OBJECTIVE: To evaluate the impact of a complex-care-based medical school in the context of the Brazilian health care system on students’ career choices. METHODS: This was a retrospective cross-sectional study based on medical regulatory organization records. It included records for 7,419 physicians who graduated from FMUSP. Geographic data were analyzed using Kernel maps, and the statistical analysis was performed with SPSS® version 24.0. A p-value less than 0.05 was considered significant. RESULTS: Of the 7,419 physicians, 68.6% (95% CI 67.5-69.7) were male, and 20.7% (95% CI 19.8%-21.7%) had no medical specialty, compared to 46.4% nationwide. Internal medicine and surgery-based specialties were more popular, accounting for 39.4% (95% CI 38.3%-40.5%) and 16.8% (95% CI 15.5%-17.6%) of our study group, compared to the Brazilian averages of 25.9% and 13.5%. Our graduates also had a higher probability of staying in São Paulo City, especially when born outside the city. CONCLUSION: We believe that FMUSP remains an interesting model for studying the impact of a highly specialized center on the education and career choices of medical students.

Abstract Background The infectious diseases specialist is a medical doctor dedicated to the management of infectious diseases in their individual and collective dimensions. Objectives The aim of this paper was to evaluate the current profile and distribution of infectious diseases specialists in Brazil. Methods This is a cross-sectional study using secondary data obtained from institutions that register medical specialists in Brazil. Variables of interest included gender, age, type of medical school (public or private) the specialist graduated from, time since finishing residency training in infectious diseases, and the interval between M.D. graduation and residency completion. Maps are used to study the geographical distribution of infectious diseases specialists. Results A total of 3229 infectious diseases specialist registries were counted, with 94.3% (3045) of individual counts (heads) represented by primary registries. The mean age was 43.3 years (SD 10.5), and a higher proportion of females was observed (57%; 95% CI 55.3–58.8). Most Brazilian infectious diseases specialists (58.5%) practice in the Southeastern region. However, when distribution rates were calculated, several states exhibited high concentration of infectious diseases specialists, when compared to the national rate (16.06). Interestingly, among specialists working in the Northeastern region, those trained locally had completed their residency programs more recently (8.7 yrs; 95% CI 7.9–9.5) than physicians trained elsewhere in the country (13.6 yrs: 95% CI 11.8–15.5). Conclusion Our study shows that Brazilian infectious diseases specialists are predominantly young and female doctors. Most have concluded a medical residency training program. The absolute majority practice in the Southeastern region. However, some states from the Northern, Northeastern and Southeastern regions exhibit specialist rates above the national average. In these areas, nonetheless, there is a strong concentration of infectious diseases specialists in state capitals and in metropolitan areas.

OBJETIVO: Avaliar a associação entre consumo alimentar e presença de obesidade abdominal em indivíduos infectados pelo HIV/Aids, em uso de terapia antiretroviral de alta potência. MÉTODOS: Trata-se de estudo transversal envolvendo 223 indivíduos adultos, realizado no município de São Paulo, em 2002. A população de estudo foi classificada de acordo com a obesidade abdominal, definida pela razão das circunferências da cintura e quadril >0,95 para os homens e >0,85 para mulheres. As variáveis dietéticas estudadas foram consumo de energia (calorias e calorias/quilo de peso corporal), macronutrientes (em gramas e % da energia ingerida), fibra total (gramas) e consumo de frutas, verduras e legumes (gramas). Potenciais fatores de confusão examinados foram sexo, raça, idade, escolaridade, renda, índice de massa corporal, nível de atividade física, tabagismo, contagem de linfócitos T CD4+ e tempo de uso de inibidor de protease. Estimou-se modelo de regressão logística para avaliar a relação entre obesidade abdominal e consumo alimentar. RESULTADOS: A prevalência de obesidade abdominal foi de 45,7% e esteve associada ao maior consumo de lipídeos: para cada aumento de 10 g de lipídio na dieta a chance aumentou 1,28 vezes. O consumo de carboidratos mostrou-se negativamente associado (OR=0,93) com a presença de obesidade abdominal após ajuste pelas variáveis de controle. CONCLUSÕES: Os resultados sugerem que a quantidade de carboidratos e lipídeos na dieta, independente do consumo energético, pode modificar a chance de desenvolver obesidade abdominal na população estudada. Intervenções nutricionais podem ser benéficas na prevenção de obesidade abdominal entre pacientes vivendo com HIV/Aids.

