New approaches to second-degree burn healing: Polyvinyl alcohol membrane loaded to arnica combined to laser therapy

Second-degree burns require greater care, as the damage is more extensive and worrisome and the use of a biomaterial can help in the cell repair process, with better planning, low cost, and better accessibility. Arnica has anti-inflammatory and analgesic properties in skin lesions treatments and laser therapy is another therapeutic alternative for burns. Evaluate the effects of arnica incorporated into PVA associated or not with low intensity laser on burns in rats. PVA and PVA with arnica (PVA+A) were obtained and characterized physicochemically. Through in vivo studies, the effects of PVA and PVA+A with or without the application of laser on the lesions allowed histological and immunohistochemical analyzes. PVA+A was biocompatible and with sustained release of the active, being a promising pharmacological tool and confirmed that laser therapy was effective in accelerating the healing process, due to its potential biomodulator, improving inflammatory aspects, promoting rapid healing in skin lesions.

Testing, Inequities and Vulnerability of Adolescents to Sexually Transmitted Infections

Sexually transmitted infections (STIs) should form part of the comprehensive healthcare agenda for adolescents and young people (A&Y) and testing plays a strategic role in STI prevention. However, little attention has been paid to the social and programmatic obstacles to this practice among A&Y. The aim of this study is to describe the prevalence of testing for syphilis and HIV reported by a group of A&Y, analyzing its relationship with variables potentially indicative of inequities related to vulnerability to STIs. This was a cross-sectional survey applied to students at public high schools in three cities in the state of São Paulo, Brazil. The responses of 369 young people who reported having started sexual life were analyzed. The analysis included description of the frequencies of demographic and socioeconomic variables and their associations with testing for syphilis and HIV through the chi-square test. The concentration index (CI) was also calculated, with construction of the respective concentration curve for the associated variables. Positive associations were found between occurrence of testing and living in homes with up to three inhabitants, living in a marital situation with a regular or committed partnership, previous use of primary care services and previous use of hospitals or emergency services. The concentration curve for testing STIs showed significant contributions from the associated variables. The findings indicated that situations of inequity need to be addressed in order to reduce A&Y's vulnerability to STIs.

Geographic Distribution of the Prevalence of Neurocysticercosis in the Municipality of Piedade, São Paulo

Background:

Neurocysticercosis is a globally occurring parasitosis that affects the central nervous system. The main clinical manifestation is seizures.The aim of this study was to analyze the geographic distribution of patients with seizures attending the Emergency Unit of the Piedade municipality, SP, with a diagnosis of neurocysticercosis, and to compare the association of its prevalence with age, basic sanitation and food hygiene habits between rural and urban areas.

Methods:

One hundred thirty-six patients with seizures were evaluated. The Epidemiological data of all subjects will be described.

Results:

The diagnosis of neurocysticercosis was confirmed in 24 patients, corresponding to a prevalence of 17.65%. The presence of an open sewer predominated in the rural area, while the consumption of unwashed fruits, presence of elderly people and geographic distribution were similar in the two areas.

Conclusions:

Urgent measures to raise awareness about the disease and preventive actions should be taken by world authorities.

Care seeking behavior of people with common mental disorders in São Paulo-Brazil

Background

Mental health in developing countries is a keen area for improvements. Epidemiological research in this field helps to reinforce information, generate hypothesis and guide police makers. This study intends to analyze patterns of care seeking among cases of common mental disorders (CMD) in São Paulo city in 2015.

Methods

The data is from the population-based survey ISA-Capital 2015 and the screening for common mental disorders follows the Self-reporting questionnaire (SRQ-20). The study analyses care seeking according to sociodemographic and health conditions.

Results

The prevalence of CMD was 19.7% (95% CI 18.2–21.4%). There was a higher prevalence of CMD among who sought care in last 30 days (25.4%). Among CMD cases, care seeking presented significant different prevalence ratio (PR) for: women (PR 1.13; 95% CI 1.05–1.2); age 60 years or more (PR 1.13; 95% CI 1.05–1.22) and 30–44 years (PR 1.10; 95% CI 1.01–1.2); brown skin (PR 0.92; 95% CI 0.86–0.97); single or divorced (PR 0.93; 95% CI 0.89–0.99); unemployed (PR 1.06; 95% CI 1.01–1.12); last 15 days referred morbidity (PR 1.3; 95% CI 1.2–1.34); physical disability (PR 1.11; 95% CI 1.06–1.18); and chronic disease (PR 1.15; 95% CI 1.07–1.24).

Conclusion

Identifying vulnerable groups and developing proper public health actions is important to promote equity accessibility. Analysing care seeking behavior among people with CMD is a strong contribution.

Declaração de óbito e saúde

Editorial sobre o artigo original: Drumond EF, Machado CJ, Salles PGO. Análise de confiabilidade da causa básica e associadas de morte. Rev Fac Ciênc Méd Sorocaba. 2019;21(4):X-X. DOI: 10.23925/1984-4840.2019v21i4a7

Inactive Calcified Cysts In Neurocysticercosis: Is This Actually The Case?

Neurocysticercosis is a worldwide disease that is extensively neglected. Its real gravity is not disclosed to people. Knowledge for the population in all countries must be done urgently.

