ABSTRACT BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.

Resumo: Introdução: A realização de residência médica (RM) é uma vertente de qualificação considerada “padrão ouro” para a especialização médica. A compreensão dos motivos que levam ou não à maior fixação do profissional estimulado pela RM e a identificação dos fatores que dificultam a permanência do médico no local ou contribuem para isso são importantes informações para a estruturação dos programas de RM e sistema de saúde. O objetivo deste estudo foi avaliar a prevalência de fixação dos egressos no estado do Tocantins, após a implantação das residências médicas no período de 2013 a 2017. Método: Trata-se de uma pesquisa observacional do tipo quantitativo, com delineamento transversal, de caráter descritivo e analítico, com uso da técnica telematizada e questionário próprio, realizada com 44 egressos dos programas de RM no estado do Tocantins. O projeto foi revisado e aprovado pelo Comitê de Ética da Universidade Federal do Tocantins (UFT) sob o Parecer nº 2.292.540. Resultados: A prevalência de fixação foi de 65,9% dos médicos no estado do Tocantins. A maioria dos residentes era do sexo feminino (59,1%), com idade média de 30,8±3,1 anos e renda entre dez e 20 salários mínimos (55,8%), e trabalhou durante a residência (84,1%). As especialidades com maior índice de fixação foram as cirurgias geral e médica. No caso desse estudo, a maioria dos participantes atua nas redes privada e estadual. O principal motivo para não fixação no Tocantins foi cursar outra residência ou subespecialidade em outro estado (64,7%). Conclusão: A prevalência de fixação das RMs no Tocantins no período analisado pode ser considerada alta (65,9%). O perfil de feminização, o juvenescimento e o motivo da não fixação dos egressos são importantes indicadores para serem analisados em conjunto com o processo de fixação e oferta de vagas nas especialidades disponibilizadas no Tocantins. Os resultados do estudo apontaram uma perspectiva favorável e estratégica dos Programas de Residência Médica (PRM) na fixação de médico no Tocantins, o que não pode ser generalizado para a realidade de um sistema de saúde tão desigual no país. Um maior investimento público na estruturação dos serviços da rede de saúde, em especial na rede municipal, na organização de apoio e no desenvolvimento socioeconômico das cidades é necessário.

Abstract: Introduction: The accomplishment of medical residency (MR) is a type of qualification considered to be the “gold standard” for medical specialization. Understanding whether there is actually greater professional settlement or not stimulated by MR and which factors hinder or contribute to the physician’s permanence in that place, are important information for the structuring of medical residency and health system programs. The aim of this study was to evaluate the prevalence of settlement of medical residents who finished the residency training in the state of Tocantins, after the implementation of medical residency programs in the period from 2013 to 2017. Method: This is an observational quantitative research, with a cross-sectional, descriptive and analytical design, using the telematic technique and its own questionnaire, carried out with 44 medical residents that finished the medical residency program in the state of Tocantins. The project was reviewed and approved by the Ethics Committee of the Federal University of Tocantins (UFT) under Opinion number 2.292.540. Results: The prevalence of settlement was 65.9% of physicians in the state of Tocantins. Most residents were females (59.1%), with a mean age of 30.8 ± 3.1 years, income between 10 and 20 minimum wages (55.8%) and worked during their residency training (84.1%). The specialties that showed the highest settlement rates were general surgery and clinical medicine, and among these, the majority works for the private and state health networks. The main reason for not settling in Tocantins was to attend another residency or subspecialty program in another state (64.7%). Conclusion: The prevalence of medical residents that finished the residency and settled in Tocantins during the analyzed period can be considered high (65.9%). The fact that most of these individuals are young and female and the reason for not settling in the state are important indicators to be analyzed together with the settlement process and the offering of positions in the specialties available in Tocantins. The results of the study indicated a favorable and strategic perspective of the Medical Residency Programs (MRP) in the medical settlement in Tocantins, which cannot be generalized to the reality of such an unequal health system in the country. A larger public investment in the structuring of health network services is necessary, especially in the municipal network, in the organization of support and socioeconomic development of cities.

