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Abstract Background There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). Methods The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. Results A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. Conclusions Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population. HLAB27 HLAB HLA B27 B HLA-B2 SpA, , (SpA) worldwide However mixedrace mixed race populations RBE. . (RBE) multicenter observational 4 Brazil follow 1 (1 rheumatologist 2 (2 18 ≥1 years 3 (3 axial protocol historical 109 included 734 73 73.4 444 44 44. ±13.2 132 13 (±13.2 uveitis Conversely psoriasis activity mobility world Furthermore HLAB2 B2 HLA-B (SpA (RBE ( ≥ 10 7 73. ±13. (±13. ±13 (±13 ±1 (±1 ± (±

https://doi.org/10.1186/s42358-024-00372-0

[SciELO Preprints] - Influenza vaccination in the elderly during the COVID-19 pandemic: A population-based study in 133 Brazilian cities
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Menezes, Ana Maria B Curi Hallal, Pedro Freitas Silveira, Mariângela C Wehrmeister, Fernando Lessa Horta, Bernardo Jardim Dornellas de Barros, Aluísio Pires Hartwig, Fernando Oliveira, Paula Vidaletti, Luís Paulo A Mesenburg, Marilia Jacques, Nadege C Barros, Fernando Gomes Victora, Cesar

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Publication date: 2021-02-08

Abstract: En Pt

Influenza vaccination coverage in the elderly was analysed during the COVID-19 pandemic through the EPICOVID-19, a population-based study conducted in 133 cities from the 26 Brazilian states and Federal District. Twenty five census tracts were sampled with probability proportional to the size of the tract, 10 households by census tracts and one random person interviewed. A total of 33,250 people were interviewed being 8,262  ≥60 years old. The elderly were asked whether they had had a flu vaccine in 2020. Vaccination coverage was 82.3% (CI95%=8 0.1-84.2) with no difference by sex, age, and region. Higher vaccination coverage was observed in the richest compared to the poorest (84.7% and 80.1%; p=<0.001), and among those with higher schooling (87.3% and 83.2; p=0.007). The indigenous presented lower coverage (56.9%) than other ethnic groups (>80%) (p=0.056). A positive association existed between vaccination coverage and number of comorbidities for men, but not for women. Most of those who were vaccinated (97.5%) received the vaccine in the public health system. The private was chosen mostly in the south, by the rich and by those with more schooling. Vaccination coverage was seven percentage points lower than the government target, and inequalities should be reverted in future campaigns.

Avaliou-se a cobertura vacinal para influenza em idosos na pandemia COVID-19 através do EPICOVID-19, inquérito de base populacional realizado em 133 cidades sentinela dos 26 estados brasileiros e Distrito Federal. Selecionou-se 25 setores censitários por cidade com amostragem proporcional ao tamanho, 10 domicílios por setor e uma pessoa por domicílio, aleatoriamente. Foram entrevistadas 33.250 pessoas, sendo 8.265 idosos. Perguntou-se aos idosos se haviam sido vacinados contra gripe em 2020. A cobertura foi de 82,3% (IC 95% 80,1–84,2), sem diferenças por sexo, idade ou região. Foram observadas maiores coberturas no quintil mais rico (84,7% contra  80,1% no mais pobre; p<0.001) e naqueles com graduação completa (87,3% contra 83,2% com fundamental incompleto; p=0.007), e menor cobertura nos indígenas (56,9% comparado a coberturas superiores a 80% nos demais grupos étnicos) (p=0,056). Houve associação positiva da cobertura com número de comorbidades entre homens, mas não entre mulheres. A maioria vacinou-se na rede pública (97,5%), sendo a rede privada mais utilizada na região sul, pelos mais escolarizados e mais ricos. Conclui-se que a cobertura vacinal ficou sete pontos percentuais abaixo da meta governamental, e que desigualdades devem ser revertidas em futuras campanhas.

https://doi.org/10.1590/SciELOPreprints.1797

Respiratory symptoms (COPD Assessment Test and modified Medical Research Council dyspnea scores) and GOLD-ABCD COPD classification: the LASSYC study
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Oca, Maria Montes de

; Varela, Maria Victorina Lopez

; Menezes, Ana Maria B.

; Wehrmeister, Fernando C.

