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Aim: To investigate the level of self-reported work ability and its association with manual patient handling in healthcare workers. Design: Cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Methods: A total of 320 healthcare workers answered a self-administered questionnaire regarding manual patient handling, work ability, occupational factors, occurrence of low back pain and sociodemographic and lifestyle factors from November 2016 to March 2017. The association between manual patient handling and low back pain was analysed with Poisson regression models. Results: The prevalence ratio of inadequate work ability was 43.42%. Manual patient handling (PR 1.375, 95% CI 1.038–1.821), bachelor education (PR 2.150, 95% CI 1.272–3.632), less than bachelor education (PR 2.166, 95% CI 1.218–3.855), seniority (PR 1.049, 95% CI 1.024–1.086), poor sleep quality (PR 1.425, 95% CI 1.13–1.796) and presence of low back pain (PR 2.003, 95% CI 1.314–3.052) were all positively associated with an inadequate work ability., Funding for open access charge: Universidad de Huelva/CBUA

OBJECTIVE: To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of Sao Paulo, Brazil. METHODS: A total of 157 primary care services from five health regions in midwestern Sao Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults' care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS: Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults' care. CONCLUSIONS: The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care. OBJETIVO: Avaliar o desempenho da atenção integral ao idoso em serviços de atenção primária do Sistema Único de Saúde no estado de São Paulo, Brasil. MÉTODOS: Um total de 157 serviços de atenção primária de cinco regiões de saúde do centro-oeste paulista respondeu, de outubro a dezembro de 2014, o instrumento pré-validado Questionário de Avaliação e Monitoramento de Serviços de Atenção Básica 2014. Foram selecionadas 155 questões, com base nas políticas e diretrizes nacionais sobre essa temática. As respostas indicam o desempenho do serviço na atenção ao idoso, agrupadas em três domínios de análise: atenção à saúde para o envelhecimento ativo e saudável (45 indicadores, d1), atenção às doenças crônicas não transmissíveis (89 indicadores, d2) e rede de apoio na atenção ao envelhecimento (21 indicadores, d3). A medida de desempenho foi a soma de respostas positivas (valor 1) ou negativas (valor 0) para cada indicador. Os serviços foram agrupados segundo k-médias dos escores de desempenho de cada um dos domínios. Após a ponderação dos domínios (testes Z), foram estimadas as associações entre os escores de cada domínio e variáveis independentes de gestão (tipologia, planejamento e avaliação dos serviços), por meio de regressão linear simples e múltipla. RESULTADOS: A atenção às doenças crônicas não transmissíveis (d2) mostrou, para todos os agrupamentos, melhor desempenho médio (55,7) do que os domínios d1 (35,4) e d3 (39,2). O desempenho do serviço na área geral de planejamento e avaliação esteve associado ao desempenho da atenção ao idoso. CONCLUSÕES: Os serviços avaliados apresentaram implementação incipiente da atenção integral ao idoso. O quadro avaliativo pode contribuir para processos de melhoria da qualidade da atenção primária à saúde. publishersversion published

Made available in DSpace on 2021-06-25T10:33:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Background. Reference symphysis-fundal height (SFH) curves for pregnancies complicated by maternal hyperglycemia are not available. Objective. To build an SFH curve according to gestational age for pregnant women with hyperglycemia-type 2 diabetes (T2DM), gestational diabetes mellitus (GDM), or mild gestational hyperglycemia (MGH) and compare it with three other curves in use in Brazil. Methods. Prospective cohort study of 422 pregnant women with hyperglycemia attending the Perinatal Diabetes Research Center (PDRC) of Botucatu Medical School, São Paulo State University/UNESP. Between 13 and 41 weeks of pregnancy, 2470 SFH measurements were obtained (mean 5.85 per woman). For the assessment of glycemic control, 2074 glucose level measurements were taken and the glycemic mean (GM) at each gestational week was estimated. Results. GM was adequate (

Women presenting with advanced breast cancer tumors are common in Brazil. Little is known about factors contributing to the delay in seeking care. The aim of this study was to identify factors associated with longer time intervals between the onset of breast cancer symptoms and the first medical visit in the Federal District, Brazil. The analysis included 444 symptomatic women with incident breast cancer, interviewed between September, 2012 and September, 2014, during their admission for breast cancer treatment in nine public hospitals in the Federal District. Patients with metastatic disease at diagnosis were not included in this study. The outcome was time interval between symptom onset and the first medical visit, whether > 90 (34% of patients) or ≤ 90 days. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI). In the multivariate analysis, the > 90 day interval was significantly associated with patients not performing mammography and/or breast ultrasound in the two years prior to breast cancer diagnosis (OR = 1.97; 95%CI: 1.26-3.08), and with more advanced stages (OR = 1.72; 95%CI: 1.10-2.72). Furthermore, there was a lower chance of delay in patients with higher levels of education (OR = 0.95; 95%CI: 0.91-0.99). A relatively high proportion of breast cancer patients in the Brazilian Federal District experienced delay to attend the first medical consultation after the symptoms onset. Increasing breast cancer awareness, especially among women with low educational levels and those not participating in mammography screening programs could contribute to reduce this delay. São comuns no Brasil os casos de mulheres com tumores de mama em estágio avançado ao diagnóstico inicial. Há pouca informação sobre os fatores que contribuem para a demora na busca de atendimento. O estudo teve como objetivo identificar os fatores associados a intervalos mais longos entre o início dos sintomas do câncer de mama e a primeira consulta médica no Distrito Federal, Brasil. A análise incluiu 444 mulheres sintomáticas com diagnóstico de câncer de mama, entrevistadas entre setembro de 2012 e setembro de 2014, durante a internação para o tratamento do câncer em nove hospitais públicos no Distrito Federal. As pacientes com doença metastática ao diagnóstico não foram incluídas no estudo. A variável de desfecho era o intervalo entre o início dos sintomas e a primeira consulta médica, sendo classificada como > 90 dias (34% das pacientes) ou ≤ 90 dias. Foi usada regressão logística para estimar os odds ratios (OR) e intervalos de 95% de confiança (IC95%). Na análise multivariada, o intervalo de > 90 dias mostrou associação significativa com a falta de mamografia e/ou de ultrassom mamário nos dois anos anteriores ao diagnóstico de câncer de mama (OR = 1,97; IC95%: 1,26-3,08), e com estágios mais avançados da doença (OR = 1,72; IC95%: 1,10-2,72). Além disso, houve probabilidade menor de demora em pacientes com maior escolaridade (OR = 0,95; IC95%: 0,91-0,99). Uma proporção relativamente alta de pacientes com câncer de mama no Distrito Federal sofreram demora na primeira consulta médica após o início dos sintomas. Uma maior conscientização sobre câncer de mama, principalmente entre mulheres com menores níveis de escolaridade e aquelas que não participam em programa de rastreamento com mamografia, pode contribuir para a redução dessa demora. Las mujeres que presentan tumores avanzados de cáncer de mama son comunes en Brasil. Se sabe poco sobre los factores que contribuyen al retraso en la búsqueda de atención. El objetivo de este estudio fue identificar los factores asociados a los intervalos de tiempo más largos entre la aparición de los síntomas de cáncer de pecho y la primera visita médica en el Distrito Federal, Brasil. El análisis incluyó a 444 mujeres con síntomas de cáncer de pecho, que fueron entrevistadas entre septiembre 2012 y septiembre 2014, durante el tratamiento de cáncer de mama en nueve hospitales públicos del Distrito Federal. Pacientes con enfermedad metastásica en el diagnóstico no estuvieron incluidos en este estudio. El resultado fue el intervalo de tiempo entre la aparición de los síntomas y la primera visita médica, si > 90 (34% de pacientes) o ≤ 90 días. La regresión logística se usó para estimar odds ratios (OR) y los intervalos de 95% de confianza (IC95%). En el análisis multivariado, los > 90 días de intervalo estuvieron significativamente asociados con pacientes que no se realizaron mamografías y/o ultrasonidos en el pecho en los dos años previos al diagnóstico de cáncer de mama (OR = 1.97; 95%CI: 1.26-3.08), y en estadios más avanzados (OR = 1.72; 95%CI: 1.10-2.72). Además, hubo una probabilidad más baja de retraso en pacientes con niveles más altos de educación (OR = 0.95; 95%CI: 0.91-0.99). Una proporción relativamente alta de pacientes con cáncer de pecho en el Distrito Federal sufrieron retrasos para realizar las primeras consultas médicas tras la aparición de los síntomas. El aumento de la concienciación sobre el cáncer de mama, especialmente entre mujeres con bajo nivel educacional y quienes no participaron en programas de mamografías pudieron contribuir a la reducción de este retraso.