ABSTRACT CONTEXT AND OBJECTIVE: Few studies have assessed the impact of medical residencies on the public healthcare system. The aim here was to assess the number of specialists who remained in the state of Tocantins after finishing the medical residency program during the first two years of the first programs (2013 and 2014). DESIGN AND SETTING: Cross-sectional and exploratory study conducted at the Federal University of Tocantins in Brazil. METHODS: All graduates of medical residency programs in Tocantins, of the years 2013 and 2014, were interviewed by telephone and e-mail between May and July 2014. RESULTS: Information was obtained from 37 graduates from medical residency. Seventeen (50.0%) were working in the state public healthcare system and only six (17.6%) in a municipal service in June 2014. Considering only the 24 doctors who had never worked in the state of Tocantins before their residency, it was observed that two who graduated in 2013 (20.0%) and five who graduated in 2014 (35.7%), i.e. seven out of the total number (29.2%), had established their homes in Tocantins. CONCLUSIONS: The number of graduates from medical residency who stayed in the state of Tocantins in 2013 and 2014 was small. However, this was related to the absence of other programs for continuation of the specialization. The state healthcare system was primarily responsible for employment of these doctors within public services. On the other hand, hiring by municipal services was extremely low.

RESUMO CONTEXTO E OBJETIVO: A relação entre os hormônios sexuais e a asma tem sido investigada em diversos estudos. Esta revisão tem como objetivo descrever a relação entre hormônios sexuais (endógenos e exógenos) e a inflamação nas vias aéreas, especialmente na asma, em eventos diferentes (na asma pré-menstrual, durante o uso de anticoncepcionais, na menopausa, no uso de terapia hormonal e na gestação). TIPO DE ESTUDO E LOCAL: Revisão narrativa da literatura médica, Universidade Federal do Tocantins (UFT) e Universidade Federal de São Paulo (Unifesp). MÉTODO: Pesquisamos o Portal de Periódicos Capes, uma plataforma brasileira que fornece acesso a artigos nas bases de dados MEDLINE, PubMed, SciELO e LILACS. Os descritores utilizados foram asma, hormônios sexuais, mulheres e uso de anticoncepcionais, com base no "Medical Subject Headings". RESULTADOS: As associações entre hormônios sexuais e asma ainda permanecem obscuras. Em adultos, a asma é mais frequente em mulheres do que em homens. Além disso, a mortalidade por asma é significativamente maior no sexo feminino, destacando-se que o sistema imunológico sofre influência de hormônios sexuais, seja porque a progesterona estimula o fator bloqueador induzido pela progesterona e citocinas Th2 ou porque contraceptivos derivados de progesterona e estrógeno estimulam o fator de transcrição GATA-3. CONCLUSÕES: A associação entre asma e hormônios sexuais femininos permanece obscura. Nós especulamos que as flutuações do estrogênio são responsáveis pelas exacerbações da asma que ocorrem nas mulheres. Devido à ação anti-inflamatória do estrogênio há redução da produção de TNF-α, da expressão do interferon-γ e da atividade das células NK. Sugerimos que sejam realizados novos estudos para esclarecer os mecanismos fisiopatológicos dessas interações.

ABSTRACT CONTEXT AND OBJECTIVE: The relationship between sex hormones and asthma has been evaluated in several studies. The aim of this review article was to investigate the association between asthma and female sex hormones, under different conditions (premenstrual asthma, use of oral contraceptives, menopause, hormone replacement therapy and pregnancy). DESIGN AND SETTING: Narrative review of the medical literature, Universidade Federal do Tocantins (UFT) and Universidade Federal de São Paulo (Unifesp). METHODS: We searched the CAPES journal portal, a Brazilian platform that provides access to articles in the MEDLINE, PubMed, SciELO, and LILACS databases. The following keywords were used based on Medical Subject Headings: asthma, sex hormones, women and use of oral contraceptives. RESULTS: The associations between sex hormones and asthma remain obscure. In adults, asthma is more common in women than in men. In addition, mortality due to asthma is significantly higher among females. The immune system is influenced by sex hormones: either because progesterone stimulates progesterone-induced blocking factor and Th2 cytokines or because contraceptives derived from progesterone and estrogen stimulate the transcription factor GATA-3. CONCLUSIONS: The associations between asthma and female sex hormones remain obscure. We speculate that estrogen fluctuations are responsible for asthma exacerbations that occur in women. Because of the anti-inflammatory action of estrogen, it decreases TNF-α production, interferon-γ expression and NK cell activity. We suggest that further studies that highlight the underlying physiopathological mechanisms contributing towards these interactions should be conducted.