; Ramirez, Larissa

; Miravitlles, Marc

Jornal Brasileiro de Pneumologia

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2021, Volume 47 N. 5 elocation e20210156

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

RESUMO Objetivo Avaliar a frequência e gravidade dos sintomas respiratórios de 24 horas de acordo com a classificação COPD GOLD-ABCD (versão 2017), a distribuição dos pacientes com DPOC nas categorias GOLD usando escores mMRC (≥2) ou CAT (≥10) e concordância entre esses pontos de corte. Métodos Neste estudo transversal (estudo LASSYC), os sintomas respiratórios diários de 24 horas foram avaliados pelo questionário Avaliando os Sintomas Respiratórios em DPOC (Evaluating Respiratory Symptoms - E-RS), Instrumento de Sintomas Noturnos de DPOC (Nighttime Symptoms of COPD Instrument -NiSCI), Instrumento de Sintomas Matinais de DPOC (Early Morning Symptoms of COPD Instrument - EMSCI), pontuações CAT e mMRC. Resultados Entre os 734 pacientes com DPOC, 61% eram do sexo masculino, idade 69,6 ± 8,7 anos, VEF1% pós-BD 49,1 ± 17,5%, mMRC 1,8 ± 1,0 e CAT 15,3 ± 0,8,1. Por mMRC 33,7% eram do grupo A, 29,2% do grupo B, 10,2% do grupo C e 26,9% do grupo D. Por CAT, 22,3% eram do grupo A, 41% do grupo B, 4,8% do grupo C e 31,9% do grupo D. Usando o mMRC, a gravidade dos escores E-RS, NiSCI e EMSCI aumentou do grupo A para D. Usando o CAT, os grupos B e D tiveram os escores mais altos. A concordância entre mMRC e CAT foi de 89,5% (estatística Kappa = 75,7%). Para a pontuação mMRC de 2, a pontuação CAT ≥11 mostrou o índice de Youden máximo (1,34). Para a pontuação mMRC de 1, a pontuação CAT ≥9 e ≥10 mostrou o índice de Youden máximo (1,48). Conclusão A classificação GOLD COPD por CAT parece discriminar melhor os sintomas de 24 horas. Os resultados não suportam o uso equivalente de CAT≥10 e mMRC≥2 para avaliação dos sintomas.

ABSTRACT Objective To assess the frequency and severity of 24-hour respiratory symptoms according to COPD GOLD-ABCD classification (2017-version), the distribution of the patients with COPD into GOLD categories using mMRC (≥2) or CAT (≥10) scores, and agreement between these cut-off points. Methods In this cross-sectional study (LASSYC study), 24-hour day respiratory symptoms were assessed by the Evaluating Respiratory Symptoms in COPD (E-RS) questionnaire, Nighttime Symptoms of COPD Instrument (NiSCI), Early Morning Symptoms of COPD Instrument (EMSCI), CAT and mMRC scores. Results Among the 734 patients with COPD, 61% were male, age 69.6±8.7 years, FEV1% post-BD 49.1±17.5%, mMRC 1.8±1.0 and CAT 15.3±.8.1. By mMRC 33.7% were group-A, 29.2% group-B, 10.2% group-C and 26.9% group-D. By CAT 22.3% were group-A, 41% group-B, 4.8% group-C and 31.9% group-D. Using the mMRC the severity of E-RS, NiSCI and EMSCI scores increased from group A to D. Using the CAT, the groups B and D had the higher scores. Agreement between mMRC and CAT was 89.5% (Kappa statistics=75.7%). For mMRC score of 2, CAT score of ≥11 showed the maximum Youden’s index (1.34). For mMRC score of 1, CAT score of ≥9 and ≥10 showed the maximum Youden’s index (1.48). Conclusion GOLD COPD classification by CAT seems to better discriminate 24-hour symptoms. Results do not support the equivalent use of CAT≥10 and mMRC≥2 for assessing symptoms.

https://doi.org/10.36416/1806-3756/e20210156 104 downloads

Giardiasis in urban and rural Amazonas, Brazil is driven by zoonotic and cosmopolitan A and B assemblages
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dos Reis, Lisiane Lappe