To describe the characteristics of the management process in primary health care units as well as the profile of managers, and to discuss the implications of these elements for the attainment of Unified Health System principles in Brazil in accordance with the propositions of the Alma-Ata Declaration.This descriptive, cross-sectional study used data collected with the Primary Care Service Quality Assessment tool (QualiAB), a self-administered, web-based instrument. QualiAB was voluntarily answered by 157 unit managers from 41 municipalities in the state of São Paulo from October to December 2014.Of 157 units, 67 (42.7%) were family health care units and 58 (36.9%) were "traditional" units; 95 (60.5%) were located in urban peripheries. At the time of the study, eight (5.0%) units did not have a manager and eight (5.0%) were managed by the city health secretary. Almost 80% of the managers were nurses and performed multiple tasks in addition to management. Multidisciplinary support (technical supervision as a means of continuing education) was available in 75 (47.7%) units; 60 (38.2%) units did not have any kind of multidisciplinary support. Participation in evaluative processes was mentioned in 130 (82.8%) units. The main results of evaluations were planning and reprogramming of activities with the engagement of the multiprofessional team in 40 units (25.5%) and definition of an annual activity plan in 38 (24.2%). Twenty-nine units (17.8%) did not have access to the results of evaluations.The study supports the importance of work process management and the need to (re)invest in training and recognition of local management as a strategy to produce primary health care that is capable of promoting health as a right and a condition of citizenship.Describir las características de la gestión de las unidades de atención primaria de salud y el perfil de los gerentes, y analizar las implicaciones de esos elementos en la puesta en práctica de los principios del Sistema Único de Salud de Brasil de forma coherente con las propuestas de Alma- Ata.Estudio descriptivo, transversal, con datos recolectados a través del cuestionario de Evaluación de la Calidad de Servicios de Atención Básica (QualiAB), un instrumento autoadministrado a través de Internet. En total 157 gerentes de Unidades Básicas de Salud de 41 municipios del estado de São Paulo respondieron voluntariamente el QualiAB entre octubre y diciembre de 2014.De las 157 unidades, 67 (42,7%) eran unidades salud de la familia y 58 (36,9%) eran unidades básicas de salud de organización “tradicional”; 95 (60,5%) estan ubicadas en una región urbana periférica. En el momento del estudio, ocho (5,0%) unidades no poseían gerente y ocho (5,0%) eran gestionadas por secretarios municipales de salud. Casi el 80% de los gerentes eran enfermeros y desempeñaban múltiples funciones además de la gerencia. En 75 (47,7%) unidades se disponía de apoyo multidisciplinario (supervisión técnica como forma de educación permanente); 60 (38,2%) unidades no contaban con ningún tipo de apoyo multidisciplinario. La participación en procesos de evaluación fue referida por 130 (82,8%) servicios. Las principales modificaciones inducidas por las evaluaciones fueron la planificación y reprogramación de las actividades con participación del equipo multiprofesional en 40 unidades (25,5%) y la definición de un plan anual de actividades en 38 (24,2%). No tuvieron acceso a los resultados de las evaluaciones 29 unidades (17,8%).El estudio subraya la importancia de la gestión del trabajo y la necesidad de reinvertir en la formación y valorización de la gestión local como estrategia para hacer efectiva una atención primaria de salud capaz de promover la salud como derecho y condición de ciudadanía.

The aim was to assess the association between the organizational quality of children's healthcare in primary care services and variables in the management context. An evaluative survey in 151 primary care services in 40 municipalities (counties) in the interior of the State of São Paulo, Brazil, answered the QualiAB in 2014. Services were scored according to 41 children's health indicators which comprised quality groups distributed by quartiles and were associated with 17 management indicators. The following were not associated with the quality groups: participation in the More Doctors Program/Provab-Médico (p = 0.102), availability of social services (p = 0.315), and high-risk pregnancy (p = 0.814). The association was significant for all the others. Although for some variables, groups G1 and G2 were similar to the more polar groups (G0 and G3), the latter showed differences in all the variables. The services belonging to the group considered as having the best quality (G3) were mostly organized in the Family Health Unit/Mixed model (p = 0.018), administered under outsourced management (p0.001), regularly supplied prenatal care (p0.001), had a general practitioner or family physician available on a 24/7 basis (p = 0.009), and had a support network consisting mainly of CAPSi and CAPSAd III and children's health services (p0.001). They also reported holding weekly team meetings (p0.001), studying cases of spontaneous demand (p0.001), and changing the management and organization of care based on the evaluative process (p = 0.004). In conclusion, organizational quality does not depend only on practices by health professionals, but also on administrators' decisions.Objetivou-se avaliar a associação da qualidade organizacional da atenção à saúde da criança em serviços de atenção primária à saúde (APS) com variáveis de contexto gerencial. Realizou-se pesquisa avaliativa em 151 serviços de APS de 40 municípios do interior do Estado de São Paulo, Brasil, que responderam ao QualiAB em 2014. Pontuaram-se os serviços conforme 41 indicadores de saúde da criança que, após constituírem grupos de qualidade distribuídos por quartis, foram associados a 17 indicadores de gestão. Os seguintes indicadores não apresentaram associação com os grupos de qualidade: participação no Programa Mais Médicos/Provab-médico (p = 0,102), disponibilidade de serviço de assistência social (p = 0,315) e disponibilidade de serviço para gestante de risco (p = 0,814). Em todas as outras situações, a associação foi significativa. Embora, em algumas variáveis, os grupos G1 e G2 tenham se assemelhado aos grupos mais polares (G0 e G3), estes últimos apresentaram diferenças em todas as variáveis. Os serviços que pertenciam ao grupo considerado de melhor qualidade (G3) encontraram-se, majoritariamente, organizados no modelo USF/Mista (p = 0,018), administrado por gestão terceirizada (p0,001), com oferta regular de acompanhamento pré-natal (p0,001), disponibilidade permanente de clínico geral ou médico de família (p = 0,009) e uma rede de apoio composta, principalmente, de CAPSi e de CAPSAd III e de serviços de atenção à criança (p0,001). Esse grupo também realizava reunião de equipe semanalmente (p0,001), estudava os casos de demanda espontânea (p0,001) e mudava o gerenciamento e organização da assistência com base no processo avaliativo (p = 0,004). Concluiu-se que a qualidade organizacional não depende apenas das práticas exercidas pelos profissionais de saúde, mas também das decisões dos gestores.El objetivo fue evaluar la asociación de la calidad organizativa de la atención en salud de niños en servicios de atención primaria con variables de contexto de gerencia. Se trata de una investigación de evaluación en 151 servicios de atención primaria de 40 municipios del interior del Estado de São Paulo, Brasil, que respondieron al QualiAB en 2014. Se puntuaron los servicios conforme 41 indicadores de salud del niño, que tras constituirse en grupos de calidad distribuidos por cuartiles, se asociaron a 17 indicadores de gestión. No presentaron asociación con los grupos de calidad: participación en el Programa Mais Médicos/Provab-médico (p = 0,102), disponibilidad de servicio de asistencia social (p = 0,315) y en el caso de gestante de riesgo (p = 0,814). En las demás la asociación fue significativa. A pesar de que en algunas variables los grupos G1 y G2 se asemejaron a los grupos más polarizados (G0 y G3), estos últimos presentaron diferencias en todas las variables. Los servicios que pertenecían al grupo considerado de mejor calidad (G3) se encontraron, mayoritariamente, organizados con el modelo USF/Mista (p = 0,018), administrado por gestión tercerizada (p0,001), ofertaban regularmente seguimiento prenatal (p0,001), tenían disponibilidad permanente de clínica general o médico de familia (p = 0,009) y contaban con una red de apoyo compuesta, principalmente, por CAPSi y CAPSAd III y servicios de atención al niño (p0,001). Además, mencionaron realizar una reunión de equipo semanalmente (p0,001), estudiar los casos de demanda espontánea (p0,001) y cambiar la gestión y organización de la asistencia en base al proceso evaluativo (p = 0,004). Se concluyó que la calidad organizativa no depende sólo de las prácticas ejercidas por los profesionales de salud, sino también, de las decisiones de los gestores.