OBJECTIVE: To assess the association between dietary intake and central obesity among people living with HIV/AIDS and receiving highly active antiretroviral therapy. METHODS: A cross-sectional study was conducted involving 223 adult individuals in the city of São Paulo city in 2002. The study population was classified according to central obesity, defined as waist-to-hip ratio >0.95 for men and >0.85 for women. The dietary variables studied were energy consumption (in calories and calories/kilo of body weight), macronutrients (in grams and % of energy intake), total fiber (grams) and fruit and vegetables intake (grams). The potential confounders examined were sex, skin color, age, schooling, income, body mass index, physical activity, smoking habits, peripheral CD4+ T lymphocyte count and length of protease inhibitor use. The multiple logistic regression model was performed in order to evaluate the association between central obesity and dietary intake. RESULTS: The prevalence of central obesity was 45.7% and it was associated with greater consumption of lipids: for every increase of 10g of lipid intake the odds of central obesity increased 1.28 times. Carbohydrate consumption showed negative association (OR=0.93) with central obesity after adjustment for control variables. CONCLUSIONS: The results suggest that the amount of carbohydrates and lipids in the diet, regardless of total energy intake, may modify the chance of developing central obesity in the studied population. Nutritional interventions may be beneficial for preventing central obesity among HIV/AIDS patients.

OBJETIVO: Avaliar a associação entre consumo alimentar e presença de obesidade abdominal em indivíduos infectados pelo HIV/Aids, em uso de terapia antiretroviral de alta potência. MÉTODOS: Trata-se de estudo transversal envolvendo 223 indivíduos adultos, realizado no município de São Paulo, em 2002. A população de estudo foi classificada de acordo com a obesidade abdominal, definida pela razão das circunferências da cintura e quadril >0,95 para os homens e >0,85 para mulheres. As variáveis dietéticas estudadas foram consumo de energia (calorias e calorias/quilo de peso corporal), macronutrientes (em gramas e % da energia ingerida), fibra total (gramas) e consumo de frutas, verduras e legumes (gramas). Potenciais fatores de confusão examinados foram sexo, raça, idade, escolaridade, renda, índice de massa corporal, nível de atividade física, tabagismo, contagem de linfócitos T CD4+ e tempo de uso de inibidor de protease. Estimou-se modelo de regressão logística para avaliar a relação entre obesidade abdominal e consumo alimentar. RESULTADOS: A prevalência de obesidade abdominal foi de 45,7% e esteve associada ao maior consumo de lipídeos: para cada aumento de 10 g de lipídio na dieta a chance aumentou 1,28 vezes. O consumo de carboidratos mostrou-se negativamente associado (OR=0,93) com a presença de obesidade abdominal após ajuste pelas variáveis de controle. CONCLUSÕES: Os resultados sugerem que a quantidade de carboidratos e lipídeos na dieta, independente do consumo energético, pode modificar a chance de desenvolver obesidade abdominal na população estudada. Intervenções nutricionais podem ser benéficas na prevenção de obesidade abdominal entre pacientes vivendo com HIV/Aids.

OBJECTIVE: To assess the association between dietary intake and central obesity among people living with HIV/AIDS and receiving highly active antiretroviral therapy. METHODS: A cross-sectional study was conducted involving 223 adult individuals in the city of São Paulo city in 2002. The study population was classified according to central obesity, defined as waist-to-hip ratio >0.95 for men and >0.85 for women. The dietary variables studied were energy consumption (in calories and calories/kilo of body weight), macronutrients (in grams and % of energy intake), total fiber (grams) and fruit and vegetables intake (grams). The potential confounders examined were sex, skin color, age, schooling, income, body mass index, physical activity, smoking habits, peripheral CD4+ T lymphocyte count and length of protease inhibitor use. The multiple logistic regression model was performed in order to evaluate the association between central obesity and dietary intake. RESULTS: The prevalence of central obesity was 45.7% and it was associated with greater consumption of lipids: for every increase of 10g of lipid intake the odds of central obesity increased 1.28 times. Carbohydrate consumption showed negative association (OR=0.93) with central obesity after adjustment for control variables. CONCLUSIONS: The results suggest that the amount of carbohydrates and lipids in the diet, regardless of total energy intake, may modify the chance of developing central obesity in the studied population. Nutritional interventions may be beneficial for preventing central obesity among HIV/AIDS patients.

OBJETIVO: Avaliar o estado nutricional de indivíduos portadores do HIV/AIDS em uso de terapia anti-retroviral de alta potência, segundo sexo e número de linfócitos T CD4.+. MATERIAL E MÉTODOS: Estudo transversal envolvendo 223 indivíduos (171 homens e 52 mulheres) tratados com inibidores de protease, com idade entre 20 e 59 anos, recrutados em um serviço de referência em tratamento de HIV/AIDS do município de São Paulo. Os dados antropométricos utilizados foram peso, estatura e circunferência da cintura (CC). O índice de massa corporal (IMC) foi calculado como a razão entre peso (kg) e estatura ao quadrado (m²), de acordo com o critério de classificação proposto pela Organização Mundial de Saúde. Os pacientes foram divididos em três categorias por número de linfócitos T CD4.+: < 200, 201 - 349 e > 350 (cel/mm³). RESULTADOS: A prevalência de sobrepeso na população foi de 30,5%, e de obesidade abdominal de 12,6%. As mulheres apresentaram prevalência maior de sobrepeso (36,5%) e de obesidade abdominal (32,7%) quando comparadas aos homens (28,7% e 6,4% respectivamente). A prevalência de baixo peso foi maior nas mulheres (7,7%) do que nos homens (2,3%). Ausência de associação significativa entre sobrepeso, obesidade abdominal e número de linfócitos T CD4.+ foi observada tanto nos homens como nas mulheres. CONCLUSÃO: As mulheres apresentaram prevalências maiores de baixo peso, sobrepeso e obesidade abdominal em relação aos homens. A obesidade é o desvio do estado nutricional mais importante, superando a desnutrição, nesta população de indivíduos portadores do HIV/AIDS em uso de terapia anti-retroviral de alta potência.