; da Silva, Túllio Romão Ribeiro

; Braga, Francisco Carlos de Oliveira

; do Nascimento, Naara Macedo

; de Menezes, Katia Maria Lima

; Nava, Alessandra Ferreira Dales

; Lima, Natália Aparecida de Souza

; Vicente, Ana Carolina Paulo

Memórias do Instituto Oswaldo Cruz

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2021, Volume 116 elocation e210280

Abstract: En | Text: En | PDF: En

BACKGROUND Giardia duodenalis is a protozoan parasite that infects humans and other mammals and causes giardiasis worldwide. Giardia is genotyped into eight assemblages (A-H), with assemblages A and B considered zoonotic. OBJECTIVES The aim of this study was to determine the assemblages of G. duodenalis from individuals living in rural and urban areas of the Amazonas State. METHODS 103 human faecal specimens microscopically positive for the presence of Giardia obtained from four municipalities in Amazonas and four animal faecal specimens were genotyped based on the sequences of two genes, triosephosphate isomerase (TPI) and β-giardin (BG). FINDINGS In humans, assemblage A was the most represented with the identification of sub-assemblages AI, AII and AIII based on BG and sub-assemblages AI and AII based on TPI. Similarly, there is a diversity of sub-assemblage B considering BG (B and BIII) and TPI (B, BIII and BIV). In addition, we characterised homogeneous and heterogeneous genotypes comprising assemblages/sub-assemblages A and B in individuals from urban and rural areas. Here, for the first time, it was genotyped Giardia that infects animals from the Brazilian Amazon region. We identified sub-assemblage AI in one Ateles paniscus and two Felis catus and sub-assemblage BIV in one Lagothrix cana. MAIN CONCLUSIONS Therefore, humans and animals from the urban and rural Amazon share Giardia genotypes belonging to assemblages A and B, which are found in cosmopolitan regions around the world.

https://doi.org/10.1590/0074-02760210280

Population-level seropositivity trend for SARS-Cov-2 in Rio Grande do Sul, Brazil
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Barros, Aluísio J D

; Victora, Cesar G

; Menezes, Ana M B

; Horta, Bernardo L

; Barros, Fernando C

; Hartwig, Fernando P

; Victora, Gabriel D

; Vidaletti, Luis Paulo

; Silveira, Mariângela F

; Mesenburg, Marilia A

; Jacques, Nadège

; Struchiner, Cláudio J

; Brust, Flávia Roberta

; Dall’Agnol, Marinel M

; Delamare, Ana Paula Longaray

; François, Carlos Henrique R

; Ikeda, Maria Letícia R

; Pellegrini, Débora C P

; Reuter, Cézane Priscila

; Silva, Shana G da

; Dellagostin, Odir A

; Hallal, Pedro C

Revista de Saúde Pública

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2021, Volume 55 elocation 78

Abstract: En | Text: En | PDF: En

ABSTRACT OBJECTIVE To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.

https://doi.org/10.11606/s1518-8787.2021055004075

Population-level seropositivity trend for SARS-Cov-2 in Rio Grande do Sul, Brazil
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Barros, Aluísio J D

; Victora, Cesar G

; Menezes, Ana M B

; Horta, Bernardo L

; Barros, Fernando C

; Hartwig, Fernando P

; Victora, Gabriel D

; Vidaletti, Luis Paulo

; Silveira, Mariângela F

; Mesenburg, Marilia A

; Jacques, Nadège

; Struchiner, Cláudio J

; Brust, Flávia Roberta

; Dall’Agnol, Marinel M

; Delamare, Ana Paula Longaray

; François, Carlos Henrique R

; Ikeda, Maria Letícia R

; Pellegrini, Débora C P

; Reuter, Cézane Priscila

; Silva, Shana G da

; Dellagostin, Odir A

; Hallal, Pedro C

Revista de Saúde Pública

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2021, Volume 55 elocation 78

Abstract: En | Text: En | PDF: En

https://doi.org/10.11606/s1518-8787.2021055004075

Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study
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Barros, Aluisio J D