[Prevalence of common mental disorders and associated factors in urban residents of São Paulo, Brazil]

Studies in developing countries report a steady increase in mental disorders, with major social and economic repercussions. The current study proposes to analyze the prevalence of common mental disorders (CMDs) and associated factors in urban residents of São Paulo, Brazil. Based on data collected in the Health Survey in São Paulo City (ISA-Capital) in 2015, the study identified the presence of CMDs using the Self-Reporting Questionnaire (SRQ-20). The association of CMDs with sociodemographic variables and health conditions was analyzed as relative frequency, corrected by the respective weights resulting from cluster sampling, estimating the prevalence and 95% confidence intervals (95%CI) and assessing the association's significance by the chi-square test, corrected by the F distribution. Prevalence of CMDs was 19.7% (95%CI: 18.2-21.4), higher in women (24.3%); persons 60 years or older (25.3%); followers of the African-Brazilian umbanda or candomblé religions (37.8%); widows/widowers (30.4%); individuals that had never attended school (31.4%); unemployed (28.3%); those with family income up to one minimum wage (28.8%); individuals that reported illness in the previous 15 days (36.9%); those with physical disabilities (21.6%); mental or intellectual disabilities (44.4%); emotional or mental problems (48.9%); headache (33.63%); and individuals with one or more chronic diseases (24.1%). The information in this study reaffirms the relevance of the prevalence of CMDs and their association with the most vulnerable social groups, corroborating the need to implement public measures in mental health.

Equidade na cobertura dos gastos com saúde pelo Sistema Único de Saúde de pessoas com indicativos de transtornos mentais comuns no município de São Paulo

RESUMO: Introdução: O objetivo deste trabalho foi verificar a equidade na cobertura/complementação dos gastos com saúde pelo Sistema Único de Saúde (SUS) de pessoas com indicativos de transtornos mentais comuns (TMC), no ano de 2008, no município de São Paulo. Métodos: Foi realizado um estudo de corte transversal a partir dos dados do Inquérito de Saúde no Município de São Paulo de 2008 (ISA-Capital 2008). Os sujeitos incluídos na pesquisa tinham 16 anos de idade ou mais e indicativos de TMC, avaliados por meio do instrumento Self-Reporting Questionnaire (SRQ-20). Foram analisados: a procura pelo SUS, a cobertura dos gastos com saúde pelo SUS e os gastos com saúde no último mês, correlacionando-os com aspectos sociodemográficos e de condições de saúde. Resultados: A procura pelo SUS foi menor entre as pessoas de cor branca, renda per capita elevada, com união estável e Ensino Superior. A cobertura pelo SUS foi menor entre as faixas etárias de 45 a 59 anos e de 60 anos ou mais, com renda per capita elevada, Ensino Médio ou Técnico e Ensino Superior. As pessoas que gastaram mais com a saúde da família foram aquelas com idade igual ou superior a 60 anos, de cor branca, renda per capita mais elevada, com união estável e Ensino Superior. Conclusões: Foi observado que o SUS atende e cobre os gastos majoritariamente daqueles com renda per capita e escolaridade mais baixas, denotando uma cobertura desigual que favorece os mais necessitados. Porém, considerando o fator idade, ficou explícita uma situação de iniquidade, pois foi constatada maior cobertura dos gastos em saúde pelo SUS para a população mais jovem.

Use, access, and equity in health care services in São Paulo, Brazil

The study analyzed how socioeconomic factors are associated with seeking, access, use, and quality of health care services in São Paulo, Brazil. Data were obtained from two household health surveys in São Paulo. We used logistic regression to analyze associations between socioeconomic factors and seeking, access, use, and quality of health care services. Access to health care services was high among those who sought it (94.91% in 2003 and 94.98% in 2008). The proportion of access to and use of health care services did not change significantly from 2003 to 2008. Use of services in the public sector was more frequent in lower socioeconomic groups. There were some socioeconomic differences in seeking health care and resolution of health problems. The study showed almost universal access to health care services, but the results suggest problems in quality of services and differences in quality experienced by lower socioeconomic groups, who mostly use the Brazilian Unified National Health System (SUS).

Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003-2008

Background

Access to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the “Smiling Brazil” Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003.

Method

Data was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to 2008 regarding socioeconomic characteristics and dental health service use were explored.

Results

Overall, dental health service use increased between 2003 and 2008 and was at both time points more common among those who had higher income, better education, better housing conditions, private health care plans and were Caucasian. Inequalities in use of dental health care did not decrease over time. Among the reasons for not seeking dental care, not having teeth and financial difficulty were more common in lower socioeconomic groups, while thinking it was unnecessary was more common in higher socioeconomic groups.

Conclusions

The Brazilian oral health policy is still in a period of expansion and seems to have contributed slightly to increased dental health service use, but has not influenced socioeconomic inequalities in the use of these services. Acquiring deeper knowledge about inequalities in dental health service use will contribute to better understanding of potential barriers to reducing them.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1928-y) contains supplementary material, which is available to authorized users.

Use of generic drugs in São Paulo city, Brazil, in 2003: a population-based study

OBJECTIVE

to analyze the use and perception of generic drugs by people with diabetes and hypertension in São Paulo City, Brazil, considering the Brazilian Generic Drug Policy.

