Private Systems Research Articles

Physical Activity Habits Among Physicians: Data From the Athens Medical Association.

Physicians' exercise habits vary across different medical specialties and health service infrastructure. We assessed physicians' exercise performance according to the recommendations of the 2020 European Society of Cardiology Guidelines. This cross-sectional study comprised 742 physicians of the Athens Medical Association (AMA), Greece. Utilizing a self-administered questionnaire, physicians' exercise habits, demographics, specialty, and infrastructure [Hellenic National Health care System (HNHS) or Private System (PS)] were assessed. Subjects were categorized: Moderate-intensity weekly exercise ≥150min. (Group A); Moderate-intensity weekly exercise <150 min. (Group B). 53.4% of AMA members met the recommended exercise criteria, averaging 240 ± 285 min./week. Significant differences were noted between Group A and B in male sex (58.3% vs 43.1%, P < 0.001), Body Mass Index (24.7 ± 3.8kg/m2 vs 26.2 ± 4.7kg/m2, P < 0.001), Smoking (17.4% vs 23.5%, P = 0.04), Diabetes Mellitus (6.6% vs 11.8%, P = 0.01), and activity monitoring wearables usage (45.2% vs 29.8%, P < 0.001). Significantly more doctors in the PS categorized in Group A (P = 0.008). After adjustment for confounders, HNHS reported 33% decreased odds of achieving the exercise recommendations compared to PS (Odds Ratio: 0.676; 95% CI: 0.484-0.943, P = 0.03). Several factors affect adherence of AMA members to exercise goals. HNHS AMA doctors are less adherent to exercise recommendations, emphasizing the need to strengthen prevention strategies.

Influence of access on survival of renal cancer in a Brazilian center.

644 Background: The introduction of tyrosine kinase inhibitors (TKI) and recently immunotherapy has brought major survival benefits for metastatic renal cancer (mRCC) patients (pts). In Brazil, there is no approved 2nd line treatment for mRCC in the Public Health System (PHS). Our center is unique, because it provides care for both PHS and Private System (PrS) population, enabling us to make the comparison of overall survival (OS) of these pts. Methods: We retrospectively reviewed medical records of all mRCC pts treated with 1st line TKI at our service from 2007 to 2018. Categorial variables were compared by Fisher’s exact test and continuous by Mann–Whitney. Survival was estimated by Kaplan-Maier method, prognostic factors adjusted by Cox regression model. Results: 171 pts were eligible, 37 (21.6%) PHS and 134 (78.4%) PrS pts. Between the two groups, there was no differences in age, gender, number and sites of metastasis (mets). PHS pts had worst ECOG (≥2, in 35.1 vs 13.5%, p .007), a trend towards more poor IMDC risk (IMDC favorable 16.2 vs 26.6%, intermediate 51.4 vs 57%, poor 32.4 vs 16.4%, p.09), had less nephrectomies (73 vs 92.5%, p.008) and more non clear cell histology (32.4 vs 12.7%, p.01). Median lines of therapy were 1 for PHS vs 2 for PrS pts (p.03). Sunitinib was the 1st line agent for 91.9 vs 67.2%, and pazopanib 8.1 vs 29.9%, of the PHS and PrS pts, respectively. Median time from diagnosis of mets to treatment start was 2.29 vs 1.79 m (p.59). Median OS was 16.5 vs 26.5 m (p.0002) and progression free survival, 8.4 vs 11 m (p.01), for the PHS vs PrS. On multivariate analysis, after adjusting for factors that were present before the beginning of treatment and were statistically significant for OS in the univariate model, PHS pts still had higher risk of death (HR 1.85, IC 95 1.2-2.9, p.01), probably due to having received fewer lines of therapy (≥2 lines of therapy vs 1, HR 0.51, IC95 0.4-0.7, p .001). Conclusions: Brazilian PHS pts had significant worse OS compared to PrS pts, in part due to less access to drugs. Access to cancer drugs is a challenge worldwide, and in Brazil effort has to be done to change this reality.