Background and objectives: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. Method: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. Results: 416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. Conclusions: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population. Resumo: Justificativa e objetivos: Há poucos dados na literatura que caracterizam o padrão de uso de analgésicos na América Latina e no Brasil. Também se sabe pouco sobre o subtratamento da dor e sua influência no hábito de automedicação analgésica. O objetivo desta pesquisa é definir o padrão de uso de analgésicos entre os portadores de dor crônica (DC) e a sua potencial associação à automedicação analgésica. Método: Estudo observacional transversal com amostra de população urbana. A dor crônica foi definida como aquela presente por pelo menos 90 dias. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa institucional. Resultados: Foram incluídos 416 indivíduos; 45,7% (n = 190) portadores de dor crônica, sendo os do sexo feminino (72,3%; p = 0,04) os mais acometidos. A automedicação analgésica é praticada por 78,4% dos portadores de dor crônica. O tratamento analgésico vigente mais frequente é composto pelos anti-inflamatórios não esteroides (AINES), dipirona e paracetamol. Os opioides fracos são pouco usados e apenas 2,6% dos indivíduos com dor crônica fazem uso desses analgésicos. Nenhum dos indivíduos estava em uso de opioides potentes. Conclusões: A prática de automedicação analgésica é frequente entre os portadores de dor crônica, o que pode ser consequência da pouca prescrição de analgésicos mais potentes, como os opioides. Pode-se também dizer que, pelos dados apresentados, não ocorre uma crise de uso recreativo de opioides na população estudada. Keywords: Chronic pain, Analgesics, Self-medication, Urban population, PALAVRAS-CHAVE: Dor crônica, Analgésicos, Automedicação, População urbana

Made available in DSpace on 2019-10-06T16:14:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background Sick leaves are important events for both the worker and the employer. Many factors are related with sick leaves and depending on the factors the worker could perform a successful return to work. In this sense, the objective of this study is to identify those factors associated with return to work after sick leaves in a group of public workers in Brazil. Methods A case-control study of return to work after sick leaves in a university campus from 2010 to 2015. Logistic regression models were adjusted for two different response variables: return to work with and without restrictions. A digital database was created and completed with data from manual sources. Results A computerised database has been created, based on manual records, which has allowed us to identify labour and non-labour factors associated with the return to work after a sick leave and the possible functional readaptation, with or without restrictions, in public workers. Age at the beginning of the process, number of sick leaves, those of more than 16 days, average duration (total time of sick leaves / number of medical records), and mid-level healthcare positions were associated with return to work without restrictions. In the model of return to work with restrictions, the age of hiring by the university, the number of sick leaves, those of more than 16 days, and mid-level healthcare positions, both rural work and operational positions, were associated to the response variable. Conclusions This study has allowed us to identify the factors associated with the return to work after a period of sick leave in a large group of public workers. However, more research is needed on the mental disorders that cause sick leaves, their evaluation and the handling of these situations. Public Health Graduate Program Botucatu Medical School Univ Estadual Paulista (UNESP) Technical Assistant Botucatu Medical School Univ Estadual Paulista (UNESP) Department of Nursing University of Huelva Safety and Health Posgrade Program Universidad Espíritu Santo Department of Preventive Medicine and Public Health University of Huelva Public Health Graduate Program Botucatu Medical School Univ Estadual Paulista (UNESP) Technical Assistant Botucatu Medical School Univ Estadual Paulista (UNESP) FAPESP: 2016-23096-1

Made available in DSpace on 2019-10-04T12:34:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01. Added 1 bitstream(s) on 2019-10-09T18:33:50Z : No. of bitstreams: 1 S0034-89102019000100211.pdf: 256884 bytes, checksum: 686c125c342695f0316ccc361e812f4d (MD5) Fundacao de Ensino e Pesquisa em Ciencias da Saude da Secretaria de Estado de Saude do Distrito Federal OBJECTIVE: To identify the clinical pathways of women with breast cancer treated in public hospitals, and to analyze the factors that influence the time interval between the first appointment and the start of therapy. METHODS: A cross-sectional study was conducted with 600 women with breast cancer treated in nine public hospitals in the Brazilian Federal District. Patients were interviewed between September 2012 and September 2014. Simple and multiple logistic regression models were adjusted to evaluate the variables associated with the time interval studied. The most frequent pathway was the one that started in primary care with following care in the therapy service (28.9%). In the multiple adjustment, factors associated to a longer time interval between the first appointment and therapy were: lower family income (OR = 1.89; 95% CI 1.32-2.68), the first appointment in public services (OR = 1.78; 95% CI 1.20-2.64), care in more than two health services in the clinical pathway (OR = 1.71; 95% CI 1.19-2.44); and obtaining the anatomopathological analysis of the biopsy in public services instead of private health services (OR = 1.87; 95% CI 1.29-2.71). Independently, the implementation of specialist appointment scheduling, with care regulation, was associated with a shorter time interval between first appointment and therapy (OR = 0.33; 95% CI 0.16-0.65). CONCLUSIONS: We observed that multiple pathways were covered by women with breast cancer treated in public services of the Federal District. Socioeconomic iniquities and several aspectos of the pathways covered were associated with a longer time interval between the first appointment and the start of breast cancer therapy. Secretaria Estado Saude Dist Fed, Escola Super Ciencias Saude, Brasilia, DF, Brazil Univ Estadual Paulista, Fac Med, Programa Posgrad Saude Colet, Botucatu, SP, Brazil Hosp Alvorada Brasilia, Brasilia, DF, Brazil Univ Estadual Paulista, Fac Med, Programa Posgrad Saude Colet, Dept Saude Publ, Botucatu, SP, Brazil Univ Estadual Paulista, Fac Med, Programa Posgrad Saude Colet, Botucatu, SP, Brazil Univ Estadual Paulista, Fac Med, Programa Posgrad Saude Colet, Dept Saude Publ, Botucatu, SP, Brazil Fundacao de Ensino e Pesquisa em Ciencias da Saude da Secretaria de Estado de Saude do Distrito Federal: 41 Fundacao de Ensino e Pesquisa em Ciencias da Saude da Secretaria de Estado de Saude do Distrito Federal: 064.000.455/2013

Sickness absenteeism in public institutions compromises the execution of services, and may also generate direct impacts on the population that receives coverage. To determine if sick leave duration for temporary disabilities is associated with non-work-related illnesses (NWRI), a historical cohort study was carried out of workers at a Brazilian University. The Charlson Comorbidity Index (CCI) was obtained from the most prevalent diagnoses in each expert examination and from the corresponding days of sick leave per episode, adjusting simple and multiple Cox regression models. As a result, 70% of the NWRI temporary disabilities were due to depressive disorders, convalescence, and dorsalgia with a sick leave duration between 4 and 320 days. The factors of protection for sick leave durations until the rehabilitation were non-insulin-dependent diabetes mellitus and hypertension. Long-term sick leaves were observed in the cases that required rehabilitation of those workers diagnosed with recurrent depressive disorders, conjunctivitis, acute sinusitis, skin disorders, calculus of kidney and ureter, abdominal and pelvic pain, and same-level fall accidents. It is also worth noting that even in a disease that can justify long-term sick leaves, such as breast cancer, the duration may be shorter according to the worker&rsquo, s capacity and self-efficacy.