OBJECTIVE: To evaluate the nutritional status of HIV/AIDS patients treated with highly active antiretroviral therapy, according to gender and T CD4 + lymphocyte count. MATERIAL AND METHODS: This was a cross-sectional study, including 223 individuals (171 men and 52 women) treated with protease inhibitors, aged between 20 and 59 years. This study was developed at a HIV/AIDS reference treatment center in the city of São Paulo. Anthropometric data, including current weight, height, and waist circumference (WC) were collected. The body mass index (BMI) was calculated as the ratio between weight (kg) and the square of the height (m²), according to World Health Organization classification criteria. Patients were divided into three groups according to T CD4+ lymphocyte count: < 200, 201-349, and > 350 (cel/mm³). RESULTS: The prevalence of overweight was 30.5% and of central obesity was 12.6%. Women presented a higher prevalence of overweight (36.5%) and of central obesity (32.7%) when compared to men (28.7% and 6.4% respectively). The prevalence of underweight was higher among women than in men, respectively 7.7% and 2.3%. Categories of T CD4 + lymphocyte counts were not associated with overweight and central obesity in this population. CONCLUSION: Women presented a higher prevalence of underweight, overweight and central obesity in relation to men. Obesity is the most important deviation of nutritional status, overcoming malnutrition, in these HIV/AIDS patients treated with highly active antiretroviral therapy.

OBJETIVO: Avaliar o estado nutricional de indivíduos portadores do HIV/AIDS em uso de terapia anti-retroviral de alta potência, segundo sexo e número de linfócitos T CD4.+. MATERIAL E MÉTODOS: Estudo transversal envolvendo 223 indivíduos (171 homens e 52 mulheres) tratados com inibidores de protease, com idade entre 20 e 59 anos, recrutados em um serviço de referência em tratamento de HIV/AIDS do município de São Paulo. Os dados antropométricos utilizados foram peso, estatura e circunferência da cintura (CC). O índice de massa corporal (IMC) foi calculado como a razão entre peso (kg) e estatura ao quadrado (m²), de acordo com o critério de classificação proposto pela Organização Mundial de Saúde. Os pacientes foram divididos em três categorias por número de linfócitos T CD4.+: < 200, 201 - 349 e > 350 (cel/mm³). RESULTADOS: A prevalência de sobrepeso na população foi de 30,5%, e de obesidade abdominal de 12,6%. As mulheres apresentaram prevalência maior de sobrepeso (36,5%) e de obesidade abdominal (32,7%) quando comparadas aos homens (28,7% e 6,4% respectivamente). A prevalência de baixo peso foi maior nas mulheres (7,7%) do que nos homens (2,3%). Ausência de associação significativa entre sobrepeso, obesidade abdominal e número de linfócitos T CD4.+ foi observada tanto nos homens como nas mulheres. CONCLUSÃO: As mulheres apresentaram prevalências maiores de baixo peso, sobrepeso e obesidade abdominal em relação aos homens. A obesidade é o desvio do estado nutricional mais importante, superando a desnutrição, nesta população de indivíduos portadores do HIV/AIDS em uso de terapia anti-retroviral de alta potência.

OBJECTIVE: To evaluate the nutritional status of HIV/AIDS patients treated with highly active antiretroviral therapy, according to gender and T CD4 + lymphocyte count. MATERIAL AND METHODS: This was a cross-sectional study, including 223 individuals (171 men and 52 women) treated with protease inhibitors, aged between 20 and 59 years. This study was developed at a HIV/AIDS reference treatment center in the city of São Paulo. Anthropometric data, including current weight, height, and waist circumference (WC) were collected. The body mass index (BMI) was calculated as the ratio between weight (kg) and the square of the height (m²), according to World Health Organization classification criteria. Patients were divided into three groups according to T CD4+ lymphocyte count: < 200, 201-349, and > 350 (cel/mm³). RESULTS: The prevalence of overweight was 30.5% and of central obesity was 12.6%. Women presented a higher prevalence of overweight (36.5%) and of central obesity (32.7%) when compared to men (28.7% and 6.4% respectively). The prevalence of underweight was higher among women than in men, respectively 7.7% and 2.3%. Categories of T CD4 + lymphocyte counts were not associated with overweight and central obesity in this population. CONCLUSION: Women presented a higher prevalence of underweight, overweight and central obesity in relation to men. Obesity is the most important deviation of nutritional status, overcoming malnutrition, in these HIV/AIDS patients treated with highly active antiretroviral therapy.