JOSE ELUF NETO
Projetos de Pesquisa
Unidades Organizacionais
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Follow-up of women screened for cervical cancer in S & atilde;o Paulo, Brazil: An analysis of the times to diagnostic investigation and treatment(2021) RIBEIRO, Caroline Madalena; SILVA, Isabel dos Santos; NETO, Jose Eluf; CURY, Lise Cristina Pereira Baltar; SILVA, Gulnar Azevedo eBackground: Cervical cancer incidence and mortality rates are higher in Brazil than in western countries. Access to cytology-based screening has increased in the country in recent decades, but few studies have assessed the quality of the follow-up care of women with abnormal screening tests that require further investigation. Methods: A record-linkage cohort study was conducted in Sa & tilde;o Paulo state. Women aged 25+ years, who were screened in 2010, and whose test revealed a high-grade, or more severe, lesion were eligible. Follow-up information on diagnostic investigations, treatments and mortality was obtained through record-linkage of health databases. The Kaplan-Meier method was used to estimate median times between screening and diagnostic investigation, and diagnosis and treatment initiation. Cox survival models were used to identify correlates of the length of these time intervals. Results: 4300 women had a high-grade, or more severe, test result. Of these, 2788 (64.8 %) had a diagnostic investigation record, 1763 (41 %) a confirmed diagnosis of a precursor lesion or cancer, and 1247 (70.7 %) a treatment record. The median time to diagnosis was 190 days, with the probability of undergoing a diagnostic investigation within 30 days of the abnormal screening test being 7%. The median time to treatment was 81 days, with the probability of undergoing treatment within 60 days of a confirmed diagnosis being 44 %. Delays in diagnosis and treatment were associated with area-based healthcare indicators. Conclusion: Times to diagnosis and treatment were long, well above recommendations. Strategies to improve follow-up care must be prioritized to ensure screening reduces cervical cancer incidence and mortality.
- Survival analysis of young adults from a Brazilian cohort of non-small cell lung cancer patients(2021) NICOLAU, Jessica Silva; LOPEZ, Rossana Veronica Mendoza; LUIZAGA, Carolina Terra de Moraes; RIBEIRO, Karina Braga; ROELA, Rosimeire Aparecida; MAISTRO, Simone; KATAYAMA, Maria Lucia Hirata; NATALINO, Renato Jose Mendonca; JR, Gilberto de Castro; NETO, Jose Eluf; FOLGUEIRA, Maria Aparecida Azevedo KoikeBackground: The influence of age at diagnosis in non-small cell lung cancer (NSCLC) prognosis is unclear. Objectives: To compare in a Brazilian cohort of NSCLC patients of different age groups: 1) The overall survival; 2) Clinical features and treatment options. Methods: This is a retrospective cohort study using a hospital-based registry, for NSCLC patients registered in years 2000-2009. Patients were grouped into three age groups: Young adults (YA: < 40 years), middle-aged (MA: 40-64 years) and elderly (E: >= 65 years). Kaplan-Meier was used to estimate overall survival and Cox regression for hazard ratios (HRs) and 95% confidence intervals. Results: 17,422 NSCLC patients were included: 370 YA (2.1%), 8,697 MA (49.9%) and 8,355 E (48.0%). Compared with older age groups, the YA group had a higher proportion of females, patients diagnosed with adenocarcinoma and metastatic disease (63.2%). Overall survival was longer in YA in the entire cohort and in all clinical stages (CSs) (p < 0.001). For YA, higher education level was a good prognosis factor (compared with illiterate and incomplete elementary); advanced or metastatic disease (compared with early-stage disease) and treatment based in radiotherapy or chemotherapy (CT) (without surgery), compared with treatment combinations with surgery, were poor prognostic factors. Young men (but not women) had lower HR of death compared with older groups; YA had lower HR of death in all CSs compared with patients from older groups. A higher percentage of YA were treated with surgery or CT in early-stage disease compared with older groups. Besides that, YA and MA patients treated with surgery or CT had a better prognosis than elderlies. Conclusions: In this Brazilian cohort of NSCLC patients, most young individuals were diagnosed with metastatic disease. YA presented longer survival than older age groups in all CSs, but mainly in CS I/II and III, where some patients may achieve long remissions or cure.