Made available in DSpace on 2019-10-06T16:14:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-03-04 Propose: Group B streptococcus is responsible for severe infections in neonates resulting from vertical transmission from pregnant women colonized in the anal, perineal or vaginal regions. The identification of colonized patients and use of intrapartum prophylaxis may reduce the risk of neonatal infection. Methods: A cross-sectional study of pregnant women of gestational age between 35 and 37 weeks was conducted. Material was collected from patients for laboratory identification of group B streptococcus. Epidemiological data, including weight, height, body mass index, antibiotic use during pregnancy, pathologies during pregnancy (diabetes, hypertensive diseases, and hypothyroidism), twinning, and others, were also collected from patients. Results: The sample consisted of 501 pregnant women, and the prevalence of group B streptococcus was 14%. The mean age was 29 years, and the mean BMI was 30.7. During pregnancy, 204 patients had some type of infection, and 201 used antibiotics. Ninety-five patients were diagnosed with gestational diabetes mellitus and 74 with some type of hypertensive disease. Conclusions: The prevalence of group B streptococcus observed did not differ from that observed in other studies. None of the factors studied can be considered as risk or protective factors for maternal colonization by group B streptococcus. Federal District State Secretariat of Health (Secretaria de Estado de Saúde do Distrito Federal) Graduate Program in Obstetrics Gynaecology and Mastology Paulista State University (Universidade Estadual Paulista UNESP) Campus de Botucatu Graduate Program in Collective (Public) Health Paulista State University (Universidade Estadual Paulista UNESP) Campus de Botucatu Hospital Regional de Taguatinga Farmácia Hospitalar, Área Especial 24 do Setor C Norte Graduate Program in Obstetrics Gynaecology and Mastology Paulista State University (Universidade Estadual Paulista UNESP) Campus de Botucatu Graduate Program in Collective (Public) Health Paulista State University (Universidade Estadual Paulista UNESP) Campus de Botucatu

The study analyzes the differences among cases of violence against women registered in police reports (PR) at the Women's Protection Police Station (WPPS) during regular working hours, and those registered during after-hours, in a medium-sized city in the inland state of São Paulo, Brazil. This is a cross-sectional study based on data from PRs registered for one year (2013/2014). PRs were differentiated by period of registration, at regular working hours and after-hours (dependent variable). A chi-square test was used to compare groups. In total, 440 PRs were registered, 373 during regular working hours, and 67 during after-hours. Cases of violence registered during after-hours evidenced more significant threats to women's integrity, as shown by the higher number of cases of perpetrators' flagrante delicto, requests for protective measures and greater severity of assaults, such as bruises, need for hospitalization and referral to forensic medicine (IML), which characterize the greater severity of occurrences when WPPS are closed. Thus, women lack a specialized reception service and a full guarantee of rights in periods of highest risk and vulnerability.Este estudo analisa as diferenças entre os casos de violência contra a mulher, formalizados em boletins de ocorrência (BO) na Delegacia de Defesa da Mulher (DDM), durante a rotina dos formalizados nas Delegacias Civis durante os plantões policiais, em um município de médio porte do interior paulista. Trata-se de um estudo transversal, com base nos BOs realizados no período de um ano (2013/2014). As ocorrências foram diferenciadas conforme o período em que foram lavrados os BOs, na rotina ou nos plantões, sendo este último tomado como variável dependente. As comparações entre os grupos foram realizadas pelo teste χ2. Foram registrados 440 boletins, sendo 373 na rotina e 67 no plantão. As ocorrências realizadas nos plantões apresentaram maior ameaça à integridade da mulher com um maior número de flagrantes do agressor, solicitação de medidas protetivas e gravidade das agressões, como hematomas, hospitalização e encaminhamento ao IML; caracterizando maior gravidade das ocorrências no período em que a DDM está fechada. Deste modo, falta às mulheres um serviço especializado de acolhimento e ampla garantia de direitos nos períodos de maior risco e vulnerabilidade.

This article aims to identify changes in indicators for the organization of children's health services in primary care in the State of São Paulo, Brazil. An evaluative study was conducted with three series of cross-sectional evaluations with participation by 81 services, involving 32 municipalities (counties) in the central-west region of the state, who answered the Quali AB questionnaire in 2007, 2010, and 2014. The analysis used 74 children's health indicators and 7 services indicators. Comparison of the indicators evidenced changes in the organization of children's healthcare, with an improvement in the majority of the indicators in 2010 and maintenance or worsening in 2014, compared to 2007. In conclusion, children's health policy recommendations have not been fully realized in the organization of the supply of comprehensive care, although relevant issues such as childhood obesity and violence have been addressed by a few services.O presente artigo tem por objetivo identificar mudanças nos indicadores de organização da atenção à saúde da criança em serviços de atenção primária do Estado de São Paulo, Brasil. Pesquisa avaliativa desenvolvida por três séries de avaliações transversais com a participação de 81 serviços, envolvendo 32 municípios do centro-oeste paulista, que responderam ao instrumento Quali AB nos anos de 2007, 2010 e 2014. A análise utilizou 74 indicadores de saúde da criança e 7 de caracterização dos serviços. A comparação dos indicadores evidenciou mudanças na organização de ações de saúde da criança, com melhora da maioria dos indicadores em 2010 e manutenção, ou piora, em 2014, em relação a 2007. Conclui-se que os avanços preconizados pelas políticas de atenção à saúde da criança não têm se efetivado plenamente na organização da oferta da atenção integral, ainda que temas relevantes como obesidade infantil e violência sejam abordados em um pequeno número de serviços.El objetivo del presente artículo es identificar cambios en los indicadores de organización de la atención a la salud infantil en los servicios de atención primaria del estado de São Paulo, Brasil. Se trata de una investigación evaluativa, desarrollada por tres series de evaluaciones transversales con la participación de 81 servicios, involucrando a 32 municipios del centro-oeste paulista, que respondieron al instrumento Quali AB durante los años de 2007, 2010 y 2014. El análisis utilizó 74 indicadores de salud infantil y 7 de caracterización de los servicios. La comparación de los indicadores evidenció cambios en la organización de acciones de salud infantil, con una mejora de la mayoría de los indicadores en 2010 y un mantenimiento, o empeoramiento, en 2014, comparándolo con 2007. Se concluye que los avances preconizados por las políticas de atención a la salud infantil no se han hecho efectivos plenamente en la organización de la oferta de atención integral, aunque algunos temas relevantes como la obesidad infantil y la violencia sean abordados en un pequeño número de servicios de atención primaria.

This study aimed to compare gender-related differences in outcomes of patients undergoing TAVI over a long-term follow-up period.Transcatheter aortic valve implantation (TAVI) has been considered the standard therapy for patients with inoperable or high-risk symptomatic aortic stenosis. The influence of gender-related differences in outcomes of patients undergoing TAVI is currently on debate.From January 2008 to January 2015, 819 patients (49% men) underwent TAVI and were included in a multicenter Brazilian registry. Patients were followed-up and clinical outcomes were evaluated according to the updated Valve Academic Research Consortium-2 criteria.Mean follow-up was 497 ± 478 days. Compared with women, men had a lower rate of major or life-threatening bleeding (12.0% vs. 20.6%; HR = 0.57 [95CI% 0.40-0.81]; P = 0.001), and major vascular complications (6% vs. 11.7%; HR = 0.50 [95CI% 0.31-0.82]; P = 0.004). At 30 days, all-cause mortality was lower in men than in women (6.5% vs. 11.5%; P = 0.013), however, cumulative all-cause mortality was similar between groups (25.9% vs. 29.7%, men and women, respectively, HR = 0.92 [95CI% 0.71-1.19]; P = 0.52) over the entire follow-up period. By adjusted Cox regression model, renal function, diabetes, peripheral artery disease, and chronic obstructive pulmonary disease (COPD) remained independently predictors of all-cause mortality.In this large-scale study evaluating patients undergoing TAVI, 30-day mortality was higher among women than men driven by significant higher rates of major or life-threatening bleeding and major vascular complications. However, all-cause mortality on long-term follow-up was similar between groups. © 2016 Wiley Periodicals, Inc.

