ALEX JONES FLORES CASSENOTE
Projetos de Pesquisa
Unidades Organizacionais
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Validation of CD4(+) T-cell and viral load data from the HIV-Brazil Cohort Study using secondary system data(2018) CASSENOTE, Alex Jones Flores; GRANGEIRO, Alexandre; ESCUDER, Maria Mercedes; ABE, Jair Minoro; SEGURADO, Aluisio Augusto CotrimBackgroundThe HIV-Brazil Cohort Study (HIV-BCS) is a research primarily based on data collection from medical records of people living with HIV/AIDS in Brazil. The aim of this study was to present the validating design and results for the laboratory biomarkers viral load and CD4+ T-cell count from the HIV-Brazil Cohort Study.MethodsA total of 8007 patients who were started cART from 2003 to 2013 were considered eligible for this study. Total follow-up time was 32,397years. The median duration of follow-up was 3.51years (interquartile range - IQR 1.63-6.13years; maximum 11.51years). We used secondary data from the Brazilian Laboratory Tests Control System (SISCEL). Incidence of lab testing rates per 100 person years (100 py) were used to compare the number of laboratory tests carried out among cohort sites considering different databases for CD4+ T-cell counts and HIV viral load assessments. Descriptive statistics including 95% confidence interval, Pearson correlation coefficient, Bland-Altman agreement analysis and kappa coefficient agreement were applied for analysis.ResultsA total of 80,302 CD4+ T-cell counts and 79,997 HIV viral load assessments were observed in HIV-BCS versus 94,083 CD4+ T-cell counts and 84,810 viral loads from the Brazilian Laboratory Tests Control System. The general CD4+ T-cell HIV-BCS testing rate was 247 per 100 py versus 290 per 100 py and the viral load HIV-BCS testing rate was 246 per 100 py versus 261 per 100 py. The general correlation observed for the lowest quantitative CD4+ T-cell count before cART was 0.970 (p<0.001) and for the log of the highest viral load before cART was 0.971 (p<0.001). The general agreement coefficient for categorized CD4+ T-cell count was 0.932 (p<0.001) and for viral load was 0.996 (p<0.001).ConclusionsThe current study confirms that biomarkers CD4(+) T-cell count and viral load from the HIV-BCS have a high correlation and agreement with data from SISCEL, rendering both databases reliable and useful for epidemiological studies on HIV care in Brazil.
- Stray dogs in urban fragments: relation between population's perception of their presence and socio-demographic factors(2018) GUILLOUX, Aline G. A.; PANACHAO, Ligia I.; ALVES, Ana J. S.; ZETUN, Carolina B.; CASSENOTE, Alex J. F.; DIAS, Ricardo A.Stray dogs are associated with environment and public health impacts. Sao Paulo is a city with approximately 2.5 million owned dogs and until the time of writing no studies describing the distribution of the stray dog population have been conducted in this city. Therefore, no scientific support for intervention plans is available. The objective of this study was to evaluate the association of local sociodemographic and environmental factors with the population perception of presence of stray dogs in urban fragments of Sao Paulo city. A convenience sample of six urban fragments was selected. In-depth interviews were performe, using a systematic random sample of households in each study area, between October/2010 and January/2011 to identify socio-demographic factors of interest and determine the population's perception of stray dogs. Additionally, the presence of stray dogs was estimated by photographic mark-recapture method. The degree of human-dog proximity and environmental factors such as waste handling were associated to the sighting of stray dogs. Stray dogs were observed in two of the six study areas, agreeing with the greater population perception of this issue on those areas. Intervention in these factors and encouragement of responsible ownership are two potential solutions for management and reduction of problems associated with the presence of stray dogs.
- Physician's sociodemographic profile and distribution across public and private health care: an insight into physicians' dual practice in Brazil(2018) MIOTTO, Bruno Alonso; GUILLOUX, Aline Gil Alves; CASSENOTE, Alex Jones Flores; MAINARDI, Giulia Marcelino; RUSSO, Giuliano; SCHEFFER, Mario CesarBackground: The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country's medical workforce. Physicians' simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services. Methods: A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians' sociodemographic characteristics and their engagement with public and private services. Results: From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68-0.89]; PR 0.47 [0.38-0.56]), less experienced (PR 0.78 [0.73-0.94]; PR 0.44 [0.36-0.53]) and predominantly female (PR 0.79 [0.71-0.88]; PR 0.68 [0.6-0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48-0.69]) and mixed sectors (PR 0.31 [0.25-0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58-2.43]), specialized (PR 1.29 [1.17-1.42]) and male (PR 1.35 [1.21-1.51]), often working less than 20 h per week (PR 2.04 [1.4-2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16-1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1.11-1.37]). Conclusion: The study shows that more than half of Brazilian physicians currently engage with dual practice, while only one fifth dedicate exclusively to public services, highlighting also substantial differences in sociodemographic and work-related characteristics between public, private and dual-practitioners. These results are consistent with the international literature suggesting that physicians' sociodemographic characteristics can help predict dual practice forms and prevalence in a country.
- Internal migration of physicians who graduated in Brazil between 1980 and 2014(2018) SCHEFFER, Mario Cesar; CASSENOTE, Alex Jones Flores; GUILLOUX, Aline Gil Alves; POZ, Mario Roberto DalBackground: The internal migration of physicians from one place to another in the same country can unbalance the supply and distribution of these professionals in national health systems. In addition to economic, social and demographic issues, there are individual and professional factors associated with a physician's decision to migrate. In Brazil, there is an ongoing debate as to whether opening medicine programmes in the interior of the country can induce physicians to stay in these locations. This article examines the migration of physicians in Brazil based on the location of the medical schools from which they graduated. Methods: A cross-sectional design based on secondary data of 275,801 physicians registered in the Regional Councils of Medicine (Conselhos Regionais de Medicina-CRMs) who graduated between 1980 and 2014. The evaluated outcome was migration, which was defined as moving away from the state where they completed the medicine programme to another state where they currently work or live. Results: 57.3% of the physicians in the study migrated. The probability of migration ratio was greater in small grouped municipalities and lower in state capitals. 93.4% of the physicians who trained in schools located in cities with less than 100,000 inhabitants migrated. Fewer women (54.2%) migrated than men (60.0%). More than half of the physicians who graduated between 1980 and 2014 are in federative units different from the unit in which they graduated. Individual factors, such as age, gender, time of graduation and specialty, vary between the physicians who did or did not migrate. Conclusions: The probability of migration ratio was greater in small municipalities of the Southeast region and strong in the states of Tocantins, Acre and Santa Catarina. New studies are recommended to deepen understanding of the factors related to the internal migration and non-migration of physicians to improve human resource for health policies.