Abstract P4-10-15: Impact of delay in breast cancer diagnosis and treatment according to health insurance status in southwest Brazil and Houston, Texas

Abstract Background: Access to medical care vary across the world and is related to different health systems with an impact in recurrence.Objective: To evaluate disparities in breast cancer(BC) diagnosis and treatment between public and private services in southwest Brazil and at two public safety net hospitals in Houston, Texas.Methods: Women diagnosed with BC stages I-III between 2009 to 2011, and treated at the four hospitals in Brazil and two health centers in US were included. All statistical analyses were performed in R studio software, and p&amp;lt;0.05 was considered significant.Results: 1245 women were included: 967 from public health system (PHS) (20.3% from Houston, Texas) and 274 from private system(PS). Recurrence rate was higher in PHS (14.6% vs. 2.6%, p&amp;lt;0.001) Table 1. Clinical and demographic characteristics of the patientsCharacteristicsPublic (%), n=967Private (%), n=274pDiscovery of BC By patient530 (54.8)92 (33.5) Routine exam87 (9)109 (39.8) Screening mammography270 (27.9)23 (8.4) Other80 (8.3)50 (18.3)&amp;lt;0.001Initial treatment Surgery687 (71)241 (88) Neo-adjuvant chemotherapy224 (23.2)27 (9.8) Neo-adjuvant hormone therapy23 (2.3)27 (9.8) Not available33 (3.4)3 (1.1)&amp;lt;0.001Clinical Stage I293 (30.3)113 (41.2) II342 (35.4)52 (19) III271 (28)15 (5.5) Unknown61 (6.3)94 (34.3)&amp;lt;0.001Subtype HR+/HER2 -561 (58)192 (70.1) HR-/HER2+108 (11.1)29 (10.6) HR-/HER2+76 (7.9)14 (5.1) Triple negative149 (15.4)28 (10.2) Unknown73 (7.6)11 (4)0.012Symptomatic at Diagnosis Yes591 (61.1)100 (36.5) No306 (31.6)97 (35.4) Unknown70 (7.2)77 (28.1)&amp;lt;0.001Recurencen=772n=146 No719 (74.4)193 (70.4) Yes142 (14.6)7 (2.6) Unknown106 (11)74 (27)&amp;lt;0.001 . Considering the interval in weeks: symptoms to diagnosis, diagnosis to first treatment (either surgery or neoadjuvant chemotherapy), diagnosis to first systemic treatment, diagnosis to surgical treatment and diagnosis to radiotherapy were longer in public patients (24.1 vs. 8.7; 11.1 vs. 3.5; 18.6 vs. 9.8; 16.9 vs. 5.6; 51.4 vs. 26.1; p&amp;lt;0.001). Table 2. Delay disparities between public and private health system PublicPrivatepSymptoms to diagnosis Number of patients575146 Time (weeks)24.1 (0.4-104.9)8.7 (0.0-43.7)&amp;lt;0.001Diagnosis to first treatment Number of patients663180 Time (weeks)11.1 (2.0-31.5)3.5 (0.0-11.0)&amp;lt;0.001Diagnosis to first systemic treatment Number of patients526106 Time (weeks)18.6 (2.6-44.7)9.8 (1.9-29.3)&amp;lt;0.001Diagnosis to surgical treatment Number of patients657178 Time (weeks)16.9 (3.4-45.6)5.6 (0.0-32.9)&amp;lt;0.001Diagnosis to radiotherapy Number of patients465127 Time (weeks)51.4 (18.7-88.4)26.1 (5.6-66.4)&amp;lt;0.001 In multivariate analysis, PHS (HR 1.72; 95% CI 1.34-1.88; p adj=0.003), presence of symptoms (HR 2.29; 95% CI 1.39-3.78; p adj=0.001), clinical stage III (HR 1.62; 95% CI 1.35-1.93; p adj&amp;lt;0.001), and triple negativity and HER2neu positivity (1.18; 95% CI 1.03-1.35; p adj=0.021) were all associated with a higher recurrence rate.Conclusions: There were significant disparities between PHS and PS. Women in the PHS presented higher rates of recurrence, advanced clinical stages at diagnosis, symptoms and more aggressive subtypes by IHC. additionally, the interval between symptoms to diagnosis and diagnosis to treatments was longer in PHS. Citation Format: NematiShafaee M, Natal RA, Ramalho S, Dória MT, Conz L, Cabello V, Pavanello M, Mano MS, Linck RDM, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Bondy ML, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, Cabello C. Impact of delay in breast cancer diagnosis and treatment according to health insurance status in southwest Brazil and Houston, Texas [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-15.