Made available in DSpace on 2013-09-27T14:54:12Z (GMT). No. of bitstreams: 1 WOS000314513600028.pdf: 594657 bytes, checksum: 3b48dcbc94a3826215ff6e6552f098f5 (MD5) Previous issue date: 2012-01-01 Made available in DSpace on 2013-09-30T18:26:17Z (GMT). No. of bitstreams: 1 WOS000314513600028.pdf: 594657 bytes, checksum: 3b48dcbc94a3826215ff6e6552f098f5 (MD5) Previous issue date: 2012-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:38:20Z No. of bitstreams: 1 WOS000314513600028.pdf: 594657 bytes, checksum: 3b48dcbc94a3826215ff6e6552f098f5 (MD5) Made available in DSpace on 2014-05-20T13:38:20Z (GMT). No. of bitstreams: 1 WOS000314513600028.pdf: 594657 bytes, checksum: 3b48dcbc94a3826215ff6e6552f098f5 (MD5) Previous issue date: 2012-01-01 This study investigated the occurrence of equine arteritis virus antibodies using neutralization test in 1,400 horses from Campinas and macro metropolitan paulista mesoregions located at São Paulo State, between 2007 and 2008. Eighty (5.7%) samples showed antibodies to virus (titers from 4 to 4,096). Among the 42 cities, 15 (35.7%) presented at least one seropositive animal to equine arteritis virus. of the 238 farms analyzed 41 showed at least one seropositive animal. The occurrence was higher in sport horses like jumping horses, Quarter horses and was similar for female and male. The rate of seropositive was higher in animals older than 24 months of age. These results suggest the virus circulation among horse population in studied farms, and the need for continuing epidemiological surveillance studies. Univ Estadual Paulista, UNESP, FMVZ, Botucatu, SP, Brazil Inst Biol, São Paulo, Brazil Univ Estadual Paulista, UNESP, FMB, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, FMVZ, Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, FMB, Botucatu, SP, Brazil

Made available in DSpace on 2013-08-12T18:40:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-01 Made available in DSpace on 2013-09-30T18:20:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:21Z No. of bitstreams: 1 WOS000294822800006.pdf: 144201 bytes, checksum: e04ef46c58cb0ee8d6f31ec9b39104c2 (MD5) Made available in DSpace on 2014-05-20T13:35:21Z (GMT). No. of bitstreams: 1 WOS000294822800006.pdf: 144201 bytes, checksum: e04ef46c58cb0ee8d6f31ec9b39104c2 (MD5) Previous issue date: 2011-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) OBJECTIVE: To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery.METHODS: Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure. Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes.RESULTS: The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies (50.8% vs. 31.6%) and two years after a cesarean (44.8% vs. 18.4%). Decreased vaginal pressure was also significantly higher among women with gestational diabetes (53.9% vs. 37.8%). Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure. Maternal age, gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean. In a multivariate logistic model, gestational diabetes was an independent risk factor for gestational incontinence.CONCLUSIONS: The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy. We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean. These results may warrant more comprehensive prospective and translational studies. Univ Estadual Paulista, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil Cornell Univ, New York, NY 10021 USA Univ Estadual Paulista, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil

Made available in DSpace on 2018-12-11T17:18:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-02-01 Electrochemical Society Ministério da Saúde Secretaria de Estado de Saúde de Minas Gerais Background The global increase in C-section rates is real. In Brazil, these indices correspond to 58.94% in the Midwest region and 52.77% in the Federal District. Objective To evaluate the C-section rates and identify the groups with the greatest risk at two reference hospitals in the public network of Federal District/Brazil, using 10-Group Robson System. Method A cross-sectional study of 6579 births assisted at the Hospital A (HA) and the Hospital B (HB) during 2013. The C-section rates in each group and its respective contribution to the total hospital C-sections was compared between HA and HB. To this, was used the proportion difference test (similar to chi-square test), with RR and 95% CI, and the logistic regression analysis (OR; 95% CI) among the groups with higher C-section/total C-section. The significance limit of p < 0.05 was defined for all tests. Results The C-section rates were 50.8% at the HA and 42.3% at the HB, with 1.20 RR (95%CI = 1.13–1.28) at the HA. The highest rates were observed in Robson groups G5, G1, and G2. At the HA, G1 had a 21.5% C-section rate, which was greater than at the HB (13.8%; p < 0.05); the cesarean rates for groups G2 and G5 were higher at the HB (respectively, 18.6 and 38.1%) than at the HA (14.8 and 32.5%, respectively; p < 0.05). Conclusion These results point out specific goals to be achieved in order to reduce abusive cesarean rates in both A and B hospitals, especially in the primigravida and in those with previous C-section. Medical School Coordination Graduate School of Health Sciences/FEPECS/SES Graduate Program in Gynecology Obstetrics and Mastology Botucatu Medical School UNESP Coordenação do Curso de Medicina Escola Superior de Ciências da Saúde/FEPECS/ SES Graduate Program in Gynecology Obstetrics and Mastology Botucatu Medical School UNESP

Background The analysis of patterns of trauma deaths may improve the evaluation of a trauma system and identify areas that may benefit from more resources. The objective of this study was to analyze the epidemiology of trauma deaths in a Brazilian university hospital in order to assess the profile of these fatalities over a 16-year period. Method Retrospective study of time series using database records. The research subjects were in-hospital deaths from external causes during the years 1995, 2000, 2005 and 2010. The following variables were analyzed: cause of injury, trauma scores, time and cause of death. Results 467 cases were studied, being 325 patients (69.6%) admitted with signs of life and 142 (30.4%) considered dead on arrival. The mean age was 35.35 ± 18.03 years. 85.4% were males. Blunt trauma occurred in 73.0% of cases and penetrating mechanism in 27.0%. There was a significant increase (p 25. The mean Revised Trauma Score (RTS) was 5.24 ± 2.05. Only 25.8% of the deaths had TRISS

This descriptive study collected socio-demographic, obstetric, and diagnostic and treatment-related data from pregnant and postpartum women and their partners, for the 67 pregnant or postpartum women reported with syphilis to the National System of Diseases of Notification, users of public maternity hospitals in the Federal District of Brazil from 2009 to 2010. Data on clinical and laboratory follow-up of the newborn were obtained from the hospital patient charts, compulsory notification forms, and Infant Health Cards. Of the pregnant women, 41.8% were adequately treated; the main reason for inadequate treatment was the absence (83.6%) or inadequate treatment of the partner (88.1%). More than a third required repeat treatment at the maternity hospital due to lack of documentation of treatment during the prenatal period. Of the newborns diagnosed with congenital syphilis, 48% received radiographic investigation, 42% received a spinal tap, and 36% failed to receive any kind of intervention. Thus, the quality of prenatal care was insufficient to guarantee the control of congenital syphilis and achieve the goal of reducing incidence of the disease.