; Victora, Cesar G

; Menezes, Ana M B

; Horta, Bernardo L

; Hartwig, Fernando

; Victora, Gabriel

; Pellanda, Lúcia C

; Dellagostin, Odir A

; Struchiner, Claudio J

; Burattini, Marcelo N

; Gonçalves, Marcelo R

; Possuelo, Lia G

; Weber, Liliana P

; Estima, Sonara Lucia

; Jacques, Nadège

; Härter, Jenifer

; Silva, Shana G

; Frizzo, Matias

; Lima, Rosangela C

; Barros, Fernando C

; Silveira, Mariângela F

; Hallal, Pedro C

Revista de Saúde Pública

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2020, Volume 54 elocation 75

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

RESUMO OBJETIVO Descrever práticas de distanciamento social em nove municípios do Rio Grande do Sul por sexo, idade, escolaridade e cidade. MÉTODOS Foram realizados dois estudos transversais sequenciais representativos da população urbana nos municípios de Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria e Uruguaiana com o intuito de estimar a prevalência populacional de Covid-19. Foi aplicado questionário contendo três perguntas sobre distanciamento social, cujas práticas foram submetidas a análises descritivas por subgrupos. Os dados foram comparados por testes qui-quadrado. RESULTADOS Em termos de grau de distanciamento social, 25,8% dos entrevistados relataram estar praticamente isolados e 41,1% indicam praticar bastante distanciamento. Relataram ficar em casa o tempo todo 20,1% dos entrevistados, e 44,5% informam que saem apenas para atividades essenciais. Mais da metade dos domicílios não recebe visitas de não moradores. O grupo que relatou menos distanciamento social foi o de adultos entre 20 e 59 anos, enquanto mais de 80% dos entrevistados com 60 anos ou mais relataram estar praticamente isolados ou fazendo bastante distanciamento. As mulheres relataram fazer mais distanciamento que os homens, e os grupos de maior escolaridade foram os que relataram sair diariamente para atividades regulares com mais frequência. CONCLUSÕES Os grupos mais jovens e mais idosos estão mais protegidos pelo distanciamento social, mas há grupos bastante expostos, o que pode ser um limitador importante no controle da progressão da epidemia de Covid-19.

ABSTRACT OBJECTIVE To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. METHODS Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. RESULTS In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. CONCLUSIONS The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.

https://doi.org/10.11606/s1518-8787.2020054002810

Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study
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Barros, Aluisio J D

; Victora, Cesar G

; Menezes, Ana M B

; Horta, Bernardo L

; Hartwig, Fernando

; Victora, Gabriel

; Pellanda, Lúcia C

; Dellagostin, Odir A

; Struchiner, Claudio J

; Burattini, Marcelo N

; Gonçalves, Marcelo R

; Possuelo, Lia G

; Weber, Liliana P

; Estima, Sonara Lucia

; Jacques, Nadège

; Härter, Jenifer

; Silva, Shana G

; Frizzo, Matias

; Lima, Rosangela C

; Barros, Fernando C

; Silveira, Mariângela F

; Hallal, Pedro C

Revista de Saúde Pública

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2020, Volume 54 elocation 75

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

https://doi.org/10.11606/s1518-8787.2020054002810 994 downloads

Combining capacity and heterosis in eggplant hybrids under high temperatures
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Valadares, Ricardo de N

; A Nóbrega, Danieli

; Lima, Lilian B de

; Silva, Jordana Antônia dos S

; Santos, Ana Maria M dos

; Melo, Roberto de A

; Menezes, Dimas

Horticultura Brasileira

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jul 2019, Volume 37 N. 3 Pages 348 - 353