Constructing ID-based cryptographic technique for IFP and GDLP based cryptosystem

Shamir developed an idea of the ID-based cryptographic technique in 1984 [1]. In its place of making and issuing a public key for each user, the ID-based cryptographic scheme authorized each user to choose his name or network address etc. as his public key. The public-key verification is so easy and direct by using the advantage of public key cryptosystem. In this study, we proposed the new ID-based cryptographic scheme for applying public-key cryptosystem based on Integer Factorization Problem (IFP) and Generalized Discrete Logarithm Problem (GDLP). The main benefit of the ID-based cryptographic technique based on our proposed scheme over other published ID-based cryptosystems in the literature, is that the number of users can be extended to a * L users without undignified the system's security even when users plan, where L and a are the system's private keys and factors in N – 1 respectively.

66. Field Research in EMS: Who is Doing the Work?

Purpose: To determine what types of EMS systems (public vs. private) are contributing to the peer reviewed field research in EMS and what type of research is being done by these agencies.Methods: A Medline literature search was conducted of all peer reviewed journals using the search terms: EMS, emergency medical services, EMT, paramedic, and ambulance. Studies published between 1976 and 1995 meeting these criteria were reviewed and classified as field or non-field studies. Studies were classified as field studies if they evaluated clinical outcomes or overall EMS system structure and performance. The type of EMS system in which the study was conducted was classified as: public (PB), private (PR), or a mixture of public and private agencies (PP). If the type of system was not evident in the paper, the primary author or EMS agency was contacted by phone. The primary affiliation of the first author was classified as being with: an educational institution, hospital, government agency, or EMS agency. Each study was also classified as being primarily clinical or evaluating EMS system structure. Review articles, editorials, and meta-analyses were excluded as were studies in which critical data elements could not be verified. Fischer's exact test was used for statistical analysis.Results: A total of 365 studies were evaluated with 66 non-field studies being excluded from analysis. 75 studies did not meet inclusionary criteria. This left 224 studies for analysis. PB systems accounted for 167 (74.5%) of field studies, with PP 44 (19.6%) and PR 13 (5.8%). Clinical studies were more commonly done by PB systems (72.5%) when compared to PR systems (38.5%), p = 0.02. System structure studies accounted for the majority of studies done by PR systems (61.5%). An affiliation with an educational institution such as a university occurred in 61.2% of the studies. The number of field studies done by PB systems has increased steadily over the last 10 years while field studies published by PR and PP systems has remained at a low level, with none published from 1992–1994.

No. 1 ESS ADF: Teletypewriter Stations and Transmission Facilities

A solid-state electronic station controller, small enough to be housed within Model 33, 35 and 37 teletypewriters, administers station on-line procedures. To realize automatic message reception and transmission at the station, the controller samples all traffic exchanged between the line and the station teletypewriter, detects message-and device-control characters and generates and detects station-identity codes. In addition, the controller monitors the status of the station teletypewriter and provides appropriate alarms which are displayed on an attendant unit. Stations are linked to the No. 1 ESS ADF office via the Bell System's private line telegraph network. New ac and dc data sets have been developed to accommodate speeds up to 300 bauds with lower distortion and crosstalk generation than previously attainable with former transmission apparatus.

Escola comunitária: a encruzilhada entre a favela e a cidade

Este artigo descreve e analisa um tipo de escola desatrelada do Poder Público e da rede privada, localizada em áreas de extrema pobreza, construída e administrada pelos moradores dessas áreas. É a escola comunitária, cuja história oferece a possibilidade para se refletir como a população pobre enfrenta e resolve os problemas da falta de acesso de seus filhos à instrução formal. Ao longo do trabalho, descrevem- se e analisam-se também as mutações que se produzem na cultura de um grupo social, ao experimentar o jogo de forças presente em sua interação com a cidade, da qual se encontra separado. A existência dessa modalidade escolar constitui uma denúncia da omissão do Estado em relação ao ensino público, mas também faz emergir a ação coletiva, que inclui a demanda por escolas e outros serviços, por meio dos quais a população tenta interagir com a cidade.