METHODS

this was a cross-sectional study using data from a household health survey (ISA-Capital) in 2003; analysis was performed on knowledge regarding generic drugs and on the association between their use and sociodemographic and socio-economic characteristics.

RESULTS

603 people with hypertension and diabetes were included in the study, low use of generic drugs was found (33.3% and 26.3, respectively) and low cost was the major reported advantage of generic drugs (71.0% and 71.1%, respectively); there was no statistically significant difference between the use of generic medication and age, sex or schooling.

CONCLUSION

low cost and there being no difference between generic drug use and education level strengthen the importance of generic drugs for promoting equity and universal access to medication.

Access to medication in the Public Health System and equity: populational health surveys in São Paulo, Brazil

ABSTRACT: Introduction: Since 2003, the access to medication has been increasing in Brazil and particularly in São Paulo. The present study aimed to analyze the access to medication obtained in the public sector and the socioeconomic differences in this access in 2003 and 2008. Also, we explored the difference in access to medication from 2003 to 2008. Method: Data were obtained from two cross-sectional population-based household surveys from São Paulo, Brazil (ISA-Capital 2003 and ISA-Capital 2008). Concentration curve and concentration index were calculated to analyze the associations between socioeconomic factors and access to medication in the public sector. Additionally, the differences between 2003 and 2008 regarding socioeconomic characteristics and access to medication were studied. Results: Access to medication was 89.55% in 2003 and 92.99% in 2008, and the proportion of access to medication did not change in the period. Access in the public sector increased from 26.40% in 2003 to 48.55% in 2008 and there was a decrease in the concentration index between 2003 and 2008 in access to medication in the public sector. Conclusions: The findings indicate an expansion of Brazilian Unified Health System (Sistema Único de Saúde ) users, with the inclusion of people of higher socioeconomic position in the public sector. As the SUS gives more support to people of lower socioeconomic position in terms of medication provision, the SUS tends to equity. Nevertheless, universal coverage for medication and equity in access to medication in the public sector are still challenges for the Brazilian public health system.

Coverage by the public health services of medication and vaccines for the population with diabetes mellitus

This study analyzed the coverage by the public health service of expenses with medication and vaccines for the adult population of São Paulo with self-reported diabetes mellitus in 2003 and the implications for access to medicines and vaccination campaigns programs. Data were collected by the Multicenter Health Survey of São Paulo. The Unified Health System (SUS) was widely used by the population for vaccination against influenza and pneumonia and there was significant private sector participation for coverage of expenses with medication, with an estimated coverage of 38% by SUS. There were no significant differences in the prevalence of use of public services for vaccination among the categories of variables studied, suggesting a universal distribution of vaccination by the public health service. Unlike vaccinations, in 2003 the coverage of medication expenses by the public health service was recent in Brazil, which may explain the low level of coverage. An analysis of coverage of vaccination and medication expenses in diabetes mellitus population since 2003 may contribute to be the basis for policies to broaden access of the population to health services.

Agregação familiar da doença renal crônica secundária à hipertensão arterial ou diabetes mellitus: estudo caso-controle

No Brasil, a hipertensão e o diabetes mellitus tipo 2 são responsáveis por 60% dos casos de doença renal crônica terminal em terapia renal substitutiva. Estudos americanos identificaram agregação familiar da doença renal crônica, predominante em afrodescendentes. Um único estudo brasileiro observou agregação familiar entre portadores de doença renal crônica quando comparados a indivíduos internados com função renal normal. O objetivo deste artigo é avaliar se existe agregação familiar da doença renal crônica em familiares de indivíduos em terapia renal substitutiva causada por hipertensão e/ou diabetes mellitus. Estudo caso-controle tendo como casos 336 pacientes em terapia renal substitutiva portadores de diabetes mellitus ou hipertensão há pelo menos 5 anos e controles amostra pareada de indivíduos com hipertensão ou diabetes mellitus e função renal normal (n = 389). Os indivíduos em terapia renal substitutiva (casos) apresentaram razão de chance de 2,35 (IC95% 1,42-3,89; p < 0,001) versus controles de terem familiares com doença renal crônica terminal, independente da raça ou doença de base. Existe agregação familiar da doença renal crônica na amostra estudada e esta predisposição independe da raça e da doença de base (hipertensão ou diabetes mellitus).

Prevalence of fatigue reported by physiotherapists operating diathermy equipment for microwave

Objective: To Analyze the association between prevalence of fatigue referred by physical therapists and their occupational exposure to radiation emitted by therapeutic microwave diathermy equipment. Methods: A Cross-sectional study conducted in 193 physical therapists from four cities of the west of Paraná State, Brazil. A specified structured web questionnaire was applied for collecting data about microwave diathermy exposition and potential confounders, plus the Multidimensional Assessment of Fatigue (MAF). Statistical analysis included logistic regression and Student's t-test. Results: The prevalence of fatigue in the category exposed to microwave diathermy was higher (15.0%) than in non-exposed (2.9%). On multivariate logistic regression, a significant independent association between exposure to microwave diathermy and prevalence of fatigue was observed (odds ratio 4.93; 95% confidence interval 1.04 - 23.25; p = 0.04). The Student's t-test showed significant difference between the number of hours exposed to diathermy microwave, being 3,839.1 within physical therapists who referred fatigue and 497.6 within others (p = 0.004). Conclusion: The results demonstrate a significant and independent association between occupational exposure of physical therapists to radiation of microwave diathermy and prevalence of fatigue. Therefore, occupational safety guidelines aimed at these professionals as a prevention of possible adverse effects, as well as the replication of this study are suggested.