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

RESUMO Este trabalho teve como objetivo estimar a capacidade combinatória e a heterose de híbridos de berinjela em condições de altas temperaturas. Foram avaliados sete genitores, doze combinações híbridas oriundas de um dialelo parcial e o híbrido Ciça F1 como testemunha. O experimento foi conduzido em casa de vegetação, no delineamento experimental de blocos ao acaso com quatro repetições, de abril a dezembro de 2017. Foram avaliados os caracteres relacionados a altas temperaturas: viabilidade polínica (PV) e índice de pegamento de frutos (FFI) e os caracteres morfoagronômicos: número de frutos por planta (NFP), peso do fruto (FWe), produção por planta (PP), comprimento do fruto (FL), largura do fruto (FWi), relação comprimento/largura do fruto (FLWR) e a altura da planta (PH). Os resultados da análise de variância evidenciaram maior importância dos efeitos gênicos aditivos em relação aos efeitos gênicos não-aditivos na maior parte dos caracteres, exceto para PV. Os genitores CNPH 141, CNPH 135, CNPH 109 e CNPH 51 destacaram-se com efeitos gênicos favoráveis para obtenção de genótipos tolerantes a altas temperaturas, por apresentar boa capacidade geral de combinação (CGC) para os caracteres FFI, NFP e PP. Os híbridos 1x4 e 3x4 apresentaram estimativas positivas tanto para CGC, quanto para capacidade específica de combinação (CEC), demonstrando maior potencial de uso em cruzamentos para incremento do FFI, NFP e PP, sob altas temperaturas. Os híbridos 1x4, 1x5 e 1x6 expressaram heterose positiva para a maioria dos caracteres analisados. O híbrido 1x4 destacou-se com as maiores médias para PV, FFI, NFP e PP. Para o FWe, FL, FWi e FLWR observou-se tanto heterose positiva quanto negativa, consequência da variabilidade fenotípica dos genitores para esses caracteres, o que sugere possibilidade de seleção para diferentes tamanhos e formatos.

ABSTRACT The objective of this work was to estimate the combinatorial capacity and heterosis of eggplant hybrids under high temperature conditions. Seven genitors, twelve hybrid combinations, originated from a partial diallel, and the Ciça F1 hybrid, as control, were evaluated. The experiment was conducted under greenhouse conditions in randomized block design with four replications, from April to December 2017. The assessed traits related to high temperatures were pollen viability (PV) and fruit fixation index (FFI); the morphoagronomic traits were number of fruits per plant (NFP), fruit weight (FWe), production per plant (PP), fruit length (FL), fruit width (FWi), fruit length/width ratio (FLWR) and plant height (PH). The variance analysis showed greater participation of the additive gene effects in relation to the non-additive gene effects in most traits, except for PV. The genitors CNPH 141, CNPH 135, CNPH 109 and CNPH 51 stood out with favorable gene effects to obtain genotypes tolerant to high temperatures, since they present good general combining ability (GCA) for the traits FFI, NFP and PP. The 1x4 and 3x4 hybrids presented positive estimates for both GCA and specific combining ability (SCA), demonstrating a greater potential to be used in breeding to increase the FFI, NFP and PP, under high temperatures. The 1x4, 1x5 and 1x6 hybrids expressed positive heterosis for most analyzed traits. The 1x4 hybrid stood out for the highest averages for PV, FFI, NFP and PP. For FWe, FL, FWi and FLWR, both positive and negative heterosis were observed, as consequence of the phenotypic variability of the genitors for these traits and suggests the possibility of selection for different sizes and formats.

https://doi.org/10.1590/s0102-053620190315 724 downloads

10.

Programas de reabilitação pulmonar em pacientes com DPOC
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Wehrmeister, Fernando César

; Knorst, Marli

; Jardim, José Roberto

; Macedo, Elaine Cardozo

; Noal, Ricardo Bica

; Martínez-Mesa, Jeovany

; González, David Alejandro

; Dumith, Samuel Carvalho

; Maia, Maria de Fátima

; Hallal, Pedro Curi

; Menezes, Ana Maria Baptista

Jornal Brasileiro de Pneumologia

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aug 2011, Volume 37 N. 4 Pages 544 - 555

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

Programas de reabilitação pulmonar visam à melhora do paciente com DPOC em vários aspectos. Esta revisão teve como objetivo avaliar a literatura sobre reabilitação em pacientes com DPOC. Foi realizada uma revisão sistemática incluindo artigos publicados entre 2005 e 2009, indexados em bases de dados nacionais e internacionais e escritos em inglês, espanhol ou português. Os artigos foram classificados segundo o critério da Global Initiative for Chronic Obstructive Lung Disease para nível de evidência científica (grau de recomendação A, B e C). Os desfechos exercício, qualidade de vida, sintomas, exacerbações, mortalidade e função pulmonar foram pesquisados. Os tratamentos foram classificados como reabilitação padrão, reabilitação parcial, exercícios de força e exercícios de resistência. Dos 40 artigos selecionados, 4, 18 e 18 foram classificados com graus A, B e C, respectivamente. Das 181 análises oriundas desses artigos, 61, 50, 23, 23, 20 e 4, respectivamente, foram relacionadas aos desfechos qualidade de vida, exercício, sintomas, exacerbação, função pulmonar e mortalidade. Em todos os desfechos avaliados, os programas de reabilitação padrão tiveram efeitos positivos sobre os desfechos estudados, exceto para mortalidade pelo reduzido número de análises. Entretanto, não foram verificadas diferenças nos efeitos sobre os desfechos estudados quando os diferentes programas de reabilitação foram comparados. Programas de reabilitação pulmonar podem ser considerados importantes ferramentas no arsenal do tratamento da DPOC, merecendo atenção dos gestores em saúde para a implementação de políticas públicas que os incluam como rotina nos serviços de saúde.

