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ABSTRACT BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.
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BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.
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Internato e Residência , Brasil , Estudos Transversais , Educação de Pós-Graduação em Medicina , Humanos , Faculdades de MedicinaRESUMO
Abstract: Introduction: The accomplishment of medical residency (MR) is a type of qualification considered to be the "gold standard" for medical specialization. Understanding whether there is actually greater professional settlement or not stimulated by MR and which factors hinder or contribute to the physician's permanence in that place, are important information for the structuring of medical residency and health system programs. The aim of this study was to evaluate the prevalence of settlement of medical residents who finished the residency training in the state of Tocantins, after the implementation of medical residency programs in the period from 2013 to 2017. Method: This is an observational quantitative research, with a cross-sectional, descriptive and analytical design, using the telematic technique and its own questionnaire, carried out with 44 medical residents that finished the medical residency program in the state of Tocantins. The project was reviewed and approved by the Ethics Committee of the Federal University of Tocantins (UFT) under Opinion number 2.292.540. Results: The prevalence of settlement was 65.9% of physicians in the state of Tocantins. Most residents were females (59.1%), with a mean age of 30.8 ± 3.1 years, income between 10 and 20 minimum wages (55.8%) and worked during their residency training (84.1%). The specialties that showed the highest settlement rates were general surgery and clinical medicine, and among these, the majority works for the private and state health networks. The main reason for not settling in Tocantins was to attend another residency or subspecialty program in another state (64.7%). Conclusion: The prevalence of medical residents that finished the residency and settled in Tocantins during the analyzed period can be considered high (65.9%). The fact that most of these individuals are young and female and the reason for not settling in the state are important indicators to be analyzed together with the settlement process and the offering of positions in the specialties available in Tocantins. The results of the study indicated a favorable and strategic perspective of the Medical Residency Programs (MRP) in the medical settlement in Tocantins, which cannot be generalized to the reality of such an unequal health system in the country. A larger public investment in the structuring of health network services is necessary, especially in the municipal network, in the organization of support and socioeconomic development of cities.
Resumo: Introdução: A realização de residência médica (RM) é uma vertente de qualificação considerada "padrão ouro" para a especialização médica. A compreensão dos motivos que levam ou não à maior fixação do profissional estimulado pela RM e a identificação dos fatores que dificultam a permanência do médico no local ou contribuem para isso são importantes informações para a estruturação dos programas de RM e sistema de saúde. O objetivo deste estudo foi avaliar a prevalência de fixação dos egressos no estado do Tocantins, após a implantação das residências médicas no período de 2013 a 2017. Método: Trata-se de uma pesquisa observacional do tipo quantitativo, com delineamento transversal, de caráter descritivo e analítico, com uso da técnica telematizada e questionário próprio, realizada com 44 egressos dos programas de RM no estado do Tocantins. O projeto foi revisado e aprovado pelo Comitê de Ética da Universidade Federal do Tocantins (UFT) sob o Parecer nº 2.292.540. Resultados: A prevalência de fixação foi de 65,9% dos médicos no estado do Tocantins. A maioria dos residentes era do sexo feminino (59,1%), com idade média de 30,8±3,1 anos e renda entre dez e 20 salários mínimos (55,8%), e trabalhou durante a residência (84,1%). As especialidades com maior índice de fixação foram as cirurgias geral e médica. No caso desse estudo, a maioria dos participantes atua nas redes privada e estadual. O principal motivo para não fixação no Tocantins foi cursar outra residência ou subespecialidade em outro estado (64,7%). Conclusão: A prevalência de fixação das RMs no Tocantins no período analisado pode ser considerada alta (65,9%). O perfil de feminização, o juvenescimento e o motivo da não fixação dos egressos são importantes indicadores para serem analisados em conjunto com o processo de fixação e oferta de vagas nas especialidades disponibilizadas no Tocantins. Os resultados do estudo apontaram uma perspectiva favorável e estratégica dos Programas de Residência Médica (PRM) na fixação de médico no Tocantins, o que não pode ser generalizado para a realidade de um sistema de saúde tão desigual no país. Um maior investimento público na estruturação dos serviços da rede de saúde, em especial na rede municipal, na organização de apoio e no desenvolvimento socioeconômico das cidades é necessário.