[Sociotechnical healthcare networks for acupuncture: a case study on the basic training of medical students]

This is a qualitative study on the sociotechnical networks that underlie the University of São Paulo School of Medicine's Acupuncture League. The actor-network methodology, developed by Bruno Latour in studies on scientific productivity, is used. Consisting of field observations, semistructured interviews and a document analysis, the study presents relevant findings, with emphasis on understanding acupuncture as a therapeutic strategy effective in healthcare, modulating the use of drugs. It also identifies the need for regulation of the teaching and practice of acupuncture and recognition of other healthcare professionals as colleagues in the practice of this therapeutic method.

[Geraldo Horácio de Paula Souza, China and Chinese medicine, 1928-1943]

This essay is on the writings of sanitary doctor Geraldo Horácio de Paula Souza in Eugenia e Imigração (1928) and, after an official trip to the Orient, in Digressões sobre a medicina chinesa clássica (1942) and A sabedoria chinesa diante da ciência ocidental e a Escola Médica de Pequim (1943). The documents, analyzed according to the conceptual approach of Carlo Ginzburg, indicate a change in his view of the Chinese. Trained according to the Rockefeller Foundation's model of experimental medicine, Geraldo de Paula Souza was guided in his work by scientific rigor and record imagery. In his youth he was of the opinion that the Chinese civilization was stagnated, but this view changed after his visit, when he perceived the Chinese republic's capacity to modernize.

Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study

OBJECTIVE

Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population.

METHODS

A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression.

RESULTS

Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications.

CONCLUSIONS

In this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism.

Traditional learning and problem-based learning: self-perception of preparedness for internship

OBJECTIVE

This study aims to evaluate Pontificia Universidade Católica de São Paulo (PUC-SP) medical students' perception of their preparedness to attend the internship course by comparing students who entered the internship in 2009, who were taught according to the traditional learning method, and those who entered the internship in 2010, who were taught according to the new method, i.e. problem-based learning (PBL).

METHODS

50 traditional learning method students answered a standard Lickert scale questionnaire upon entering internship in 2009. In 2010, the process was repeated with PBL students. The questionnaire was based upon the Preparation for Hospital Practice Questionnaire. This questionnaire was evaluated by professors from three medical schools in Brazil regarding its applicability. The original questions were classified according to the importance these professors attributed to them, and less important questions were removed. Scores obtained from the Student's t-test were considered significant with p < 0.05.

RESULTS

A significant statistical difference was observed in 16 questions, and the traditional learning method students reported higher average scores. When questions were divided into dimensions, a significant statistical difference appeared in the dimensions " social aspects of health", "medical skills", and "ethical concepts"; traditional learning method students again reported higher scores (p < 0.001 for all dimensions). Higher scores were also reported when the average of the answers to the whole questionnaire was calculated.

CONCLUSION

Traditional learning method students consider themselves to be better prepared for internship activities than PBL students, according to the following three comparative means: by analyzing the answers to each question, by grouping these answers into dimensions, and by calculating the means of answers to the whole questionnaire.

Ethnicity and cutaneous melanoma in the city of Sao Paulo, Brazil: a case-control study

BACKGROUND

Over the last century the incidence of cutaneous melanoma has increased worldwide, a trend that has also been observed in Brazil. The identified risk factors for melanoma include the pattern of sun exposure, family history, and certain phenotypic features. In addition, the incidence of melanoma might be influenced by ethnicity. Like many countries, Brazil has high immigration rates and consequently a heterogeneous population. However, Brazil is unique among such countries in that the ethnic heterogeneity of its population is primarily attributable to admixture. This study aimed to evaluate the contribution of European ethnicity to the risk of cutaneous melanoma in Brazil.

METHODOLOGY/PRINCIPAL FINDINGS

We carried out a hospital-based case-control study in the metropolitan area of Sao Paulo, Brazil. We evaluated 424 hospitalized patients (202 melanoma patients and 222 control patients) regarding phenotypic features, sun exposure, and number of grandparents born in Europe. Through multivariate logistic regression analysis, we found the following variables to be independently associated with melanoma: grandparents born in Europe-Spain (OR = 3.01, 95% CI: 1.03-8.77), Italy (OR = 3.47, 95% CI: 1.41-8.57), a Germanic/Slavic country (OR = 3.06, 95% CI: 1.05-8.93), or ≥ 2 European countries (OR = 2.82, 95% CI: 1.06-7.47); eye color-light brown (OR = 1.99, 95% CI: 1.14-3.84) and green/blue (OR = 4.62; 95% CI 2.22-9.58); pigmented lesion removal (OR = 3.78; 95% CI: 2.21-6.49); no lifetime sunscreen use (OR = 3.08; 95% CI: 1.03-9.22); and lifetime severe sunburn (OR = 1.81; 95% CI: 1.03-3.19).