Pulmonary rehabilitation programs are aimed at providing benefits to COPD patients, in various aspects. Our objective was to review the literature on COPD patient rehabilitation. This systematic review involved articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). The outcome measures were exercise, quality of life, symptoms, exacerbations, mortality, and pulmonary function. Treatments were classified as standard rehabilitation, partial rehabilitation, strength exercises, and resistance exercises. Of the 40 articles selected, 4, 18, and 18 were classified as grades A, B, and C, respectively. Of the 181 analyses made in these articles, 61, 50, 23, 23, 20, and 4, respectively, were related to the outcome measures quality of life, exercise, symptoms, exacerbations, pulmonary function, and mortality. The standard rehabilitation programs showed positive effects on all of the outcomes evaluated, except for mortality (because of the small number of analyses). However, we found no differences among the various rehabilitation programs regarding their effects on the outcomes studied. Rehabilitation programs can be considered important tools for the treatment of COPD. Therefore, health administrators should implement public policies including such programs in the routine of health care facilities.

39763 downloads Cited 2 times in SciELO

11.

Tratamento farmacológico da DPOC
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Menezes, Ana Maria Baptista

; Macedo, Silvia Elaine Cardozo

; Noal, Ricardo Bica

; Fiterman, Jussara

; Cukier, Alberto

; Chatkin, José Miguel

; Fernandes, Frederico Leon Arrabal

Jornal Brasileiro de Pneumologia

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aug 2011, Volume 37 N. 4 Pages 527 - 543

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

Aproximadamente sete milhões de brasileiros acima de 40 anos são acometidos pela DPOC. Nos últimos anos, importantes avanços foram registrados no campo do tratamento medicamentoso dessa condição. Foi realizada uma revisão sistemática incluindo artigos originais sobre tratamento farmacológico da DPOC publicados entre 2005 e 2009, indexados em bases de dados nacionais e internacionais e escritos em inglês, espanhol ou português. Artigos com tamanho amostral menor de 100 indivíduos foram excluídos. Os desfechos sintomas, função pulmonar, qualidade de vida, exacerbações, mortalidade e efeitos adversos foram pesquisados. Os artigos foram classificados segundo o critério da Global Initiative for Chronic Obstructive Lung Disease para nível de evidência científica (grau de recomendação A, B e C). Dos 84 artigos selecionados, 40 (47,6%), 18 (21,4%) e 26 (31,0%) foram classificados com graus A, B e C, respectivamente. Das 420 análises oriundas desses artigos, 236 referiam-se à comparação de fármacos contra placebo nos diversos desfechos estudados. Dessas 236 análises, os fármacos mais frequentemente estudados foram anticolinérgicos de longa duração, a combinação β2-agonistas de longa duração + corticosteroides inalatórios e corticosteroides inalatórios isolados em 66, 48 e 42 análises, respectivamente. Nas mesmas análises, os desfechos função pulmonar, efeitos adversos e sintomas geraram 58, 54 e 35 análises, respectivamente. A maioria dos estudos mostrou que os medicamentos aliviaram os sintomas, melhoraram a qualidade de vida, a função pulmonar e preveniram as exacerbações. Poucos estudos contemplaram o desfecho mortalidade, e o papel do tratamento medicamentoso nesse desfecho ainda não está completamente definido. Os fármacos estudados são seguros no manejo da DPOC, com poucos efeitos adversos.

