Research plots the African-Brazilian profiles University studies prevalence of kidney disease in Maranh達o
FEDERAL UNIVERSITY OF MARANHÃO PRESIDENT Natalino Salgado Filho COMMUNICATION ADVISOR Francisca Ester de Sá Marques PRODUCTION Sansão Hortegal REPORTER Lúcia Scotero Sansão Hortegal LAYOUT DESIGNER Fabiana França TRANSLATION Michelle Bahury PHOTOGRAPHY Edgar Rocha Sansão Hortegal Thaís Rodrigues Archives UnA-SUS/UFMA
FEDERAL UNIVERSITY OF MARANHÃO The Bacanga University City Av. dos Portugueses, 1966, Bacanga ZIP CODE 65080-805 Brazil, Maranhão, São Luís Phone: +55 (98) 3272-8020 E-mail: ascom@ufma.br Site: www.ufma.br Facebook: www.facebook.com/ufmaoficial
PREVRENAL STUDY Natalino Salgado Filho MEMBERS Ricardo de Castro Cintra Sesso Joyce Santos Lages Dyego José de Araújo Brito Alcione Miranda dos Santos João Victor Leal Salgado Giselle Andrade dos Santos Silva Francisco Monteiro Jr Francival Leite de Souza Gisele Silva Pereira Ana Luisa Bezelga Elton Jonh Freitas Santos Elisângela Milhomem dos Santos Isabela Leal Calado Natália Ribeiro Mandarino Deuzilene Pedra Viegas Raimunda Sheyla Carneiro Dias Elane Viana Hortegal Mara Silvia Pinheiro Cutrim Emanoel Catarino Serra Santos Inácio Silva Diniz Adriana Aragão Silva Eliane Nascimento Gilberto Castelo Branco Souza UNIVERSITY HOSPITAL OF THE FEDERAL UNIVERSITY OF MARANHÃO Rua Barão de Itapary, 227, Centro ZIP CODE 65020-070 Brazil, Maranhão, São Luís Phone: +55 (98) 2109-1227 E-mail: ascom@huufma.br Site: www.huufma.br
PrevRenal Study
The study is taking the nephrology to places where health care was not available to identify kidney diseases, and other comorbities
PrevRenal benefits more than one thousand maroons in Maranhão A multidisciplinary team from the Federal University conducts the largest survey on the health of African-Brazilian in the state
The real situation of the kidney disease in specific groups is still unknown in Brazil. The Prevalence of Chronic kidney disease study (PrevRenal), however, this reality begins to change. Developed by a multidisciplinary team from the Federal University of Maranhão (UFMA), the survey objects to investigate of the prevalence the Chronic kidney disease in minority groups, with ethnic and social characteristics that differentiate them from the general population. The staff is monitoring 32 maroon communities in the city of Alcântara, state of Maranhão, where 1.513 African-Brazilians live. The focus of the survey is to identify diseases such as diabetes, hypertension, kidney
problems, besides indices of nutrition and other changes. This Study is a result of actions that were based on solid proposals discussed in the 9th Conference about the Kidney disease Prevention in disadvantaged populations in South America, held in November 2011, in the city of São Luís, Maranhão. The event was attended by representatives of the Brazilian Society of Nephrology, The International Society of Nephrology and the Latin American society of Nephrology and Hypertension. A multidisciplinary team, comprised of approximately 100 professionals of the University Hospital UFMA is coordinated by Professor Natalino Salgado Filho, president of the university and
a member of the Department of Epidemiology and Prevention of Renal Disease of Brazilian Society of Nephrology (SBN), in partnership with Professor Ricardo Sesso, from the Federal University of São Paulo (Unifesp). “It is the largest healhs survey ever conducted on residents of maroon communities in Maranhão” says Professor Natalino, explaining that they were chosen because 90% of this population is considered almost pure, in other words, low level of interbreeding. For him, the search has been providing healthcare for those people who are disadvantaged because they live former slave areas, generally isolated and distant from the urban area.
An Unique opportunity “This study may serve as reference for other populations of black race and low socioeconomic status across the country,” says Professor Sesso. For him, the PrevRenal will allow a better knowledge the prevalence of these diseases in the population, identify risk factors, and possibly indicate strategies for its prevention. “Several aspects are unique because no other national studies on the prevalence of chronic kidney disease and its risk factors in our midst,” he says. In his opinion, the maroon community of Alcantara offers unique opportunity for this study and provides relevant information to the implementation of public health actions and
A multidisciplinayr team is coordenated by the professors Natalino and Sesso (from the left to the right.)
improvements in the care of these individuals. According to Natalino, beyond the scientific gain, the work allows
The survey includes educational actions, that promotes renal health.