CONCLUSIONS

Our results indicate that European ancestry is a risk factor for cutaneous melanoma. Such risk appears to be related not only to skin type, eye color, and tanning capacity but also to others specific characteristics of European populations introduced in the New World by European immigrants.

Correlation of fatigue with pain and disability in rheumatoid arthritis and osteoarthritis, respectively

OBJECTIVE

To investigate the correlation of fatigue with pain in rheumatoid arthritis patients and with disability in osteoarthritis patients.

METHODS

Twenty patients with rheumatoid arthritis and 20 patients with osteoarthritis were evaluated. The degree of fatigue was evaluated with a visual analogue scale and the Multidimensional Assessment of Fatigue. Pain was evaluated with a visual analogue scale as well as Patient Global Assessment. For disability evaluation, the Health Assessment Questionnaire was performed. Age, gender, disease duration, education, income, antirheumatic drugs used and comorbidity were also obtained. Statistical analysis included Fisher exact, Shapiro-Wilk, Kruskal-Wallis and Spearman tests. The significance level was 0.05.

RESULTS

Fatigue was more significantly increased in patients with osteoarthritis than in patients with rheumatoid arthritis when evaluated with Multidimensional Assessment of Fatigue (P < 0.05). Pain was found to correlate with fatigue evaluated with visual analogue scale or Multidimensional Assessment of Fatigue in patients with rheumatoid arthritis (r = 0.46; P < 0.05). Health Assessment Questionnaire was associated with fatigue visual analogue scale in patients with osteoarthritis (r = 0.54; P < 0.05). Patient Global Assessment correlates with fatigue visual analogue scale (r = 0.44; P < 0.003). Patients were similar in both groups: all females, similar mean age, with long disease duration and low income.

CONCLUSION

Our results corroborate that fatigue in rheumatoid arthritis patients correlates with the degree of pain, while in osteoarthritis patients it is associated with disability. Therefore, we found that fatigue has different correlates in osteoarthritis and rheumatoid arthritis, and we suggest that disability, not pain, is a correlate of fatigue in osteoarthritis patients.

The family health system: analysis of a health survey in Sao Paulo, Brazil

BACKGROUND

The Family Health Strategy (FHS) has been implemented as a strategy for primary care improvement in Brazil. Working with teams that include one doctor, one nurse, auxiliary nurses and community health workers in predefined areas, the FHS began in 1994 (known then as the Family Health Program) and has since grown considerably. The programme has only recently undergone assessment of outcomes, in contrast to more routine evaluations of infrastructure and process.

METHODS

In 2001, a health survey was carried out in two administrative districts (with 190,000 inhabitants) on the outskirts of the city of São Paulo, both partially served by the FHS. Chronic morbidity (hypertension, diabetes and ischaemic heart disease) of individuals aged 15 or older was studied in areas covered and not covered by the programme. Stratified univariate analysis was applied for sex, age, education, income, working status and social insurance of these populations. Multivariate analysis was applied where applicable.

RESULTS

There was a distinct pattern in the morbidity profile of these populations, suggesting differentiated self-knowledge on chronic disease status in the areas served by the FHS.

CONCLUSION

The FHS can increase population awareness of chronic diseases, possibly through increasing access to primary care.

High frequency of lamivudine resistance mutations in Brazilian patients co-infected with HIV and hepatitis B

This study analyzed the genotype distribution and frequency of lamivudine (LAM) and tenofovir (TDF) resistance mutations in a group of patients co-infected with HIV and hepatitis B virus (HBV). A cross-sectional study of 847 patients with HIV was conducted. Patients provided blood samples for HBsAg detection. The load of HBV was determined using an "in-house" real-time polymerase chain reaction. HBV genotypes/subgenotypes, antiviral resistance, basal core promoter (BCP), and precore mutations were detected by DNA sequencing. Twenty-eight patients with co-infection were identified. The distribution of HBV genotypes among these patients was A (n = 9; 50%), D (n = 4; 22.2%), G (n = 3; 16.7%), and F (n = 2; 11.1%). Eighteen patients were treated with LAM and six patients were treated with LAM plus TDF. The length of exposure to LAM and TDF varied from 4 to 216 months. LAM resistance substitutions (rtL180M + rtM204V) were detected in 10 (50%) of the 20 patients with viremia. This pattern and an accompanying rtV173L mutation was found in four patients. Three patients with the triple polymerase substitution pattern (rtV173L + rtL180M + rtM204V) had associated changes in the envelope gene (sE164D + sI195M). Mutations in the BCP region (A1762T, G1764A) and in the precore region (G1896A, G1899A) were also found. No putative TDF resistance substitution was detected. The data suggest that prolonged LAM use is associated with the emergence of particular changes in the HBV genome, including substitutions that may elicit a vaccine escape phenotype. No putative TDF resistance change was detected after prolonged use of TDF.