- Adherence to intensive nutrition care in head and neck cancer patients undergoing radiotherapy(2021) FARIA, Sheilla de Oliveira; HOWELL, Doris; CARVALHO, Andre Lopes; FARIA, Rafael de Oliveira; ELUF NETO, JosePurpose The aim of this study was to determine the prevalence and effect of adherence to intensive nutritional care on nutritional outcomes and survival in head and neck cancer patients undergoing radiotherapy. Methods Three-hundred and seventeen head and neck cancer patients referred to intensive nutrition support during radiotherapy were retrospectively analyzed. Patients who missed less than 25% of their appointments with the dietitian were considered adherent. Primary outcome was percentage weight loss during treatment. Secondary outcomes were overall survival and patients' capacity to accomplish their caloric and protein recommendations. Logistic regression was used to examine predictors of weight loss and Kaplan-Meier to estimate survival. Results Less than half of the patients (n = 145, 45.7%) were adherent. Statistically significant less weight loss in the adherent group (42.8% vs 55.8%; p = 0.02) was found, despite no difference in energy or protein intake. Logistic regression models after adjusting for other variables demonstrated that adherence resulted in 43% protection from significant weight loss (odds ratio 0.57, 95% CI 0.34-0.97). Overall survival was not different between groups. Conclusion Findings demonstrated that patients who were adherent to weekly contacts with the dietitian had less weight loss, but not better survival or nutritional intake. Additional investigation of factors that may act as barriers or enablers for adherence could help improve the outcomes in this population.
- Physical activity for cancer patients during COVID-19 pandemic: a call to action(2021) REZENDE, Leandro F. M.; LEE, Dong Hoon; FERRARI, Gerson; ELUF-NETO, Jose; GIOVANNUCCI, Edward L.Self-isolation is strongly recommended for cancer patients during the COVID-19 pandemic, but may lead to physical inactivity and prolonged sitting time. The benefits of physical activity for cancer patients are manifold, such as reduced anxiety, fewer depressive symptoms, less fatigue, better quality of life, and improved physical function. In the last decade, several oncology-related organizations have provided guidance and summarized the evidence on the role of physical activity for cancer survivors. In this comment, we provide a brief summary of these recommendations and benefits of physical activity for cancer patients; and we recommend that oncologists and health practitioners should promote an active lifestyle for these patients during the pandemic and thereafter. Suggestions for implementing these actions in the clinical settings are also provided.
- A espiritualidade/religiosidade como desafio ao cuidado integral: aspectos regulatórios na formação médica brasileira(2021) TROFA, Gabrielle Cordeiro; GERMANI, Ana Claudia Camargo Gonçalves; OLIVEIRA, Janaine Aline Camargo de; ELUF NETO, JoseAbstract The aim of this study was to assess the quality of oral care provided in Brazilian primary care and identify associated contextual socioeconomic factors. This is a cross-sectional study whose unit of analysis was all the oral care teams that participated in an external assessment for the second cycle of the Access and Quality Improvement Program - Primary Care. Quality was measured in the following dimensions: access, resolution, work process, care coordination and infrastructure. The quality criteria of the external assessment were grouped into these dimensions and weighted using Item Response Theory. The indicator of oral care quality was the result of grouping latent variables. Descriptive analyses were performed by region and association between “Oral Care Quality” and the Municipal Human Development Index (HDI), with 5% significance. Only 25% of the oral care teams were considered good. The infrastructure dimension obtained the best results and care coordination the worst. There was no statistically significant difference between municipalities with high and low HDIs. Quality assessment is vital to ensure the continuous improvement of quality healthcare.
