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Multimorbidity patterns and associated factors in a megacity: a cross-sectional study
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Aguiar, Ricardo Goes de

; Simões, Daniela

; Castro, Shamyr Sulyvan

; Goldbaum, Moises

; Cesar, Chester Luiz Galvão

; Lucas, Raquel

Revista de Saúde Pública

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2024, Volume 58 elocation 26

Abstract: En | Text: En | PDF: En

ABSTRACT OBJECTIVE To identify empirical patterns of multimorbidity and quantify their associations with socioeconomic, behavioral characteristics, and health outcomes in the megacity of São Paulo. METHODS This was a cross-sectional study conducted through household interviews with residents aged 20 years or older in urban areas (n = 3,184). Latent class analysis was used to identify patterns among the co-existence of 22 health conditions. Age-adjusted prevalence ratios were estimated using Poisson regression. RESULTS The analysis of latent classes showed 4 patterns of multimorbidity, whereas 58.6% of individuals were classified in the low disease probability group, followed by participants presenting cardiovascular conditions (15.9%), respiratory conditions (12.8%), and rheumatic, musculoskeletal, and emotional conditions (12.8%). Older individuals, with lower schooling and lower household income, presented higher multimorbidity prevalence in cardiovascular, respiratory, rheumatic, musculoskeletal, and emotional conditions patterns compared with the low disease probability pattern. CONCLUSION The results showed four distinct patterns of multimorbidity in the megacity population, and these patterns are clinically recognizable and theoretically plausible. The identification of trends between patterns would make it feasible to estimate the magnitude of the challenge for the organization of health care policies.

https://doi.org/10.11606/s1518-8787.2024058006058

Multimorbidade e utilização de serviços de saúde no município de São Paulo, Brasil: prevalência e fatores associados
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Aguiar, Ricardo Goes de

; Monteiro, Camila Nascimento

; Castro, Shamyr Sulyvan de

; Figueiredo, Tatiane Kosimenko Ferrari

; Goldbaum, Moisés

; Cesar, Chester Luiz Galvão

Ciência & Saúde Coletiva

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2024, Volume 29 N. 9 elocation e15002022

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract The scope of this paper was to estimate the prevalence of multimorbidity in the city of São Paulo and to verify the factors associated with the utilization of the health services. It involved a population based cross-sectional study based on data from the Health Survey in the city of São Paulo, in which descriptive analysis was conducted, and logistic regression models were developed using multimorbidity and sociodemographic independent variables, living conditions and use of health services as the outcome. A total of 3,184 individuals aged 20 years or older participated, with a mean age of 43.8 years. The prevalence of multimorbidity was 50.7% among women, 62.5% among those who reported some health problem and 55.1% among those who had recourse to health services in the last 2 weeks. A higher prevalence was identified among those who used the health service due to a mental health problem (66.1%), and in those who reported higher health expenditures in the preceding month (55.4%). Multimorbidity was more frequently associated with aging, in the population with a higher economic status, with worse self-rated health, who frequented health services for 6 months or less, who reported a health problem, or who had a health plan and opted for polypharmacy.

Resumo O objetivo foi estimar a prevalência de multimorbidade no município de São Paulo e verificar os fatores associados à utilização de serviços de saúde. Estudo transversal de base populacional a partir do Inquérito de Saúde do Município de São Paulo (ISA-Capital 2015), em que foi realizada análise descritiva e foram elaborados modelos de regressão logística utilizando como desfecho a multimorbidade e variáveis independentes sociodemográficas, de condições de vida e utilização de serviços de saúde. Participaram 3.184 indivíduos com 20 anos ou mais, idade média de 43,8 anos. A prevalência de multimorbidade foi de 50,7% entre as mulheres, 62,5% entre os que relataram algum problema de saúde e 55,1% entre os que utilizaram serviços de saúde nas duas últimas semanas. Foi identificada maior prevalência nos indivíduos que usaram serviço de saúde por problema de saúde mental (66,1%) e que informaram maiores despesas com saúde no último mês (55,4%). A multimorbidade foi mais frequente com o envelhecimento, na população com nível econômico mais elevado, com pior autoavaliação de saúde, que utilizou serviços de saúde há seis meses ou menos, que relatou problema de saúde, que tinha plano de saúde e fazia uso da polifarmácia.