Approximately seven million Brazilians over 40 years of age have COPD. In recent years, major advances have been made in the pharmacological treatment of this condition. We performed a systematic review including original articles on pharmacological treatments for COPD. We reviewed articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles with a sample size < 100 individuals were excluded. The outcome measures were symptoms, pulmonary function, quality of life, exacerbations, mortality, and adverse drug effects. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). Of the 84 articles selected, 40 (47.6%), 18 (21.4%), and 26 (31.0%) were classified as grades A, B, and C, respectively. Of the 420 analyses made in these articles, 236 were regarding the comparison between medications and placebos. Among these 236 analyses, the most commonly studied medications (in 66, 48, and 42 analyses, respectively) were long-acting anticholinergics; the combination of long-acting β2 agonists and inhaled corticosteroids; and inhaled corticosteroids in isolation. Pulmonary function, adverse effects, and symptoms as outcomes generated 58, 54, and 35 analyses, respectively. The majority of the studies showed that the medications evaluated provided symptom relief; improved the quality of life and pulmonary function of patients; and prevented exacerbations. Few studies analyzed mortality as an outcome, and the role that pharmacological treatment plays in this outcome has yet to be fully defined. The medications studied are safe to use in the management of COPD and have few adverse effects.

28006 downloads

12.

Consumo abusivo de álcool e fatores associados: estudo de base populacional
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Costa, Juvenal S Dias da

; Silveira, Mariângela F

; Gazalle, Fernando K

; Oliveira, Sandro S

; Hallal, Pedro C

; Menezes, Ana Maria B

; Gigante, Denise P

; Olinto, Maria T A

; Macedo, Silvia

Revista de Saúde Pública

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apr 2004, Volume 38 N. 2 Pages 284 - 291

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

OBJETIVO: Determinar a prevalência e os fatores associados ao consumo abusivo de álcool. MÉTODOS: Estudo transversal de base populacional incluindo 2.177 indivíduos adultos (20 a 69 anos) residentes na zona urbana da cidade de Pelotas, RS. Amostragem em múltiplos estágios. Consumo de álcool abusivo foi definido como mais de 30 g/dia. A análise ajustada foi realizada por regressão logística não condicional. RESULTADOS: A prevalência de consumo abusivo de álcool foi de 14,3%, sendo 29,2% para os homens e 3,7% para as mulheres. Os seguintes grupos apresentaram maior consumo abusivo de álcool após análise ajustada: homens, idosos, indivíduos com pele preta ou parda, de nível social mais baixo, fumantes pesados e que apresentam alguma doença crônica. Somente entre os homens, os que apresentavam distúrbios psiquiátricos menores mostraram maior índice de consumo abusivo e entre as mulheres a relação foi inversa com idade. Constatou-se também que entre os hipertensos, aqueles classificados como consumidores excessivos apresentavam pior controle da doença. CONCLUSÕES: O consumo abusivo de álcool é elevado e acarreta inúmeras conseqüências negativas para a saúde e qualidade de vida dos indivíduos. Os resultados indicam uma alta prevalência de consumo abusivo de álcool e identificam alguns subgrupos da população mais suscetíveis ao alcoolismo.

OBJECTIVE: To determine the prevalence of heavy alcohol consumption and factors associated with it in a Brazilian adult population. METHODS: Cross-sectional population-based study including 2,177 adults (aged 20 to 69), living in the urban area of the municipality of Pelotas, Rio Grande do Sul State, Brazil. The sample was selected in multiple stages. Heavy alcohol consumption was defined as above 30g/day. The adjusted analysis was conducted by logistic regression. RESULTS: The prevalence of heavy alcohol consumption was 14.3% (29.2% among men and 3.7% among women). The following groups presented higher prevalences of heavy alcohol consumption after adjusted analysis: men, elderly people, blacks or mulattoes, heavy smokers, and people who present some kind of chronic disease. Men with minor psychiatric disorders showed higher prevalences of heavy alcohol consumption than other men. Among women, association between age and heavy alcohol consumption was inversely related. Furthermore, the study indicates that among hypertensive subjects, those with heavy alcohol consumption presented worse disease management. CONCLUSIONS: Heavy alcohol consumption is high and results in countless negative consequences for the individual's health and quality of life. Our results highlight the high prevalence of heavy alcohol consumption and indicate subsections of the whole population more susceptible to alcoholism.

