RODRIGO DIAZ OLMOS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
DVCLME-62, Hospital Universitário
DVCLME-62, Hospital Universitário
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
bookPart Princípios básicos dos exames de rastreamento, sobrediagnóstico e prevenção quaternária(2022) OLMOS, Rodrigo Diaz- Health care professionals' perceptions about atrial fibrillation care in the Brazilian public primary care system: a mixed-methods study(2022) PASCHOAL, Elisabete; GOODEN, Tiffany E.; OLMOS, Rodrigo D.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; MANASEKI-HOLLAND, Semira; LIP, Gregory Y. H.; THOMAS, G. Neil; JOLLY, Kate C.; LANCASHIRE, Emma; LANE, Deirdre A.; GREENFIELD, Sheila; GOULART, Alessandra C.Background: Atrial fibrillation (AF) negatively impacts health systems worldwide. We aimed to capture perceptions of and barriers and facilitators for AF care in Brazilian primary care units (PCUs) from the perspective of healthcare professionals (HCPs).Methods: This mixed-methods, cross-sectional study utilised an exploratory sequential design, beginning with the quantitative data collection (up to 18 closed questions) immediately followed by a semi-structured interview. HCPs were recruited from 11 PCUs in the Sao Paulo region and included managers, physicians, pharmacists, nurses and community health agents. Descriptive statistics were used to present findings from the quantitative questionnaire and inductive analysis was used to identify themes from the qualitative data.Results: One hundred seven HCPs were interviewed between September 2019 and May 2020. Three main themes were identified that encapsulated barriers and facilitators to AF care: access to care (appointments, equipment/tests and medication), HCP and patient roles (HCP/patient relationship and patient adherence) and the role of the organisation/system (infrastructure, training and protocols/guidelines). Findings from the qualitative analysis reinforced the quantitative findings, including a lack of AF-specific training for HCPs, protocols/guidelines on AF management, INR tests in the PCUs, patient knowledge of AF management and novel oral anticoagulants (NOACs) as key barriers to optimal AF care.Conclusions: Development and implementation of AF-specific training for PCU HCPs are needed in Brazil, along with evidence-based protocols and guidelines, educational programmes for patients, better access to INR tests for patients taking warfarin and availability of NOACs.
- Cardiovascular medications and long-term mortality among stroke survivors in the Brazilian Study of Stroke Mortality and Morbidity (EMMA)(2022) SOUZA, Karla A. S.; VARELLA, Ana C.; OLMOS, Rodrigo D.; ROMAGNOLLI, Carla; GOODEN, Tiffany E.; THOMAS, G. Neil; LIP, Gregory Y. H.; SANTOS, Itamar S.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; GOULART, Alessandra C.Aim To investigate the association between medication use and long-term all-cause mortality in a Brazilian stroke cohort. Methods Both ischemic and hemorrhagic stroke were evaluated. Medication use was assessed as: never, only pre-stroke, only post-stroke, and continuous use. We evaluated anti-hypertensives, anti-diabetics, lipid-lowering drugs, anti-platelets, and anti-coagulants. Cox regression models were adjusted for sociodemographic and cardiovascular risk factors. Results Among 1173 incident stroke cases (median age: 68; 86.8% were ischemic, 70% first-ever stroke), medication use was low (overall: 17.5% pre-stroke, 26.4% post-stroke, and 40% were under continuous use). Anti-hypertensives and anti-platelets (aspirin) were the continuous cardiovascular medications used most often, at 83.5% and 72%, respectively, while statins (39.7%) and anti-diabetics (31.3%) were the least used. Medication use (pre-stroke, post-stroke and continuous use) was associated with a reduction in all-cause mortality risk, particularly among those under continuous use (multivariable hazard ratio, 0.52; 95% confidence interval (CI), 0.46-0.66) compared with never-users. Among ischemic stroke patients, this effect was similar (multivariable hazard ratio, 0.52; 95% CI, 0.40-0.68). No significant associations were evident among hemorrhagic stroke patients. Conclusions The risk of all-cause mortality was reduced by 48% among those with ischemic stroke under continuous use of medications. Secondary prevention should be emphasized more strongly in clinical practice. Geriatr Gerontol Int 2022; center dot center dot: center dot center dot-center dot center dot.