Mortalidade materna por eclâmpsia

OBJETIVO: analisar fatores associados à mortalidade materna causada por eclâmpsia. MÉTODOS: estudo de coorte retrospectivo revisando-se prontuários médicos dos partos assistidos no Conjunto Hospitalar de Sorocaba (janeiro/1995 a dezembro/2005). Variáveis pesquisadas: ano do parto, características sócio-demográficas maternas, antecedentes familiares, pessoais e obstétricos, características da gestação, parto, puerpério, atendimento realizado, evolução e condições de alta. A análise estatística incluiu teste exato de Fisher, correlação de Pearson, e regressão múltipla de Poisson. RESULTADOS: registraram-se 35.973 partos, 179 casos de eclâmpsia, 52 com sérias complicações, 23 com maior permanência no tratamento intensivo e 8 evoluíram para óbito. A proporção de eclâmpsia decresceu no período (0,90% para 0,37%; r= - 0,746; p=0,008), mas mantendo a proporção de casos com sérias complicações (0,25% para 0,17%, r= - 0,45; p=0,162). A proporção de óbitos foi maior entre pacientes não brancas (RR=9,10; IC95%=1,83-45,23; p=0,007) e menor entre as tratadas com sulfato de magnésio (RR=0,08; IC95%=0,02-0,35; p= 0,001). CONCLUSÕES: reduziu-se a proporção de eclâmpsia entre os partos assistidos no Conjunto Hospitalar de Sorocaba, porém, a eclâmpsia continua sendo importante causa de óbito materno na região. Este estudo revela que é fundamental o aperfeiçoamento das medidas de diagnóstico precoce e tratamento da pré-eclâmpsia e eclâmpsia pela rede de atenção à saúde.

[Profile of the resident physician attended by the Group of Psychological Assistance for Students at the São Paulo University School of Medicine]

OBJECTIVES

To define the profile of medical residents assisted by a mental health care service, aiming to contribute to the understanding of this group's needs.

METHODS

Observational study, retrospective cohort design. Data were collected from the medical records of a series of residents assisted by the group of psychological care for students of the Sao Paulo University School of Medicine , during the period 1998-2002; and from the institution's general register of residents. Proportions of residents assisted according to time, year of residency, gender , age, specialty, graduation school and distance from family home are described and differences between proportions of these variables categories are analyzed.

RESULTS

The total of residents included was 2,131 with a follow-up time of 4,727 resident-years. Among them, computing first episode of care only, there were 104 residents assisted (4.9% residents assisted, or 2.2 residents assisted per 100 resident-years of follow-up). Their most frequent characteristics were: first year of residency (4.5%), age under 26 years (6.1%), female (6.9%), graduates from other schools (5.9%), and residents of cognitive specialties (6.7%). Psychiatric assistance in this sample shows an association with gender and factors related to a crisis of adaptation. The proportion of residents assisted has not increased during the period analyzed.

Incidence and predictors of severe liver fibrosis in HIV-infected patients with chronic hepatitis C in Brazil

The aim of this study was to examine the incidence and factors associated with the severity of liver fibrosis in 234 coinfected patients in Brazil. Patients were cared for in our clinic, from 1996 to 2004. Eligible patients were defined as patients with documented HIV and hepatitis C virus (HCV) infections and had previously undergone a liver biopsy. Patients with persistently normal alanine aminotransferase (ALT) were also included. The variables selected for study were age, gender, risk category, history of high alcohol consumption, CD4(+) T cell count, antiretroviral therapy usage, HCV genotype and duration of HCV infection. Stage of fibrosis was scored as follows: F0, no fibrosis; F1, portal fibrosis with no septa; F2, portal fibrosis with few septa; F3, bridging fibrosis with many septa; and F4, cirrhosis. The liver fibrosis stage was F3 in 39 (16.6%) and F4 in 20(8.5%) patients. Among patients with normal ALT, the liver fibrosis stage was F3-F4 in three patients (5.6%). Predictors of severe liver fibrosis (F3-F4) by multivariate analysis were age (older patients) and genotype 3 (genotype 1 = odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12 0.65). In summary, in the present study severe liver fibrosis was found in 25% of our patients and was associated with an age of more than 38 years at the time of liver biopsy as well as, HCV genotype 3. No differences were found with respect to CD4(+) T cell counts although patients with a CD4(+) T cell count greater than 50 were excluded.

Eqüidade no tempo de espera para determinadas cirurgias eletivas segundo o tipo de hospital em Sorocaba, SP

INTRODUÇÃO: A eqüidade na atenção à saúde tem sido alvo de grande preocupação, incluindo países em desenvolvimento e desenvolvidos. A eqüidade horizontal, entendida como tratamento igual de indivíduos que se encontram na mesma situação de saúde, tem sido investigada nos diferentes níveis de atenção à saúde. OBJETIVOS: O presente estudo busca verificar se existem disparidades no tempo de espera para cirurgias eletivas (safenectomia, colecistectomia, hemorroidectomia e histerectomia) segundo o tipo de hospital, público ou privado. METODOLOGIA: Realizou-se, em Sorocaba, um estudo transversal com 40 pacientes atendidos por hospital privado e 40 atendidos por hospital público, no período de outubro e novembro de 2005. Além do tempo de espera e tipo de hospital, foram pesquisados sexo, idade, escolaridade, renda, situação conjugal, procedência, tipo de cirurgia realizada e presença de determinadas comorbidades. RESULTADOS: Observou-se um tempo de espera maior nas categorias: hospital público (5,5 meses; p<0,001), baixa escolaridade (3,5 meses; p<0,001), menor renda (Spearman=-0,4426; p<0,001), procedência de outros municípios (2 meses; p=0,009), e cirurgia de safenectomia (5 a 7 meses; p=0,04). Após o ajuste para as variáveis comorbidade, renda, escolaridade ou procedência, o tempo de espera no hospital público se manteve significantemente maior (diferença mínima de 4,93 meses quando ajustada por renda; IC95% 3,4-6,4; p<0,001). CONCLUSÃO: Verifica-se relevante iniqüidade na atenção à saúde relacionada ao tipo de prestador de serviços de saúde.