Overview of Nephrology in Maranhão With an estimated population 657 million people and an area of 331.983 km², state of Maranhão is the second largest state in the Northeastern region and the eighth in Brazil. According to the president of the Regional SBN, Carlos Macieira, 36 nephrologists work in the state, treating currently 2,025 patients on dialysis. Besides the university hospital, five other public hospitals treat people with kidney problems in the city of São Louis and three in the countrysides. There are also seven dialysis clinics.
“The first hemodialysis machine came to São Luís in 1978, with the effort of nephrologists renowned who were part of the pioneering installation of nephrology services in the state, which is now a reference on renal replacement therapy,” says Professor Natalino. According to him, one of the great achievements of this service in Maranhão was the implementation of Nephrology at the University Hospital, which since March, 2000 performs kidney transplants. Since then, he says, almost 500 procedures have been performed in the state.
researchers to get in contact to an unknown reality, assess the impacts of these social peculiarities in the process of evolution of renal disease. “The Study is taking nephrology to places where healthcare was not available before. This is already a great achievement,” says the professor. The project, which began in 2011, has the participation of nephrologists, cardiologists, nutritionists, nurses, biochemists, physiotherapists, psychologists, occupational therapists and social workers, as well as undergraduate students healthcare. After an extensive discussion of the study, the objectives and the methodology to be employed were well defined. A clinical laboratory and physical activity assessment through questionnaires, interviews and home collection of materials, among others, began. Dived into three phases. Firstly, the patients underwent questionnaires and clinical interviews. Secondly, biological specimen collections were performed, and after that, the samples were taken to the reference laboratory.
Biological Sample Collection
lack of information about on the topic researched by the people.Moreover, it is an area of much conflict for possession of land, due to the Alcantara Launch Center facility - the aerospace base of the Brazilian Air Force. More than one thousand Maroons who were benefited by this project, had access to clinical, by this nutritional and laboratory evaluation, with Patients do image exams measurements of creatinine, cystatin C, albuminuria and Thirdly, the patients who pre urinary sodium, among others, sented either clinical or laboratory in addition to imaging studies. alterations were submitted to The actions also included imaging exams and a second blood educational activities focused collection in order to confirm the on promoting kidney health, presence of renal disease and other involving the entire population commorbities. of the related communities. To ensure compliance of the Moreover, this research maroon communities, the team will result in several scientific must overcome many challenges, papers and doctorate degrees starting with the problems of with in turn will benefit the access, since the professionals local nephrology service and have to travel by foot, motorcycle the Federal University or boat. Another difficulty is the of Maranhão.
Cultural Heritage According to the Center for Black Culture of Maranhão, there are 527 maroon communities in the state which are distributed in 134 cities, including Alcantara, located in the countryside of this city municipalities - 22 miles from the capital of Maranhão. According to the Social Network for Justice and Human Rights, around 19 000 habitants live in the region, mostly descendants of the Maroons. In 1948, due to its historical and cultural wealth, the Alcantara was considered Brazilian cultural heritage.
To ensure compliance with the maroon communities, the team must overcome many challenges
Curiosities.. To develop the Maroon project, coordinated by Professor Natalino Salgado Filho, conducted a survey with INCRA for information on the remaining 152 communities inhabiting the region, a later number 154 then upgraded to the Palmares Foundation. 3,279 families were registered and identified 13,116 inhabitants in the survey along with associations related to maroon communities. In the field, the multidisciplinary team made a clinical laboratory survey to check diabetes and hypertension participants. Imaging tests and laboratory reassessment for reaffirmation of the data were also made. All diagnosed participants are being monitored and, in some cases, are being brought from the communities in order to obtain more careful examinations in the university hospital. The team’s intent is to follow these patients until the final step to verify if the designed hypotheses have some validity. In this research, the Federal University of Maranhão is not alone. Besides Professor Natalino Salgado, the project is also being conducted in partnership with the Federal University of São Paulo, whose coordinator is Professor Ricardo Sesso. Thus, the research should result in four doctoral theses; five master dissertations, and three researchers from CNPq, who are working on collecting material on the various visited communities.