- Patient and Public Involvement and Engagement (PPIE): first steps in the process of the engagement in research projects in Brazil(2022) BENSENOR, I. M.; GOULART, A. C.; THOMAS, G. N.; LIP, G. Y. H.; ARASALINGAM, Ajini; BEANE, Abi; BENSENOR, Isabela M.; BROCKLEHURST, Peter; CHENG, Kar Keung; EL-BOURI, Wahbi; FENG, Mei; GREENFIELD, Sheila; GUO, Yutao; GURUPARAN, Mahesan; GUSSO, Gustavo; GOODEN, Tiffany E.; HANIFFA, Rashan; HUMPHREYS, Lindsey; JOLLY, Kate; JOWETT, Sue; KODIPPILY, Chamira; KUMARENDRAN, Balachandran; LANCASHIRE, Emma; LANE, Deirdre A.; LI, Xuewen; LIP, Gregory Y. H.; LI, Yan-guang; LOBBAN, Trudie; LOTUFO, Paulo A.; MANASEKI-HOLLAND, Semira; MOORE, David; NIRANTHARAKUMAR, Krishnarajah; OLMOS, Rodrigo D.; PASCHOAL, Elisabete; PIRASANTH, Paskaran; POWSIGA, Uruthirakumar; ROMAGNOLLI, Carla; SANTOS, Itamar S.; SHANTSILA, Alena; SHERON, Vethanayagan Antony; SHRIBAVAN, Kanesamoorthy; SZMIGIN, Isabelle; SUBASCHANDREN, Kumaran; SURENTHIRAKUMARAN, Rajendra; TAI, Meihui; THAVARAJAH, Bamini; THOMAS, G. Neil; TOIPPA, Timo; VARELLA, Ana C.; WANG, Hao; WANG, Jingya; ZHANG, Hui; ZHONG, JiaoyuePatient and Public Involvement and Engagement (PPIE) - sometimes called Community Engagement and Involvement (CEI) - comes as a big challenge but one that can be very helpful for health care professionals and stakeholders in planning better health policies for attending to the main needs of the community. PPIE involves three pillars: public involvement, public engagement, and participation. Public involvement occurs when members of the general population are actively involved in developing the research question, designing, and conducting the research. Public engagement tells people about new studies, why they are important, the impact of results, the possible implication of the main findings for the community, and the possible impact of these new findings in society, as well as, in the dissemination of knowledge to the general population. Participation is being a volunteer in the study. Our experience with PPIE, to the best of our knowledge the first initiative in Brazil, is a partnership with the University of Birmingham, the University of Liverpool, and the NIHR Global Health Group on Atrial Fibrillation (AF) Management focusing on the AF care pathway exploring the important aspects of diagnosis and treatment in the primary care system from a low-middle income area in Sao Paulo. The involvement of patients/public in the research represents a new step in the process of inclusion of all segments of our society based on patient illness and the gaps in knowledge aiming to open new horizons for continuous improvement and better acceptance of research projects.
- The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity(2022) GOULART, Alessandra C.; OLMOS, Rodrigo Diaz; SANTOS, Itamar S.; TUNES, Gisela; ALENCAR, Airlane P.; THOMAS, Neil; LIP, Gregory Y. H.; LOTUFO, Paulo A.; BENSENOR, Isabela M.Background Atrial fibrillation is a predictor of poor prognosis after stroke. Aims To evaluate atrial fibrillation and all-cause and cardiovascular mortality in a stroke cohort with low socioeconomic status, taking into consideration oral anticoagulant use during 12-year follow-up. Methods All-cause mortality was analyzed by Kaplan-Meier survival curve and Cox regression models to estimate hazard ratios and 95% confidence intervals (95% CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, oral anticoagulant use (as a time-dependent variable) and cardiovascular risk factors. Results Of 1121 ischemic stroke participants, 17.8% had atrial fibrillation. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with atrial fibrillation (531, IQR: 46-2039) vs. non-atrial fibrillation (1808, IQR: 334-3301), p-log rank < 0.0001). Over 12-year follow-up, previous atrial fibrillation was associated with increased mortality: all-cause (multivariable hazard ratios, 1.82; 95% CI: 1.43-2.31) and cardiovascular mortality (multivariable OR, 2.07; 95% CI: 1.36-3.14), but not stroke mortality. In the same multivariable models, oral anticoagulant use was inversely associated with all-cause mortality (oral anticoagulant time-dependent effect: multivariable hazard ratios, 0.47; 95% CI: 0.30-0.50, p = 0.002) and stroke mortality (oral anticoagulant time-dependent effect >= 6 months: multivariable OR, 0.09; 95% CI: 0.01-0.65, p-value = 0.02), but not cardiovascular mortality. Conclusions Among individuals with low socioeconomic status, atrial fibrillation was an independent predictor of poor survival, increasing all-cause and cardiovascular mortality risk. Long-term oral anticoagulant use was associated with a markedly reduced risk of all-cause and stroke mortality.