Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total

Detalhes bibliográficos
Autor(a) principal: Santos, Suzane Cristina
Data de Publicação: 2018
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações do UNICENTRO
Texto Completo: http://tede.unicentro.br:8080/jspui/handle/jspui/1557
Resumo: Introduction: The social inequalities present in our society cause an evident inequality in health access. Thus, the health and illness process should consider the cultural context in which people are inserted, as well as the several social risk factors that influence this process, such as lifestyle and behavior. In this perspective we can observe such influence in several diseases, including thyroid diseases. In cases of goiter, benign thyroid disease that has primary causes iodine deficiency, most of the regions that present a greater iodine deficiency are poor regions that have difficulties of access to care. Malignant thyroid disease may also present clinic differences related to socioeconomic status, such as worse survival, tumors treatment in advanced stages, and greater presence of malignant disease in individuals with low socioeconomic status. Objective: To verify the influence of the inequalities in the health access in the clinical and histopathological presentation of the benign and malignant thyroid diseases at the time of treatment in patients undergoing total thyroidectomy in Guarapuava city. Methodology: This was a cross-sectional observational study. We examined the records of patients undergoing total thyroidectomy at a head and neck surgery service from 2003 to 2017. Demographic variables included age, sex, marital status, and health insurance type. The clinical variables included whole thyroid volume estimated by ultrasonography, thyroid disease type, pathological diagnosis, post- surgical specimens volume and weight, TNM and clinical staging in cases of malignant disease. The sample was divided into two groups, based on health insurance type, patients attended by SUS and patients who had health insurance or private care. Data was considered non-parametric, it were presented in absolute and relative frequency distribution, or mean±SD or median (CI). To analyze the data we use the tests of Shapiro-Wilk, Kolmogorov-Smirnov, Chi-square, Mann- Whitney and Kruskal-Wallis. The level of significance was p<0.05. Results: 315 patients were identified, 104 (33.02%) belonged to SUS and 211 (66.98%) private care/health insurance. Between the two groups, the whole gland volume (p<0.001) and the surgical specimen weight (p<0.001) were significantly higher in SUS patients. In malignant diseases, being a SUS patient had an association with a greater presence of metastatic deposit (p=0.030). The thyroid volume estimated by ultrasonography was lower in patients younger than 45 years, in women and in malignant diseases (p<0.001). Patients younger than 45 years had a smaller surgical specimen volume than those aged 45 years or older (p<0.001). While, the surgical specimen weight was lower in patients younger than 45 years, in patients with private health insurance (p<0.001), and in malignant diseases (p<0.049). Conclusion: Inequalities in health access may influence the clinical presentation of benign and malignant thyroid diseases at the time of treatment, mainly in relation to the whole thyroid volume, thyroid weight and presence of metastatic deposit. The variables age, sex, and pathological diagnosis influence thyroid volume and weight.
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spelling Figueiredo, David Livingstone Alveshttp://lattes.cnpq.br/8867251982236137064.636.629-76http://lattes.cnpq.br/1515494445966252Santos, Suzane Cristina2021-04-22T18:50:21Z2018-02-19Santos, Suzane Cristina. Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total. 2018. 69 f. Dissertação (Programa de Pós-Graduação em Desenvolvimento Comunitário - Mestrado Interdisciplinar) - Universidade Estadual do Centro-Oeste, Irati-PR.http://tede.unicentro.br:8080/jspui/handle/jspui/1557Introduction: The social inequalities present in our society cause an evident inequality in health access. Thus, the health and illness process should consider the cultural context in which people are inserted, as well as the several social risk factors that influence this process, such as lifestyle and behavior. In this perspective we can observe such influence in several diseases, including thyroid diseases. In cases of goiter, benign thyroid disease that has primary causes iodine deficiency, most of the regions that present a greater iodine deficiency are poor regions that have difficulties of access to care. Malignant thyroid disease may also present clinic differences related to socioeconomic status, such as worse survival, tumors treatment in advanced stages, and greater presence of malignant disease in individuals with low socioeconomic status. Objective: To verify the influence of the inequalities in the health access in the clinical and histopathological presentation of the benign and malignant thyroid diseases at the time of treatment in patients undergoing total thyroidectomy in Guarapuava city. Methodology: This was a cross-sectional observational study. We examined the records of patients undergoing total thyroidectomy at a head and neck surgery service from 2003 to 2017. Demographic variables included age, sex, marital status, and health insurance type. The clinical variables included whole thyroid volume estimated by ultrasonography, thyroid disease type, pathological diagnosis, post- surgical specimens volume and weight, TNM and clinical staging in cases of malignant disease. The sample was divided