Genotypic distribution of hepatitis C among hepatitis C and HIV co-infected patients in Brazil

Summary:

Information on hepatitis C virus (HCV) genotypic distribution among HIV-HCV co-infected patients is lacking in Brazil as well as other Latin American countries. The objective of this study was to evaluate the level of exposure to different risk factors associated with HCV transmission among a group of co-infected patients and to characterize the genotypic distribution of HCV in this cluster. A series of 100 HIV-HCV co-infected patients was analysed. The data to be analysed were collected from specific laboratory tests. Information was collected through a questionnaire. HCV genotyping was carried out by sequencing the 5′ non-coding region of HCV. Chi-square and Fischer association tests or Kruskal-Wallis test were used to study the association between HCV transmission-related variables and the established genotypes. In conclusion, exposure to multiple risk factors associated with HCV transmission was common among HIV co-infected patients and an association between HCV genotype 3 and intravenous drug user was observed.

Clinical and histological characteristics of HIV and hepatitis C virus-co-infected patients in Brazil: a case series study

Hepatitis C virus (HCV) is an important factor contributing to morbidity and mortality in patients co-infected with HIV and HCV. In addition, liver biopsy is an important tool in the clinical management of these patients. Although liver biopsy is controversial, it is recommended for all patients. Data regarding the clinical and histological characteristics of these patients are scarce not only in Brazil but in Latin America as a whole. With the goal of better understanding these characteristics and the benefit of liver biopsy indications in this disease setting, data collected from 234 patients followed from 1996 to 2004 at Casa da AIDS, São Paulo, were analyzed. The following variables were extracted from the patients' medical files at the time of liver biopsy: sex, age, hepatitis C infection risk factors, hepatitis C infection duration, ALT levels, CD4+ T cell counts, history of alcohol abuse, history of antiretroviral therapy, HCV genotype, and liver histological alterations. CONCLUSIONS: 1 - Hepatitis C virus 1 and 3 were the most frequently identified genotypes and were diagnosed in 72% and 25.5% of cases respectively; 2 - Structural liver alterations were found to be mild or absent in 48.2% (113/234) of the analyzed patients; 3 - Fifty-three patients (23%) had normal ALT levels and 4 - Significant liver architectural changes (F2-F3) were evident in 22.5% of the patients with normal ALT levels.

Dieta vegetariana e níveis de colesterol e triglicérides

OBJECTIVE

Compare levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL) among vegetarians and omnivores.

METHODS

Blood samples were collected from 76 individuals--both males and females--separated in four different diet groups: omnivores, lacto-ovo vegetarians, lacto vegetarians, and restricted vegetarians (or vegans). Dosing was done for: TC, LDL, HDL and TG.

RESULTS

Significant difference was reported for TC, LDL and TG levels among the samples. Higher levels were reported by omnivores, with decreased levels for vegetarians as animal products were restricted, with lowest levels having been reported by vegans. Mean and standard deviation for TC were 208.09 +/- 49.09 mg/dl in the group of omnivores, and 141.06 +/- 30.56 mg/dl in the group of vegans (p < 0.001). LDL values for omnivores and vegans were respectively: 123.43 +/- 42.67 mg/dl and 69.28 +/- 29.53 mg/dl (p < 0.001). As for TG, those values were 155.68 +/- 119.84 mg/dl and 81.67 +/- 81.90 mg/dl (p < 0.01). As for HDL level no difference was reported between the samples, but HDL/TC ratio was significantly higher in vegans (p = 0.01).

CONCLUSION

Vegetarian diet was associated to lower levels of TG, TC and LDL as compared to the diet of omnivores.

[Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil]

The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.

Risk factors associated with hepatitis C among patients co-infected with human immunodeficiency virus: a case-control study

A case-control study was carried out to assess the risk factors associated with hepatitis C in patients infected with human immunodeficiency virus. One hundred eighteen patients tested positive for hepatitis C virus (HCV) and were included as cases, and 117 tested negative for HCV and were included as controls. Information was collected through a questionnaire. The risk factors that showed a significant association with co-infection by multivariate analysis were an age of 30-39 years (odds ratio [OR] = 4.65, 95% confidence interval [CI] = 1.31-16.43), an age of 40-49 years (OR = 6.48, 95% CI = 1.70-24.78), an age > 50 years (OR = 7.50, 95% CI = 1.54-36.68), use of intravenous drugs (OR = 25.46, 95% CI = 4.91-131.88), use of inhaled illicit drugs (OR = 3.56, 95% CI = 1.22-10.44), anal intercourse (OR = 3.93, 95% CI = 1.27-12.13), a sexual partner with a history of liver disease (OR = 5.45, 95% CI = 1.33-22.32), a sexual partner with a history of blood transfusions (OR = 4.79, 95% CI = 0.95-24.19), and sexual partner with a history of intravenous drug use (OR = 3.46, 95% CI = 1.24-9.65).