To outline the geographical distribution pattern of gestational trophoblastic disease (GTD) in a referral center in Bahia, Brazil, and determine the demographics of the disease.We conducted a study of data retrieved from medical records of 140 GTD patients referred to our Trophoblastic Diseases Center in 2002-2007, assessing geographical distribution across health care districts, demographics, referral sources, and previous pregnancy status.The most common GTD types were hydatidiform mole (106, 75.7%), invasive mole (32, 22.9%), choriocarcinoma (1, 0.7%), and placental site trophoblastic tumor (1, 0.7%). GTD incidence was 8.5 in 1,000 deliveries. Most patients originated from the coastal region (East district), which includes the state capital (77.9%). The 20-34 age group predominated (65%). Education level (67.9% attended elementary school only) and employment rate (42.9%) were low. Secondary hospitals were the principal source of referral (84.3%), followed by self-referrals (15.7%). Regarding previous pregnancy status, 42.1% (n = 59) had had term pregnancy, 39.3% (n = 55) no pregnancy, 15% (n = 21) miscarriage, and 0.7% (n = 1) ectopic pregnancy; 4 patients (2.9%) had previous hydatidiform mole.GTD predominated in the peak fertility age group and among patients of unfavorable sociodemographic status.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:04:03Z No. of bitstreams: 1 S1413-86702009000400009.pdf: 38330 bytes, checksum: dec003da57adab5ed6c58a22ce2890c1 (MD5) Made available in DSpace on 2013-08-22T19:04:03Z (GMT). No. of bitstreams: 1 S1413-86702009000400009.pdf: 38330 bytes, checksum: dec003da57adab5ed6c58a22ce2890c1 (MD5) Previous issue date: 2009-08-01 Made available in DSpace on 2013-09-30T18:19:31Z (GMT). No. of bitstreams: 2 S1413-86702009000400009.pdf: 38330 bytes, checksum: dec003da57adab5ed6c58a22ce2890c1 (MD5) S1413-86702009000400009.pdf.txt: 22740 bytes, checksum: 491ee4ebf000ba0dbfd50c64227d51cc (MD5) Previous issue date: 2009-08-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:34:41Z No. of bitstreams: 2 S1413-86702009000400009.pdf: 38330 bytes, checksum: dec003da57adab5ed6c58a22ce2890c1 (MD5) S1413-86702009000400009.pdf.txt: 22740 bytes, checksum: 491ee4ebf000ba0dbfd50c64227d51cc (MD5) Made available in DSpace on 2014-05-20T13:34:41Z (GMT). No. of bitstreams: 2 S1413-86702009000400009.pdf: 38330 bytes, checksum: dec003da57adab5ed6c58a22ce2890c1 (MD5) S1413-86702009000400009.pdf.txt: 22740 bytes, checksum: 491ee4ebf000ba0dbfd50c64227d51cc (MD5) Previous issue date: 2009-08-01 Although most recent publications focus on Ventilator-associated Pneumonia, Non-Ventilator-associated Hospital-acquired pneumonia (NVHAP) is still worrisome. We studied risk factors for NVHAP among patients admitted to a small teaching hospital. Sixty-six NVHAP case patients and 66 controls admitted to the hospital from November 2005 through November 2006 were enrolled in a case-control study. Variables under investigation included: demographic characteristics, comorbidities, procedures, invasive devices and use of medications (Sedatives, Antacids, Steroids and Antimicrobials). Univariate and multivariable analysis (hierarchical models of logistic regression) were performed. The incidence of NVHAP in our hospital was 0.68% (1.02 per 1,000 patients-day). Results from multivariable analysis identified risk factors for NVHAP: age (Odds Ratio[OR]=1.03, 95% Confidence Interval[CI]=1.01-1.05, p=0.002), use of Antacids (OR=5.29, 95%CI=1.89-4.79, p=0.001) and Central Nervous System disease (OR=3.13, 95%CI=1.24-7.93, p=0.02). Although our findings are coherent with previous reports, the association of Antacids with NVHAP recalls a controversial issue in the physiopathology of Hospital-Acquired Pneumonia, with possible implications for preventive strategies. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Doenças Tropicais Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital Estadual Bauru Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Saúde Pública Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Doenças Tropicais Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital Estadual Bauru Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Saúde Pública

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:23:57Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:46:29Z : No. of bitstreams: 1 2-s2.0-69049092787.pdf: 200304 bytes, checksum: 5a7a9e7dcafa2445dc988d949390c7c8 (MD5) Made available in DSpace on 2014-05-27T11:23:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-08-27 Background. A review of validated methods for assessing female sexual dysfunction and a review of male and female sexual dysfunction did not refer to any specific questionnaire for evaluating sexuality during pregnancy. A study was performed at the Obstetrics and Gynecology Department of Botucatu Medical School, São Paulo State University, Brazil to design and validate a pregnancy sexuality questionnaire, the Pregnancy Sexual Response Inventory (PSRI). Methods. Women with a singleton pregnancy between 10 and 35 weeks of gestation were randomly recruited. There were five phases in the development of the PSRI: (1) item selection; (2) item development; (3) determination of internal consistency, reliability and convergence; (4) content validity; and (5) determination of inter-interviewer reliability. Internal consistency and reliability were evaluated using Cronbach's alpha. Inter-interviewer reliability was assessed by evaluating the responses of 18 academics at various institutions, using Kappa Index and Student t test. Results. Good internal consistency and reliability were obtained (Cronbach's alpha coefficient = 0.79). Among the 18 academics, 13 totally agreed (K = 1.0), three partially agreed (K = 0.67) and two disagreed (K = 0.33) with the proposed questions. Comparisons of the mean PSRI domain scores made between the primary investigators and the other interviewers showed no significant differences in all domains (p > 0.05). Conclusion. PSRI is a new validated instrument for evaluating sexuality and sexual activity and related health concerns during pregnancy. © 2009 Rudge et al; licensee BioMed Central Ltd. Institute of Community Medicine, Tromso Department of Obstetrics and Gynecology Botucatu Medical School São Paulo State University (UNESP) Research Group Council Botucatu Medical School (UNESP) Department of Sexology Mater Dei Hospital, Belo Horizonte, MG Institute of Community Medicine University of Tromsø Department of Obstetrics and Gynecology Botucatu Medical School São Paulo State University (UNESP) Research Group Council Botucatu Medical School (UNESP)

Background: Scarce information is available about the variation in the incidence of Type 1 diabetes in the Brazilian population in the last decades. Aim: The objective of this study was to assess the long-term trends (1986–2006) in the incidence of Type 1 diabetes in Bauru, Sao Paulo State, Brazil. Subjects and methods: The annual incidence of Type 1 diabetes (per 100,000 per yr) from 1986 to 2006 was determined in children ≤14 yr of age, using the capture and recapture method. Results: A total of 176 cases were diagnosed in the study population. The overall incidence was 10.4/100,000 with a range of 2.82/100,000 in 1987 to 18.49/100,000 in 2002 representing a 6.56-fold increase within the same population. The estimated incidence, using the capture and recapture method varied from 2.82/100,000 per yr in 1987 to 27.20/100,000 per yr in 2002, representing a 9.6-fold variation. The global pattern of incidence variation was categorized as high (10-19.99/100,000 per yr), and very high (≥20/100,000 per yr) in 71.43% of the study-years. Incidence was slightly higher among females, Caucasians, children in the 5–9 yr of age range and belonging to lower socio-economic classes. Most diagnoses were established during the colder months and/or with higher pluviometric indexes. Conclusions: The incidence of Type 1 diabetes in children is increasing in Bauru, Sao Paulo State, Brazil, and the global pattern of incidence was classified as high or very high, mainly in the last 10 yr. All Brazilian regions should be involved in the study.

Background: Noise is the most common agent of occupational exposure. It may induce both auditory and extraauditory dysfunction and increase the risk of work accidents. The purpose of this study was to estimate the fraction of accidents attributable to noise occupational exposure in a mid-size city located in southeastern Brazil. Materials and Methods: In this population case-control study, which included 108 cases and 324 controls, the incidence rate ratio of work accidents controlled for several covariables was obtained by classifying occupational noise exposure into three levels, as well as determining the prevalence in each level. Results: Based on these data, the attributable fraction was estimated as 0.6391 (95% CI = 0.2341-0.3676), i.e., 63% of the work accidents that took place in the study site were statistically associated with occupational noise exposure. Discussion: The causes of this association as well as its implications in the prevention of work accidents are discussed.