into two groups, based on health insurance type, patients attended by SUS and patients who had health insurance or private care. Data was considered non-parametric, it were presented in absolute and relative frequency distribution, or mean±SD or median (CI). To analyze the data we use the tests of Shapiro-Wilk, Kolmogorov-Smirnov, Chi-square, Mann- Whitney and Kruskal-Wallis. The level of significance was p<0.05. Results: 315 patients were identified, 104 (33.02%) belonged to SUS and 211 (66.98%) private care/health insurance. Between the two groups, the whole gland volume (p<0.001) and the surgical specimen weight (p<0.001) were significantly higher in SUS patients. In malignant diseases, being a SUS patient had an association with a greater presence of metastatic deposit (p=0.030). The thyroid volume estimated by ultrasonography was lower in patients younger than 45 years, in women and in malignant diseases (p<0.001). Patients younger than 45 years had a smaller surgical specimen volume than those aged 45 years or older (p<0.001). While, the surgical specimen weight was lower in patients younger than 45 years, in patients with private health insurance (p<0.001), and in malignant diseases (p<0.049). Conclusion: Inequalities in health access may influence the clinical presentation of benign and malignant thyroid diseases at the time of treatment, mainly in relation to the whole thyroid volume, thyroid weight and presence of metastatic deposit. The variables age, sex, and pathological diagnosis influence thyroid volume and weight.Introdução: As desigualdades sociais presentes em nossa sociedade ocasionam uma evidente desigualdade em saúde. Assim, o processo de saúde e doença deve ser pensado considerando o contexto cultural em que se está inserido, bem como os diversos fatores de risco sociais influenciadores desse processo, tais como estilo de vida e de comportamento. Nesse panorama podemos observar tal influência em diversas doenças, dentre elas as neoplasias tireoidianas. Nos casos de bócio, neoplasia benigna da tireoide que possui como principal causa a deficiência de iodo, grande parte das regiões que apresentam uma carência maior de iodo, tratam-se de regiões mais pobres e com maior dificuldade de acesso a saúde. As neoplasias malignas de tireoide também podem apresentar diferenças clínicas relacionadas a fatores socioeconômicos, como pior sobrevida, tratamento de tumores em estágios mais avançados, e maior presença de doença maligna em indivíduos com piores condições socioeconômicas. Objetivo: Verificar a influência das desigualdades no acesso à saúde na apresentação clínica e histopatológica das neoplasias tireoidianas benignas e malignas no momento do tratamento em pacientes submetidos à tireoidectomia total na cidade de Guarapuava, PR. Metodologia: Trata-se de um estudo analítico observacional transversal, no qual foi realizada a revisão de prontuários de pacientes submetidos à tireoidectomia total de um serviço de cirurgia de cabeça e pescoço do município de Guarapuava/PR entre os anos de 2003 e 2017. As informações demográficas coletadas incluíram idade, sexo, estado civil e seguro de saúde. As variáveis clínicas avaliadas foram o volume total da tireoide estimado pela ultrassonografia, tipo de doença da tireoide, diagnóstico patológico, volume e peso dos espécimes pós-cirúrgicos, e o estadiamento patológico (TNM) e clínico nos casos de neoplasias. A amostra foi dividida em dois grupos, baseados no tipo de seguro de saúde, pacientes atendidos pelo SUS e pacientes que possuíam algum plano de saúde ou realizaram atendimento particular. Os dados, considerados não paramétricos, foram apresentados em distribuição de frequência absoluta e relativa, ou media e desvio padrão ou mediana e seus intervalos de confiança. Para as análises foram utilizados os testes de Shapiro-Wilk, Kolmogorov-Smirnov, Qui-quadrado, Mann-Whitney e Kruskal-Wallis. O nível de significância foi p<0,05. Resultados: A amostra foi composta por 315 pessoas, sendo 104 (33,02%) pertencentes ao SUS e 211 particular/plano de saúde (66,98%). Na comparação entre os dois grupos o volume total da glândula (p<0,001) e o peso do espécime cirúrgico (p<0,001) foram significativamente maiores nos pacientes do SUS. Nas doenças malignas, ser paciente do SUS teve associação com maior presença de metástases a distância (p=0,030). O volume da glândula estimado pela ultrassonografia foi menor em pacientes com menos de 45 anos, nas mulheres e nas neoplasias malignas (p<0,001). Pacientes com menos de 45 anos apresentaram volume do espécime cirúrgico menor do que aqueles com 45 anos ou mais (p<0,001). Enquanto o peso do espécime cirúrgico foi menor em pacientes com menos de 45 anos, em pacientes com seguros privados de saúde (p<0,001), e nas neoplasias malignas (p<0,049). Conclusão: As desigualdades no acesso a saúde podem influenciar na apresentação clínica das neoplasias benignas e malignas da tireoide no momento do tratamento, principalmente em relação ao volume total, peso da tireoide e presença de metástases à distância. As variáveis idade, sexo, e diagnóstico patológico influenciam no volume e peso da tireoide.Submitted by Fabiano Jucá (fjuca@unicentro.br) on 2021-04-22T18:50:21Z No. of bitstreams: 1 Dissertação Suzane Cristina Santos.pdf: 783888 bytes, checksum: 2f02a6a841735bd5fa2e0cadd4b4c2b6 (MD5)Made available in DSpace on 2021-04-22T18:50:21Z (GMT). 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dc.title.por.fl_str_mv Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total
title Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total
spellingShingle Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total