Utilização de serviços de saúde em áreas cobertas pelo programa saúde da família (Qualis) no Município de São Paulo

OBJETIVO: O Programa de Saúde da Família se constitui em estratégia de reorganização do sistema de atenção à saúde para o Sistema Único de Saúde. O objetivo do estudo foi verificar mudanças no perfil de utilização de serviços de saúde após implantação do Programa, identificando fatores associados às mudanças observadas. MÉTODOS: Foram analisados dados de utilização de serviços e procura por assistência em duas amostras definidas por conglomerados e representativas da população coberta (n=1.865) e não coberta pelo Programa de Saúde da Família (n=2.036) de dois distritos do Município de São Paulo. Os dados fazem parte de inquérito populacional realizado em 2001. Foi empregada a análise estatística própria para conglomerados. RESULTADOS: Na utilização de serviços, nas áreas cobertas pelo Programa de Saúde da Família, não foram observadas razões de prevalência significantemente diferentes segundo escolaridade e renda, e nas áreas não cobertas as razões de prevalência foram mais elevadas para maior escolaridade e renda. Na procura por assistência em pessoas com episódios de morbidade, nas áreas cobertas pelo Programa a razão de prevalência foi maior em pessoas com grau de limitação intenso, e nas áreas não cobertas a razão de prevalência foi mais elevada para maior escolaridade e menor para os inativos. CONCLUSÕES: Nas áreas estudadas, na população coberta pelo Programa de Saúde da Família a renda e escolaridade não se constituem em fatores que diferenciam de forma significativa o perfil de utilização de serviços de saúde e de procura por assistência, indicando que o programa pode estar contribuindo para maior equidade nessas condições.

[Prevalence of low visual acuity in public school's students from Brazil]

OBJECTIVE

Low visual acuity (VA) is an important public health problem due to its high prevalence and because it needs early diagnosis in order to prevent damage in childhood development and apprenticeship. To describe and analyze low visual acuity (VA) prevalence among school children.

METHODS

Once performed the VA test to 1st and 4th grades primary school children data were analyzed by separating students according to sex, school grade, wearing of glasses, residence area and level of access to the supplementary medical assistance (SMA).

RESULTS

The total of 9,640 students was evaluated during the year of 2000 and they presented a prevalence of low VA of 13.1% (CI 12.5-13.8%). There was a statistical significant lower prevalence in males (11.5%) compared to females (14.9%) - (PR=0.77). There was a statistical significant higher prevalence in 1st grade students (14.1%) compared to 4th grade (11.5%) - (PR=1.22). There was also a statistical significant lower prevalence for those who were not wearing glasses (12.1%) compared to those who were using glasses (42.0%) - (PR=0.29). Concerning to residence areas, Cajuru neighborhood had the lower prevalence of low VA (1.8%) and Vila Sabia neighborhood had the higher prevalence (32.4%), and a positive correlation, according to residence area, between the proportion of people with access to the Supplementary Medical Assistance and the proportion of children wearing glasses was found (r=0.64, p<0.001).

CONCLUSIONS

The low VA high prevalence shows lack in early diagnosis and continuity of assistance pointing out to the urgent need of implementation in visual health public.

[Physical aggression and social class]

OBJECTIVE

Considering the increase of violence and the scarcity of informations about the relation between social class and victimization by physical aggression, a study was conducted to investigate this association.

METHODS

A hospital-based case-control study. Cases and controls were recruited at a hospital, first-aid clinic, from 1/10/93 to 19/1/95. The study included 191 cases and 222 controls selected from among patients with non-violent clinical-surgical complaints, frequency-matched to cases by sex and age. Using a standardized questionnaire applied by trained interviewers, information obtained included social class, skin color, marital status, smoking habits, alcohol consumption and illicit drug use.

RESULTS

Adjusting for sex and age, the risk of victimization by physical aggression was significantly higher for the subproletariat, Odds Ratio (OR) 4.20, 95% Confidence Interval (95% CI) 1.99-8.84; single (OR = 2.10) or informal union (OR = 2.62) as marital status (reference group = married); smokers of more than 10 cigarettes/day (OR = 2.75); alcohol consumption (OR = 2.08 for < or = 240 grams/week and OR = 24.05 for > 240 grams/week); and illicit drug users (OR = 3.07). After adjusting for all factors studied a significant risk remained for the subproletariat (OR = 3.28, 95% CI 1.42-7.59); single as marital status (OR = 2.05, 95% CI 1.09-3.88); and alcohol consumption (OR = 2.01, 95% IC 1.07-3.77 for < or = 240 and OR = 15.93, 95% CI 5.09-49.8 for > 240 grams/week)

CONCLUSION

Social class is an important factor in the phenomenon of victimization by physical aggression, with the subproletariat deserving special attention in the strategies of intervention regarding this problem.