Perdas auditivas e zumbidos são dificuldades enfrentadas pelos trabalhadores, que sofrem suas conseqüências não apenas no ambiente de trabalho, mas também em contextos extralaborais. OBJETIVO: Verificar existência de relação dose-resposta entre perdas auditivas e zumbidos, ou seja, se o aumento destas perdas auditivas está associado ao aumento do incômodo provocado pelos zumbidos. MATERIAL E MÉTODO: Neste estudo de série de casos, transversal, foram avaliados 284 trabalhadores com exposição ao ruído ocupacional através da audiometria tonal limiar cujos resultados foram categorizados segundo Merluzzi. Aqueles que apresentaram queixas de zumbidos responderam ao Tinnitus Handicap Inventory, adaptado e validado para o português brasileiro. Ajustou-se um modelo linear generalizado para dados binomiais, verificando interação entre os fatores. RESULTADOS: Mais de 60% dos ouvidos apresentaram perda auditiva e mais de 46% apresentaram zumbidos. Verificou-se que as prevalências de zumbido aumentam com a piora dos limiares, bem como o risco de o apresentar. A interação entre ambos, considerando todos os graus de perda auditiva, foi estatisticamente significativa. CONCLUSÃO: Os resultados sugerem haver interação estatística entre perda auditiva e zumbidos, com a tendência de que, quanto maior for o déficit auditivo, maior será o incômodo provocado pelo zumbido. Hearing loss and tinnitus impact the lives of workers in every instance of their lives. AIM: this paper aims to investigate the existence of a dose-response relationship between hearing loss and tinnitus by determining whether higher levels of hearing loss can be associated with increased tinnitus-related discomfort. MATERIALS AND METHOD: this cross-sectional case study assessed 284 workers exposed to occupational noise through pure tone audiometry. Test results were categorized as defined by Merluzzi. Individuals complaining of tinnitus answered the adapted and validated Brazilian Portuguese version of the Tinnitus Handicap Inventory. A generalized linear model was adjusted for binomial data to test the interaction between these factors. RESULTS: over 60% of the ears analyzed had hearing loss, while more than 46% of them had tinnitus. Tinnitus prevalence and risk rates increased as pure tone audiometry results got worse. The association between both, considering all hearing loss degrees, was statistically significant. CONCLUSION: the results point to a statistical association between hearing loss and tinnitus; the greater the hearing loss, the greater the discomfort introduced by tinnitus.

There is an association between insulin resistance, glucose intolerance, and essential hypertension, but the relation between insulin resistance, glucose intolerance, and hypertension diagnosed during pregnancy is not well understood. Transient hypertension of pregnancy, the new-onset nonproteinuric hypertension of late pregnancy, is associated with a high risk of later essential hypertension and glucose intolerance; thus, these conditions may have a similar pathophysiology. To assess the association between insulin resistance, glucose intolerance, essential hypertension, and subsequent development of proteinuric and nonproteinuric hypertension in pregnancy in women without underlying essential hypertension, we performed a prospective study comparing glucose (fasting, 1 and 2 hours postglucose load), insulin, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), and triglycerides levels on routine screening for gestational diabetes mellitus. Women who developed hypertension in pregnancy (n = 37) had higher glycemic levels (fasting, 1 and 2 hours postglucose load) on a 100-gram oral glucose loading test, although only the fasting values showed a statistical significance (p0.05), and a significantly higher frequency of abnormal glucose loading tests, two hours after glucose load (or=140 mg/dL) (p0.05) than women who remained normotensive (n = 180). Glucose intolerance was common in women who developed both subtypes of hypertension, particularly preeclampsia. Women who developed hypertension had greater prepregnancy body mass index (p0.0001), higher frequency and intensity of acanthosis nigricans (p0.0001), and higher baseline systolic and diastolic blood pressures (por= 0.0001 for both), although all subjects were normotensive at baseline by study design; they also presented lower levels of HDL-C (p0.05). However, after adjustment for these and other potential confounders, an abnormal glucose loading test remained a significant predictor of development of hypertension (p0.05) and, specifically, preeclampsia (p0.01). There was a trend toward higher insulin and homeostasis model assessment-insulin resistance (HOMA-IR) levels in women developing any type of hypertension. When comparing women that remained normotensive to term with those with transient hypertension and preeclampsia, the preeclamptic women were born with lower weight (p0.05) and shorter length (p0.005); at screening they were older (p0.005), showed higher frequency and intensity of acanthosis nigricans (p0.0001), had higher prepregnancy BMI (p0.0005), as well as higher baseline systolic and diastolic blood pressures (por= 0.0001 for both). They also showed higher HOMA-IR levels that did not show a statistical significance. When glucose tolerance status was taken in account, an association was found between increasing indexes of hypertension (p0.05) and of HOMA-IR (p0.05) with the worsening of glucose tolerance. These results suggest that insulin resistance and relative glucose intolerance are associated with an increased risk of new-onset hypertension in pregnancy, particularly preeclampsia, and support the hypothesis that insulin resistance may play a role in the pathogenesis of this disorder.

Noise is the most frequent type of occupational exposure and can lead to both auditory and extra-auditory dysfunction as well as increasing the risk of work accidents. The purpose of this study was to estimate the attributable fraction of work accidents related to occupational noise exposure in a medium-sized city in Southeast Brazil. In this hospital-based case-control study, including 600 cases and 822 controls, the odds ratio of work accidents (controlled for several covariables) was obtained classifying occupational noise exposure into four levels and determining the prevalence at each level. Based on these data, the calculated attributable fraction was 0.3041 (95%CI: 0.2341-0.3676), i.e., 30% of work accidents in the study area were statistically associated with occupational noise exposure. The authors discuss the causes of this association and the implications for the prevention of work accidents. O ruído é o mais freqüente dos agentes de exposição ocupacional. Pode proporcionar o desenvolvimento de disfunções auditivas e extra-auditivas, bem como o aumento do risco para acidentes do trabalho. O objetivo deste estudo foi estimar a fração de acidentes do trabalho atribuível à exposição ocupacional ao ruído, ocorridos em uma cidade de porte médio localizada no Sudeste do Brasil. A partir de um estudo caso-controle de base hospitalar, com 600 casos e 822 controles, obtiveram-se os odds ratio de acidentes do trabalho controlados para diversas covariáveis, relacionando trabalhadores expostos ao ruído em quatro níveis, bem como da prevalência destas exposições. Com estes resultados, estimou-se a fração atribuível como 0,3041 (IC95%: 0,2341-0,3676), o que equivale a dizer que mais de 30% dos acidentes do trabalho ocorridos nesta localidade são estatisticamente associados à exposição ocupacional ao ruído. Discute-se a causalidade dessa relação e suas implicações para a prevenção dos acidentes do trabalho.