Multidisciplinary project of Nephrology qualifies more than a thousand professionals Currently, there are 31 million patients with chronic kidney disease (CKD), which constitutes a total of 16.8 percent of Brazil’s population. These data portray the increased number of people with the disease related to a lower quantity of nephrologists. From the observation that in Brazil, there are more than one hundred thousand patients on dialysis, there is still a huge contingent of people in the waiting line Therefore a concomitant excessive drug spending, and a very high hospitalar cost, the country spends more than two billion in remedies for the treatment of renal diseases, so there is the need for a campaign prevention of renal diseases, due to the expenses that have been done with this kind of disease. Thus, it was created the Nephrology Center in Maranhao, a project that works with a multidisciplinary team focused on the prevention of kidney disease that offers all the necessary guidance to patients with an
educational policy that works primarily in the area of disease prevention kidney. In Brazil, there are few universities with an equal structure to the University Hospital of Federal University of Maranhão (HUUFMA), in which there is a range of action approaches and treatment which is composed of a multidisciplinary team, and with a very welcoming project, which becomes a reference to Brazil. Based on this information, there is a decline in the number of nephrologists, since the number of people with CKD has increased. Thus, it was necessary to create the “Qualification Project in Multidisciplinary Nephrology,” which will run on network and in partnership with other universities, coordinated by the Open University of the Unified Health System (SUS-UnA / UFMA), in which the University Federal of Maranhão will guide this study managing the project. There will be over a thousand top-level professionals from
various areas of health in Brazil. “We will have other training and instructional courses. Later all materials will be available so that any healthcare professional can have access through applications created by the UnA-SUS / UFMA”, explains the project coordinator, Natalino Salgado, further emphasizing the active participation of the department of epidemiology and prevention kidney disease of the Brazilian Society of Nephrology (SBN), which always helps, and creates conditions for projects like this can be developed. The Specialization Course in Multidisciplinary Nephrology is funded by the Department of Health Care - SAS Ministry of Health, in partnership with the Open University of SUS (UNASUS), the Ministry of Health with the Brazilian Society of Nephrology (SBN) and will be offered by the Federal University of Maranhão (UFMA). The activities proposed a large-scale training, in the form of
distance education (DE) - a democratic way to provide knowledge to professionals even in remote areas - with at least three mandatory personal moments, which will be informed at the beginning of the course. The Qualification Project uses several innovative features which are important tools for education and learning, which prepares qualified professionals and UnASUS / UFMA has the honor the reinvent and apply many of these projects. The project will also offer self-instructional courses (without the mediation of a tutor), and will have multimedia features such as videos, animations, graphics, illustrations, games, cartoons and podcasts (audio texts). The modules will be also available in the form of applications UnA-SUS / UFMA that can be downloaded on Google Play.The creation of the course, held by Agreement of Cooperation between the Ministry of Health and the Federal University of Maranhão (UFMA), emerged from the “Prevalence of Chronic Kidney Disease Study (PREVRENAL)”. On average, there is a per capita increase of 10 per cent per annum of renal disease. In 2000, the country had 42,695 million of patients on dialysis, whereas in 2011 this number reached 91,314 million. “These data predict a population
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of 190,755 million of people, among them 20,590 million would be elderly aged 60 years or more The perspective is that in 2025 we will have the sixth oldest population of the planet”, said the nephrologist, to show the progress of the disease if some steps are not taken. In this context, the incidence rate is higher in the range of 19 to 64, which corresponds to 66.9 percent of a population of 33,555 million of people. Due to the increasing prevalence of Chromic Kidney Disease, there was a need to create the Specialization Course in Multidisciplinary Nephrology, in order to qualify health professionals in this field to meeting demand.
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BACABAL
20
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Inaugural Speech of Specialization Course in Multidisciplinary Nefrology
The Prevalence of Chronic Kidney Disease Study - PrevRenal
Pictures
PRESIDENT DUTRA UNIVERSITY HOSPITAL FEDERAL UNIVERSITY OF MARANHÃO Rua Barão de Itapary, 227, Centro ZIP CODE 65020-070 Brazil, Maranhão, São Luís Phone: +55 (98) 2109-1227 E-mail: ascom@huufma.br Site: www.huufma.br
The Brazilian Open University of Unified Health System Rua Viana Vaz, Nº 41, Centro ZIP CODE: 65020-660 Brazil, Maranhão, São Luís +55 (98) 3272-9633 unasusma@gmail.com l www.unasus.ufma.br