Santos, Suzane Cristina
Acesso à saúde
Tireoide
Neoplasias da Tireoide
Cirurgia da Tireoide
Health access
Thyroid
Malignant and benign thyroid disease
Thyroid surgery
CIENCIAS HUMANAS
CIENCIAS SOCIAIS APLICADAS
title_short Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total
title_full Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total
title_fullStr Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total
title_full_unstemmed Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total
title_sort Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total
author Santos, Suzane Cristina
author_facet Santos, Suzane Cristina
author_role author
dc.contributor.advisor1.fl_str_mv Figueiredo, David Livingstone Alves
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/8867251982236137
dc.contributor.authorID.fl_str_mv 064.636.629-76
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/1515494445966252
dc.contributor.author.fl_str_mv Santos, Suzane Cristina
contributor_str_mv Figueiredo, David Livingstone Alves
dc.subject.por.fl_str_mv Acesso à saúde
Tireoide
Neoplasias da Tireoide
Cirurgia da Tireoide
topic Acesso à saúde
Tireoide
Neoplasias da Tireoide
Cirurgia da Tireoide
Health access
Thyroid
Malignant and benign thyroid disease
Thyroid surgery
CIENCIAS HUMANAS
CIENCIAS SOCIAIS APLICADAS
dc.subject.eng.fl_str_mv Health access
Thyroid
Malignant and benign thyroid disease
Thyroid surgery
dc.subject.cnpq.fl_str_mv CIENCIAS HUMANAS
CIENCIAS SOCIAIS APLICADAS
description Introduction: The social inequalities present in our society cause an evident inequality in health access. Thus, the health and illness process should consider the cultural context in which people are inserted, as well as the several social risk factors that influence this process, such as lifestyle and behavior. In this perspective we can observe such influence in several diseases, including thyroid diseases. In cases of goiter, benign thyroid disease that has primary causes iodine deficiency, most of the regions that present a greater iodine deficiency are poor regions that have difficulties of access to care. Malignant thyroid disease may also present clinic differences related to socioeconomic status, such as worse survival, tumors treatment in advanced stages, and greater presence of malignant disease in individuals with low socioeconomic status. Objective: To verify the influence of the inequalities in the health access in the clinical and histopathological presentation of the benign and malignant thyroid diseases at the time of treatment in patients undergoing total thyroidectomy in Guarapuava city. Methodology: This was a cross-sectional observational study. We examined the records of patients undergoing total thyroidectomy at a head and neck surgery service from 2003 to 2017. Demographic variables included age, sex, marital status, and health insurance type. The clinical variables included whole thyroid volume estimated by ultrasonography, thyroid disease type, pathological diagnosis, post- surgical specimens volume and weight, TNM and clinical staging in cases of malignant disease. The sample was divided into two groups, based on health insurance type, patients attended by SUS and patients who had health insurance or private care. Data was considered non-parametric, it were presented in absolute and relative frequency distribution, or mean±SD or median (CI). To analyze the data we use the tests of Shapiro-Wilk, Kolmogorov-Smirnov, Chi-square, Mann- Whitney and Kruskal-Wallis. The level of significance was p<0.05. Results: 315 patients were identified, 104 (33.02%) belonged to SUS and 211 (66.98%) private care/health insurance. Between the two groups, the whole gland volume (p<0.001) and the surgical specimen weight (p<0.001) were significantly higher in SUS patients. In malignant diseases, being a SUS patient had an association with a greater presence of metastatic deposit (p=0.030). The thyroid volume estimated by ultrasonography was lower in patients younger than 45 years, in women and in malignant diseases (p<0.001). Patients younger than 45 years had a smaller surgical specimen volume than those aged 45 years or older (p<0.001). While, the surgical specimen weight was lower in patients younger than 45 years, in patients with private health insurance (p<0.001), and in malignant diseases (p<0.049). Conclusion: Inequalities in health access may influence the clinical presentation of benign and malignant thyroid diseases at the time of treatment, mainly in relation to the whole thyroid volume, thyroid weight and presence of metastatic deposit. The variables age, sex, and pathological diagnosis influence thyroid volume and weight.
publishDate 2018
dc.date.issued.fl_str_mv 2018-02-19
dc.date.accessioned.fl_str_mv 2021-04-22T18:50:21Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
status_str publishedVersion
dc.identifier.citation.fl_str_mv Santos, Suzane Cristina. Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total. 2018. 69 f. Dissertação (Programa de Pós-Graduação em Desenvolvimento Comunitário - Mestrado Interdisciplinar) - Universidade Estadual do Centro-Oeste, Irati-PR.
dc.identifier.uri.fl_str_mv http://tede.unicentro.br:8080/jspui/handle/jspui/1557
identifier_str_mv Santos, Suzane Cristina. Desigualdade no acesso à saúde: sua influência na apresentação clínica das neoplasias benignas e malignas da tireoide em pacientes submetidos à tireoidectomia total. 2018. 69 f. Dissertação (Programa de Pós-Graduação em Desenvolvimento Comunitário - Mestrado Interdisciplinar) - Universidade Estadual do Centro-Oeste, Irati-PR.
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