O objetivo deste estudo foi verificar se a exposição ocupacional ao ruído é um fator de risco relevante para acidentes do trabalho na cidade de Piracicaba, São Paulo, Brasil. Foi realizado um estudo caso-controle de base hospitalar. Os casos foram 600 trabalhadores entre 15 e 60 anos que sofreram acidentes ocupacionais típicos entre maio e outubro de 2004, atendidos na Central de Ortopedia e Traumatologia de Piracicaba. Os controles foram 822 trabalhadores entre 15 e 60 anos que sofreram acidente não ocupacional e receberam o primeiro atendimento no serviço ou foram trabalhadores acompanhantes dos acidentados. Foi ajustado um modelo de regressão logística múltipla, tendo como variável independente o acidente do trabalho, controlada por co-variáveis de interesse, entre elas a exposição ao ruído. Estimou-se que o risco de sofrer acidente do trabalho é cerca de duas vezes maior entre trabalhadores expostos ao ruído, controlado para diversas co-variáveis. A exposição ocupacional ao ruído não só deteriora a saúde auditiva do trabalhador, mas também se constitui em fator de risco para acidentes do trabalho. The purpose of this study was to verify whether occupational noise exposure is a significant risk factor for work accidents in the city of Piracicaba, São Paulo State, Brazil. This hospital-based case-control study included 600 workers aged 15-60 who suffered typical occupational accidents between May and October 2004 and were seen at the Piracicaba Orthopedics and Trauma Center. The control group comprised 822 workers, aged 15-60, who were also seen at the Center, and either had a non-occupational accident or were accompanying someone who had suffered an accident. A multiple logistic regression model was adjusted with work accident as an independent variable, controlled by covariables of interest such as noise exposure. The risk of having a work accident was about twice as high among workers exposed to noise, after controlling for several covariables. Occupational noise exposure not only affected auditory health status but was also a risk factor for work accidents.

The objective of this study was to verify an association between noise-induced hearing loss (NIHL) and tinnitus in workers exposed to occupational noise. Workers with a history of work noise exposure who attended two audiology outpatient clinics were interviewed and evaluated. The statistical association between NIHL and tinnitus was evaluated using an adjusted linear regression model, with tinnitus as the dependent variable and NIHL, classified into six levels, as the independent variable, with age and length of noise exposure as covariates. Data were collected from 284 workers between April and October, 2003, in Bauru, São Paulo State, Brazil. Tinnitus was observed to increase with the progression of auditory damage, controlled by age and length of noise exposure. These results suggest that investment in hearing conservation programs is needed, especially for source noise emission control and for intervention in hearing loss progression that is caused by noise exposure, in order to maintain auditory health and reduce the associated symptoms.

The purpose of this study was to verify whether occupational noise exposure is a significant risk factor for work accidents in the city of Piracicaba, São Paulo State, Brazil. This hospital-based case-control study included 600 workers aged 15-60 who suffered typical occupational accidents between May and October 2004 and were seen at the Piracicaba Orthopedics and Trauma Center. The control group comprised 822 workers, aged 15-60, who were also seen at the Center, and either had a non-occupational accident or were accompanying someone who had suffered an accident. A multiple logistic regression model was adjusted with work accident as an independent variable, controlled by covariables of interest such as noise exposure. The risk of having a work accident was about twice as high among workers exposed to noise, after controlling for several covariables. Occupational noise exposure not only affected auditory health status but was also a risk factor for work accidents.

To assess whether exposure to occupational noise is an important risk factor for work-related injuries.A population-based case-control study was performed. Data collection was carried out from May 16, 2002 to October 15, 2002 in the city of Botucatu, southeast Brazil. Cases were defined as workers who had suffered typical work-related injuries in a 90-day period previously to the study, and who identified through systematic random sampling of their households. Controls were non-injured workers randomly sampled from the same population, matched on 3:1 ratio according to sex, age group and census track. A multiple logistic regression model was adjusted, where the independent variable was exposure to occupational noise, controlled for covariates of interest.A total of 94 cases and 282 controls were analyzed. An adjusted multiple regression model showed that "work always exposed to high-level noise" and "work sometimes exposed to high-level noise" were associated to a relative risk for work-related injuries of about 5.0 (95% CI: 2.8-8.7; p0.001) and 3.7 (95% CI: 1.8-7.4; p=0.0003) respectively, when work not exposed to noise was taken as a reference, controlled for several covariates.Based on the study findings, investing in hearing conservation programs, particularly those for controlling noise emission at its source, is justifiable aiming at both hearing health maintenance and reduction of work-related injuries.

The Tinnitus Handicap Inventory is a questionnaire for assessing the impact of tinnitus by quantifying psychoemotional and functional problems it causes. The objective of the study was to validate the Brazilian Portuguese translation of this questionnaire, named Questionario de Gravidade do Zumbido.The questionnaire was applied to 135 individuals with tinnitus from two audiology clinics in Bauru, Southeastern Brazil, referred for audiologic evaluation. Its internal consistency was evaluated by Cronbach'fs alpha coefficients comparing the Brazilian version to the original instrument.It was found good reliability for scales (0.76alpha0.85) and for the whole questionnaire, which global consistency value (alpha=0.93) was identical to the original instrument.The results suggest that the Brazilian version of the questionnaire can be used in clinical practice to evaluate day-to-day difficulties caused by tinnitus in individuals who are aware of that.

Summary: Hearing loss and tinnitus impact the lives of workers in every instance of their lives. Aim: this paper aims to investigate the existence of a dose-response relationship between hearing loss and tinnitus by determining whether higher levels of hearing loss can be associated with increased tinnitus-related discomfort. Materials and method: this cross-sectional case study assessed 284 workers exposed to occupational noise through pure tone audiometry. Test results were categorized as defined by Merluzzi. Individuals complaining of tinnitus answered the adapted and validated Brazilian Portuguese version of the Tinnitus Handicap Inventory. A generalized linear model was adjusted for binomial data to test the interaction between these factors. Results: over 60% of the ears analyzed had hearing loss, while more than 46% of them had tinnitus. Tinnitus prevalence and risk rates increased as pure tone audiometry results got worse. The association between both, considering all hearing loss degrees, was statistically significant. Conclusion: the results point to a statistical association between hearing loss and tinnitus; the greater the hearing loss, the greater the discomfort introduced by tinnitus. Keywords: occupational noise, noise-induced hearing loss, tinnitus

Made available in DSpace on 2018-12-11T17:05:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-08-03 Background: The present study validates a symphysis-fundal height chart (SFH-chart) for pregnant women with type 2 diabetes mellitus (DM2), gestational diabetes mellitus (GDM) and mild gestational hyperglycemia (MGH) attending at the Diabetes and Pregnancy Reference Service of the Botucatu Medical School, UNESP, Brazil. Methods: A cross-sectional study was carried out to evaluate the performance of the specific FHC in predicting small (SGA) and large (LGA) for gestational age newborns (NB). We evaluated 206 pregnant women with DM2, GDM or MGH and their NB. The last symphysis-fundal height measure, taken at birth, was used to determine the sensitivity index (Sens), specificity index (Spe), positive prediction value (PPV), negative prediction value (NPV) and accuracy in predicting SGA and LGA. The gold standard was the Lubchenco birth weight/gestational age ratio evaluated at birth. Results: The mothers showed adequate glycemic control; 91.3 % of all pregnant women achieved HbA1c < 6,5 % in the third trimester. The SFH-chart tested achieved 100 % of Sens and NPV in predicting both SGA and LGA, with accuracy of 90.3 % (85.5; 93.6) and 91.8 % (87.2; 94.8), respectively, for predicting SGA and LGA newborns. Conclusions: The Basso SFH-chart showed high performance in predicting both SGA and LGA newborns of DM-2, GDM and MGH mothers, with better performance than the national reference SFH-chart. These findings support the internal validation of the Basso SFH-chart, which may be implemented in the prenatal care of the Diabetes and Pregnancy Reference Service-Botucatu Medical School/UNESP. Graduate Program in Gynecology Obstetrics and Mastology Botucatu Medical School UNESP Dr. Raul Bauab-Jahu Education Foundation Integrated Faculties of Jaú Department of Gynecology and Obstetrics Botucatu Medical School UNESP Departamento Ginecologia e Obstetrícia Faculdade de Medicina de Botucatu UNESP, Distrito de Rubião Jr. s/n Graduate Program in Gynecology Obstetrics and Mastology Botucatu Medical School UNESP Department of Gynecology and Obstetrics Botucatu Medical School UNESP Departamento Ginecologia e Obstetrícia Faculdade de Medicina de Botucatu UNESP, Distrito de Rubião Jr. s/n

The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA.Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin.The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.