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13.

Consumo abusivo de álcool e fatores associados: estudo de base populacional
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Costa, Juvenal S Dias da

; Silveira, Mariângela F

; Gazalle, Fernando K

; Oliveira, Sandro S

; Hallal, Pedro C

; Menezes, Ana Maria B

; Gigante, Denise P

; Olinto, Maria T A

; Macedo, Silvia

Revista de Saúde Pública

Journal Metrics
- Sobre o periódico
- SciELO Analytics

apr 2004, Volume 38 N. 2 Pages 284 - 291

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

15273 downloads

14.

Fatores de risco associados à hospitalização por bronquiolite aguda no período pós-neonatal
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Albernaz, Elaine P

; Menezes, Ana Maria B

; César, Juraci A

; Victora, Cesar G

; Barros, Fernando C

; Halpern, Ricardo

Revista de Saúde Pública

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aug 2003, Volume 37 N. 4 Pages 485 - 493

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

OBJETIVO: Investigar a relação entre fatores socioeconômicos, características maternas, aleitamento e hospitalização por bronquiolite no período pós-neonatal. MÉTODOS: Estudo caso-controle, aninhado a estudo de coorte de 5.304 crianças nascidas na cidade de Pelotas, RS. O estudo de coorte constitui-se de quatro subestudos, cada um com métodos e logística específicos. As mães foram entrevistadas por meio de questionário padronizado, em visitas hospitalares e domiciliares. Foram definidos como casos as crianças com idade entre 28 e 364 dias, que haviam sido hospitalizadas por bronquiolite. RESULTADOS: De 5.304 crianças da coorte, 113 (2,1%) foram hospitalizadas por bronquiolite. A análise multivariada hierarquizada, realizada pela regressão logística, mostrou os seguintes resultados: renda familiar, assim como idade gestacional, estiveram inversamente relacionadas ao risco de hospitalização por bronquiolite. O aleitamento materno desempenhou um fator protetor; crianças com tempo de aleitamento materno inferior a um mês tiveram risco 7 vezes maior de serem hospitalizadas por bronquiolite aguda nos primeiros três meses de vida. O risco de hospitalização por bronquiolite foi 57% maior naquelas expostas ao fumo materno. CONCLUSÕES: A hospitalização por bronquiolite está inversamente relacionada com renda familiar, idade gestacional e tempo de aleitamento materno, e diretamente relacionada com exposição a fumo materno. Não foi evidenciada associação com paridade ou história materna de asma brônquica.

OBJECTIVE: To investigate the relationship between socioeconomic factors, maternal characteristics, breastfeeding, and hospitalization for bronchiolitis in the post-neonatal period. METHODS: A nested case-control study with a cohort of 5,304 children born in the city of Pelotas, Brazil, was conducted. The cohort study consisted of four sub-studies with their own methods and logistics. Mothers were interviewed using a standard questionnaire during in-hospital and home visits. Cases were defined as any child aged 28 to 364 days who had been hospitalized for bronchiolitis. RESULTS: Among 5,304 cohort children, 113 (2.1%) were hospitalized for bronchiolitis. The hierarchical multivariate analysis performed using logistic regression showed the following results: family income and gestational age were inversely associated with the risk of hospitalization for bronchiolitis. Breastfeeding showed to have a protective effect; children who were breastfed for less than one month had 7 times less risk for being hospitalized for acute bronchiolitis in the first three months of life. The risk for hospitalization for bronchiolitis is 57% higher in those exposed to maternal smoking than in those non-exposed. CONCLUSIONS: Hospitalization for acute bronchiolitis is inversely associated with family income, gestational age and duration of breastfeeding and positively associated with maternal smoking. There was not an association with either parity or maternal history of asthma.

7132 downloads

15.

Fatores de risco associados à hospitalização por bronquiolite aguda no período pós-neonatal
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Albernaz, Elaine P

; Menezes, Ana Maria B

; César, Juraci A

; Victora, Cesar G

; Barros, Fernando C

; Halpern, Ricardo

Revista de Saúde Pública

Journal Metrics
- Sobre o periódico
- SciELO Analytics

aug 2003, Volume 37 N. 4 Pages 485 - 493

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

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