https://doi.org/10.1590/1413-81232024299.15002022

Multimorbidity patterns and associated factors in a megacity: a cross-sectional study megacity crosssectional cross sectional
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Aguiar, Ricardo Goes de

; Simões, Daniela

; Castro, Shamyr Sulyvan

; Goldbaum, Moises

; Cesar, Chester Luiz Galvão

; Lucas, Raquel

Revista de Saúde Pública

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2024, Volume 58 elocation 26

Abstract: En | Text: En | PDF: En

https://doi.org/10.11606/s1518-8787.2024058006058

Multimorbidade e utilização de serviços de saúde no município de São Paulo, Brasil: prevalência e fatores associados Paulo Brasil
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Aguiar, Ricardo Goes de

; Monteiro, Camila Nascimento

; Castro, Shamyr Sulyvan de

; Figueiredo, Tatiane Kosimenko Ferrari

; Goldbaum, Moisés

; Cesar, Chester Luiz Galvão

Ciência & Saúde Coletiva

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2024, Volume 29 N. 9 elocation e15002022

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232024299.15002022

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience
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Gomes, Walter J.

; Rocco, Isadora

; Pimentel, Wallace S.

; Pinheiro, Aislan H. B.

; Souza, Paulo M. S.

; Costa, Luiz A. A.

; Teixeira, Marjory M. P.

; Ohashi, Leonardo P.

; Bublitz, Caroline

; Begot, Isis

; Moreira, Rita Simone L

; Hossne Jr, Nelson A.

; Vargas, Guilherme F.

; Branco, João Nelson R.

; Teles, Carlos A.

; Medeiros, Eduardo A. S.

; Sáfadi, Camila

; Rampinelli, Amândio

; Moratelli Neto, Leopoldo

; Rosado, Anderson Rosa

; Mesacasa, Franciele Kuhn

; Capriata, Ismael Escobar

; Segalote, Rodrigo Coelho

; Palmieri, Deborah Louize da Rocha Vianna

; Jardim, Amanda Cristina Mendes

; Vianna, Diego Sarty

; Coutinho, Joaquim Henrique de Souza Aguiar

; Jazbik, João Carlos

; Coutinho, Henrique Madureira da Rocha

; Kikuta, Gustavo

; Almeida, Zely Sant'Anna Marotti de

; Feguri, Gibran Roder

; Lima, Paulo Ruiz Lucio de

; Franco, Anna Carolina

; Borges, Danilo de Cerqueira

; Cruz, Felipe Ramos Honorato De La

; Croti, Ulisses Alexandre

; Borim, Bruna Cury

; Marchi, Carlos Henrique De

; Goraieb, Lilian

; Postigo, Karolyne Barroca Sanches

; Jucá, Fabiano Gonçalves

; Oliveira, Fátima Rosane de Almeida

; Souza, Rafael Bezerra de

; Zilli, Alexandre Cabral

; Mas, Raul Gaston Sanchez

; Bettiati Junior, Luiz Carlos

; Tranchesi, Ricardo

; Bertini Jr, Ayrton

; Franco, Leandro Vieira

; Fernandes, Priscila

; Oliveira, Fabiana

; Moraes Jr, Roberto

; Araújo, Thiago Cavalcanti Vila Nova de

; Braga, Otávio Penna

; Pedrosa Sobrinho, Antônio Cavalcanti

; Teixeira, Roberta Tavares Barreto

; Camboim, Irla Lavor Lucena

; Gomes, Eduardo Nascimento

; Reis, Pedro Horigushi

; Garcia, Luara Piovan

; Scorsioni, Nelson Henrique Goes

; Lago, Roberto

; Guizilini, Solange

Brazilian Journal of Cardiovascular Surgery

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dec 2021, Volume 36 N. 6 Pages 725 - 735

