduzindo esse estudo caso-controle investigando a frequência das duas mutações mais comuns do gene GBA (c.1226A>G; p.N370S e c.1448T>C; p.L444P) em um grupo de 81 pacientes com DP e 81 controles, usando PCR-RFLP e confirmado pelo sequenciamento direto de produtos de PCR. No grupo experimental, três pacientes (3,7%) foram heterozigotos para a mutação c.1226A>G; p.N370S e três (3,7%), para a mutação c.1448T>C; p.L444P Nenhuma das duas mutações foi detectada no grupo controle (p =0,0284). Pacientes com a mutação c.1448T>C; p.L444P demonstraram uma tendência a apresentar os sintomas mais precocemente, porém um número amostrai maior é necessário para confirmar essa observação. Nossos resultados sugerem uma associação entre essas duas mutações no gene GBA e o desenvolvimento de DP na população de pacientes do norte Brasileiro.