- Adherence to nutritional interventions in head and neck cancer patients: a systematic scoping review of the literature(2021) FARIA, S. de Oliveira; MORAVIA, R. Alvim; HOWELL, D.; ELUF NETO, J.Background Dietary counselling provided by a dietitian, with or without oral nutritional supplements, can impact on nutritional and clinical outcomes in head and neck cancer (HNC) patients undergoing radiotherapy. However, little is known about the role of adherence to oral nutritional interventions in this population. This review aimed to map the literature for evidence of adherence to oral nutritional interventions in HNC patients undergoing radiotherapy and to identify gaps in knowledge in this field. Methods A scoping review methodology was used to identify studies, extract data, and collate and summarise results. We searched Medline, Embase, Cochrane Central and CINAHL, from the earliest available time up to 8 January 2020. Results In total, 2315 unique articles were identified, 163 studies were assessed in full and niner were included in the scoping review. The use of different measures to assess adherence and variability in the timing of the assessments was noted across studies. Despite identifying studies that have measured adherence to oral nutritional interventions, very few studies monitored its influence on clinical and nutritional outcomes in HNC patients or reported factors related to adherence. Conclusions A robust evidence base is lacking for adherence to oral nutritional intervention in HNC patients. Overall, further studies evaluating the impact of oral nutritional interventions in HNC patients undergoing radiotherapy should measure adherence to the intervention. Early recognition of non-adherence and the contributing factors could ensure intensification of nutritional support and better health outcomes.
- Economic burden of colorectal and breast cancers attributable to lack of physical activity in Brazil(2021) REZENDE, Leandro F. M.; FERRARI, Gerson; BAHIA, Luciana Ribeiro; ROSA, Roger Dos Santos; ROSA, Michelle Quarti Machado da; SOUZA, Romulo Cristovao de; LEE, Dong Hoon; GIOVANNUCCI, Edward; ELUF-NETO, JoseBackgroundThe increasing number of cancer patients has an escalating economic impact to public health systems (approximately, International dollars- Int$ 60 billion annually in Brazil). Physical activity is widely recognized as one important modifiable risk factor for cancer. Herein, we estimated the economic costs of colon and post-menopausal breast cancers in the Brazilian Unified Health System (SUS) attributable to lack of physical activity.MethodsPopulation attributable fractions were calculated using prevalence data from 57,962 adults who answered a physical activity questionnaire in the Brazilian National Health Survey, and relative risks of colon and breast cancer from a meta-analysis. Annual costs (1 Int$=2.1 reais) with hospitalization, chemotherapy and radiotherapy were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Two counterfactual scenarios were considered: theoretical minimum risk exposure level (>= 8000 MET-min/week) and physical activity guidelines (>= 600 MET-min/week).ResultsAnnually, the Brazilian SUS expended Int$ 4.5 billion in direct costs related to cancer treatment, of which Int$ 553 million due to colon and breast cancers. Direct costs related to colon and breast cancers attributable to lack of physical activity were Int$ 23.4 million and Int$ 26.9 million, respectively. Achieving at least the physical activity guidelines would save Int$ 10.3 mi (colon, Int$ 6.4 mi; breast, Int$ 3.9 mi).ConclusionsLack of physical activity accounts for Int$ 50.3 million annually in direct costs related to colon and post-menopausal breast cancers. Population-wide interventions aiming to promote physical activity are needed to reduce the economic burden of cancer in Brazil.
- Attendance for diagnostic colposcopy among high-risk human papillomavirus positive women in a Brazilian feasibility study(2021) BUSS, Lewis F.; LEVI, Jose E.; LONGATTO-FILHO, Adhemar; COHEN, Diane D.; CURY, Lise; MARTINS, Toni R.; FUZA, Luiz M.; VILLA, Luisa L.; ELUF-NETO, JoseObjective To investigate factors associated with colposcopy attendance in HPV-positive women in Sao Paulo, Brazil. Methods We analyzed data from a prospective cohort of women positive for high-risk HPV (hr-HPV) undergoing cervical cancer screening in primary care services in Sao Paulo, Brazil. Non-pregnant women attending routine screening between December 2014 and March 2016 were offered an hr-HPV test, and those testing positive and aged 25 years or older were invited for colposcopy. Sociodemographic information was recorded at study enrollment. We compared variables between women who did and did not attend colposcopy within a logistic regression framework. Results Of 1537 hr-HPV-positive women, 1235 (80.4%) attended for colposcopy, with a median time from primary test to colposcopy of 132 days. Younger age (P<0.001) and concurrent negative cytology results (P=0.025) were associated with lower attendance. Women registered at units providing both the primary test and colposcopy were more likely to attend than those at units making external referrals (788/862 [91.4%] versus 447/675 [66.2%],P<0.001). Conclusion Non-attendance for colposcopy may limit the success of future screening programs based on hr-HPV testing in Brazil. Transfer of colposcopy services to primary care is a simple and effective facilitator of attendance.