Abstract: En | Text: En | PDF: En

Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

https://doi.org/10.21470/1678-9741-2021-0960

Changes in total physical activity, leisure and commuting in the largest city in Latin America, 2003-2015
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Figueiredo, Tatiane Kosimenko Ferrari

; Aguiar, Ricardo Goes de

; Florindo, Alex Antonio

; Alves, Maria Cecília Goi Porto

; Barros, Marilisa Berti de Azevedo

; Goldbaum, Moisés

; Ferrari, Gerson

; Fisberg, Regina Mara

; Cesar, Chester Luiz Galvão

Revista Brasileira de Epidemiologia

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2021, Volume 24 elocation e210030

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO: Objetivo: Analisar a prevalência de inatividade física e o tempo médio de prática de atividade física total e por domínios (lazer e deslocamento), de acordo com sexo, faixa etária e escolaridade, em residentes de área urbana do munícipio de São Paulo, entre os anos de 2003 e 2015. Métodos: Utilizaram-se dados dos Inquéritos Domiciliares de Saúde no Município de São Paulo (2013: n = 2.514; 2015: n = 4.043). O International Physical Activity Questionnaire foi utilizado para mensurar a atividade física total, de lazer e deslocamento. Resultados foram apresentados em períodos de < 10 minutos/semana, inatividade física e minutos/semana, conforme período de avaliação, faixa etária, sexo e escolaridade. Resultados: As prevalências dos períodos < 10 minutos/semana em 2003 e 2015 foram 22,5 e 28,9% para total; 56,7 e 58,3% para lazer; e 35,2 e 39,9% para deslocamento, com mudança significativa no total em adolescentes, de 10,3 para 18,8%. Para inatividade física, as prevalências foram 54,9 e 61,6% para total; 78,2 e 78,9% para lazer; e 72 e 79,9% para deslocamento, com mudanças significativas no deslocamento em adultos, de 67,8 para 77,4%. Para as médias de atividade física total, houve diminuição significativa para adolescentes do sexo feminino (138,2 minutos/semana) e adultos com escolaridade de 0–8 (122,6 minutos/semana) e 9–11 anos (96,7 minutos/semana); no deslocamento, houve diminuição para adolescentes do sexo feminino (95 minutos/semana) e adultos do sexo masculino (95 minutos/semana) e feminino (82 minutos/semana). Conclusão: Não foram encontradas diminuições na prevalência dos períodos < 10 minutos/semana e na inatividade física no lazer. A inatividade física no deslocamento ficou ainda maior.

ABSTRACT: Objective: To analyze the prevalence of physical inactivity and the average time of practice of total physical activity and by domains (leisure and commuting), according to gender, age group and schooling, between 2003 and 2015, in residents of the urban area of the city of São Paulo. Methods: Data from Household Health Surveys in the Municipality of São Paulo (2003: n = 2,514; 2015: n = 4,043). The International Physical Activity Questionnaire was used to measure total, leisure, and commuting physical activity. Results were presented in < 10 minute/week periods, physical inactivity and minutes/week, according to evaluation period, sex, age and schooling. Results: Prevalence of < 10 minutes/week periods in 2003 and 2015 were: 22.5 and 28.9% for the total; 56.7 and 58.3% for leisure; and 35.2 and 39.9% for commuting, with significant change only in the total item, among adolescents (10.3 to 18.8%). For physical inactivity, prevalence rates were: 54.9 and 61.6% (total); 78.2 and 78.9% (leisure); and 72 and 79.9% (commuting), with significant changes only for commuting among adults (67.8 to 77.4%). For the average in minutes per week, in total, there was a significant decrease for female adolescents (138.2 minute/week) and adults with 0–8 (122.6 minutes/week) and 9–11 years (96.7 minutes/week) years of schooling; in commuting, there was a reduction for female adolescents (95 minutes/week); and male adults (95 minutes/week) and female adults (82 minutes/week). Conclusions: There were no reductions in the prevalence of < 10 min/week periods or leisure physical inactivity. Commuting physical inactivity has become even more common.

https://doi.org/10.1590/1980-549720210030

Changes in total physical activity, leisure and commuting in the largest city in Latin America, 2003-2015
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Figueiredo, Tatiane Kosimenko Ferrari

; Aguiar, Ricardo Goes de

; Florindo, Alex Antonio

; Alves, Maria Cecília Goi Porto

; Barros, Marilisa Berti de Azevedo

; Goldbaum, Moisés

; Ferrari, Gerson

; Fisberg, Regina Mara

; Cesar, Chester Luiz Galvão

Revista Brasileira de Epidemiologia

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2021, Volume 24 elocation e210030

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1980-549720210030 254 downloads

Transanal Endoscopic Proctectomy: a new approach to the total excision of the mesorectum
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Mendes, Carlos Ramon Silveira

; Ferreira, Luciano Santana de Miranda

; Sapucaia, Ricardo Aguiar

; Lima, Meyline Andrade

; Cobas, Eduardo Costa

; Araujo, Sergio Eduardo Alonso

Journal of Coloproctology (Rio de Janeiro)

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sep 2015, Volume 35 N. 3 Pages 182 - 186

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMOIntrodução:O câncer colorretal é um serio problema de saúde publica. Em 1982, Heald conseguiu reduzir a mortalidade com a padronização da excisão total do mesoreto. O uso da Microcirurgia endoscópica transanal surgiu para proporcionar ressecções de tumores de reto como método minimamente invasivo. Com a associação do TEO a ETM foi possível desenvolver uma nova abordagem para ETM.Técnica cirúrgica:O procedimento é iniciado pelo tempo perineal com o aparelho de TEO. Em seguida o sistema TEO é introduzido, com exposição da lesão por meio de uma incisão circunferencial a cerca de 2 a 4 cm da margem distal do tumor após a confecção de sutura em bolsa com fechamento do coto retal. Em seguida, faz-se dissecção pela porção posterior até a fáscia avascular pré-sacral, completando a dissecção circunferencial do mesorreto até atingir a reﬂexão peritoneal. Após essa etapa, faz-se laparoscópica com utilização de três trocateres, com mobilização do ângulo esplênico e ligadura da artéria mesentérica inferior, e também a confecção de uma ileostomia protetora. O espécime cirúrgico é retirado pela via transanal, e o procedimento tem continuidade com uma anastomose coloanal.

ABSTRACTIntroduction:Colorectal cancer is a serious public health problem. In 1982, Heald managed to reduce mortality by standardizing the total excision of mesorectum. The use of transanal endoscopic microsurgery has emerged to allow resection of rectal tumors as a minimally invasive method. With the association of Transanal Endoscopic Operation with total excision of mesorectum, it was possible to develop a new approach for total excision of mesorectum.Surgical technique:The procedure is started by the perineal time with Transanal Endoscopic Operation device; introduction of Transanal Endoscopic Operation system follows, with exposure of the lesion with a circumferential incision at a distance between 2 and 4 cm from distal tumor margin after making a purse string suture to close the rectal stump. Then, dissection is carried out by the posterior portion until reaching the presacral avascular fascia, completing the mesorectal circumferential dissection until the peritoneal reﬂection. After this step, a laparoscopic procedure is performed with the use of three trocars, with mobilization of splenic ﬂexure and ligation of the inferior mesenteric artery, as well as confection of a protective ileostomy. Then, transanal removal of the surgical specimen is performed, and the procedure goes on with a coloanal anastomosis.

https://doi.org/10.1016/j.jcol.2015.06.003 1323 downloads

Distribuição do investimento público na assistência fisioterapêutica ambulatorial, Brasil, 2000 a 2006
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Castro, Shamyr Sulyvan de

; Barbosa, Guilherme Rodrigues

; Aguiar, Ricardo Goes de

Fisioterapia em Movimento

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sep 2013, Volume 26 N. 3 Pages 639 - 645

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: O estudo da distribuição dos recursos financeiros no âmbito das atividades fisioterapêuticas na esfera do SUS é uma importante ferramenta para gestão dos serviços, assim como dos recursos financeiros, humanos e físicos. OBJETIVO: Determinar o perfil de distribuição dos recursos destinados à cobertura dos gastos com atendimento em fisioterapia no nível secundário de atenção à saúde, nas regiões do Brasil, de 2000 a 2006. MATERIAIS E MÉTODOS: Série histórica com dados a respeito do pagamento de atendimento em fisioterapia no setor secundário nas diversas regiões do país. Os dados foram coletados no site do DATASUS. Foi feita uma análise per capita considerando-se as informações populacionais disponibilizadas pelo IBGE. Efetuou-se análise descritiva e análise de correlação de Pearson. RESULTADOS: A região Nordeste apresentou maior investimento per capita no período estudado, R$ 0,4713; e a região Norte a menor, R$ 0,2834. O investimento municipal foi o que mais se ampliou em todas as regiões, houve incremento no valor total de recursos empregados no custeio de sessões de fisioterapia, de 2000 a 2006. CONCLUSÃO: O investimento de recursos financeiros em fisioterapia no nível secundário de atendimento à saúde mostrou padrões diferentes nas diversas regiões do Brasil, com maior contraste entre a região Nordeste e a Norte, com o maior e o menor investimento per capita, respectivamente.

INTRODUCTION: The study of the distribution of financial resources within the physiotherapy activities in the sphere of SUS is an important tool for management services as well as financial, human and physical resources. OBJECTIVE: To determine the profile of distribution of resources to cover costs of physical therapy sessions in a secondary level of health care in different Brazilian geographic areas. MATERIALS AND METHODS: Time series analysis of physical therapy session payments in the secondary level was accomplished from 2000 to 2006. Data were collected from DATASUS website. Per capita analysis was performed based on population information provided by IBGE. Descriptive analysis and Pearson's correlation were carried out. RESULTS: Northeast region showed the greatest per capita investment in the studied period (R$ 0.4713), while the North region had the smallest one (R$ 0.2834). From 2000 to 2006, the city's financial investments in this field increased in all Brazilian regions and the total of resources used to afford physical therapy sessions costs was increased. CONCLUSION: The investment of resources in physical therapy in a secondary level of health care showed different patterns different Brazilian geographic areas.

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Espermatogénesis en personal profesional expuestos a las radiaciones electromagnéticas
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Falcón Aguiar, María E.

; Pérez Alejo, José L.

; Somonte Ríos, Ricardo

; Piñón Montano, Ana G.

; Hernández Rodríguez, Héctor

; Acosta Quintana, Vidalina Kenia

Revista Cubana de Medicina Militar

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dec 2005, Volume 34 N. 4

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

The presence in the local environment of the non-ionizing radiations with wave frequencies between 100 and 300 Ghz, goes back to some decades, and it is associated with the scientific-technical progress. These radiations affect systems, organs and biochemical mechanisms and involve the health of the exposed. In order to know how these electromagnetic waves influence on spermatogenesis, it was conducted a study of semen from 125 professionals of closed intitutions distributed in cases and controls, randomly selected and divided into 2 groups of 63 and 62, respectively. The estimated values of the relative risk (OR) showed that the group exposed to the electromagnetic field had more possibilities of presenting alterations of the sperm count.

La presencia en el ambiente laboral de las radiaciones no ionizantes con frecuencias de ondas entre los 100 a 300 Ghz se remonta solo a algunos decenios y está asociada con el progreso científico-técnico. Estas radiaciones afectan a sistemas, órganos y mecanismos bioquímicos, y comprometen la salud de los expuestos. Con el objetivo de conocer cómo influyen estas ondas electromagnéticas sobre la espermatogénesis, se realizó un estudio del semen en 125 profesionales de instituciones cerradas distribuidos en casos y controles, seleccionados aleatoriamente y divididos en 2 grupos de 63 y 62 respectivamente. Los valores estimados de riesgo relativo (OR) indican que el grupo expuesto al campo electromagnético tiene más probabilidad de presentar alteraciones del espermiograma.

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