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CONTEXT AND OBJECTIVE:: The relationship between sex hormones and asthma has been evaluated in several studies. The aim of this review article was to investigate the association between asthma and female sex hormones, under different conditions (premenstrual asthma, use of oral contraceptives, menopause, hormone replacement therapy and pregnancy). DESIGN AND SETTING:: Narrative review of the medical literature, Universidade Federal do Tocantins (UFT) and Universidade Federal de São Paulo (Unifesp). METHODS:: We searched the CAPES journal portal, a Brazilian platform that provides access to articles in the MEDLINE, PubMed, SciELO, and LILACS databases. The following keywords were used based on Medical Subject Headings: asthma, sex hormones, women and use of oral contraceptives. RESULTS:: The associations between sex hormones and asthma remain obscure. In adults, asthma is more common in women than in men. In addition, mortality due to asthma is significantly higher among females. The immune system is influenced by sex hormones: either because progesterone stimulates progesterone-induced blocking factor and Th2 cytokines or because contraceptives derived from progesterone and estrogen stimulate the transcription factor GATA-3. CONCLUSIONS:: The associations between asthma and female sex hormones remain obscure. We speculate that estrogen fluctuations are responsible for asthma exacerbations that occur in women. Because of the anti-inflammatory action of estrogen, it decreases TNF-α production, interferon-γ expression and NK cell activity. We suggest that further studies that highlight the underlying physiopathological mechanisms contributing towards these interactions should be conducted.
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Asma/etiologia , Hormônios Esteroides Gonadais/efeitos adversos , Asma/fisiopatologia , Brasil , Anticoncepcionais Orais/efeitos adversos , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Menopausa , Gravidez , Complicações na Gravidez , Progesterona/efeitos adversos , Fatores de RiscoRESUMO
ABSTRACT CONTEXT AND OBJECTIVE: The relationship between sex hormones and asthma has been evaluated in several studies. The aim of this review article was to investigate the association between asthma and female sex hormones, under different conditions (premenstrual asthma, use of oral contraceptives, menopause, hormone replacement therapy and pregnancy). DESIGN AND SETTING: Narrative review of the medical literature, Universidade Federal do Tocantins (UFT) and Universidade Federal de São Paulo (Unifesp). METHODS: We searched the CAPES journal portal, a Brazilian platform that provides access to articles in the MEDLINE, PubMed, SciELO, and LILACS databases. The following keywords were used based on Medical Subject Headings: asthma, sex hormones, women and use of oral contraceptives. RESULTS: The associations between sex hormones and asthma remain obscure. In adults, asthma is more common in women than in men. In addition, mortality due to asthma is significantly higher among females. The immune system is influenced by sex hormones: either because progesterone stimulates progesterone-induced blocking factor and Th2 cytokines or because contraceptives derived from progesterone and estrogen stimulate the transcription factor GATA-3. CONCLUSIONS: The associations between asthma and female sex hormones remain obscure. We speculate that estrogen fluctuations are responsible for asthma exacerbations that occur in women. Because of the anti-inflammatory action of estrogen, it decreases TNF-α production, interferon-γ expression and NK cell activity. We suggest that further studies that highlight the underlying physiopathological mechanisms contributing towards these interactions should be conducted.
RESUMO CONTEXTO E OBJETIVO: A relação entre os hormônios sexuais e a asma tem sido investigada em diversos estudos. Esta revisão tem como objetivo descrever a relação entre hormônios sexuais (endógenos e exógenos) e a inflamação nas vias aéreas, especialmente na asma, em eventos diferentes (na asma pré-menstrual, durante o uso de anticoncepcionais, na menopausa, no uso de terapia hormonal e na gestação). TIPO DE ESTUDO E LOCAL: Revisão narrativa da literatura médica, Universidade Federal do Tocantins (UFT) e Universidade Federal de São Paulo (Unifesp). MÉTODO: Pesquisamos o Portal de Periódicos Capes, uma plataforma brasileira que fornece acesso a artigos nas bases de dados MEDLINE, PubMed, SciELO e LILACS. Os descritores utilizados foram asma, hormônios sexuais, mulheres e uso de anticoncepcionais, com base no "Medical Subject Headings". RESULTADOS: As associações entre hormônios sexuais e asma ainda permanecem obscuras. Em adultos, a asma é mais frequente em mulheres do que em homens. Além disso, a mortalidade por asma é significativamente maior no sexo feminino, destacando-se que o sistema imunológico sofre influência de hormônios sexuais, seja porque a progesterona estimula o fator bloqueador induzido pela progesterona e citocinas Th2 ou porque contraceptivos derivados de progesterona e estrógeno estimulam o fator de transcrição GATA-3. CONCLUSÕES: A associação entre asma e hormônios sexuais femininos permanece obscura. Nós especulamos que as flutuações do estrogênio são responsáveis pelas exacerbações da asma que ocorrem nas mulheres. Devido à ação anti-inflamatória do estrogênio há redução da produção de TNF-α, da expressão do interferon-γ e da atividade das células NK. Sugerimos que sejam realizados novos estudos para esclarecer os mecanismos fisiopatológicos dessas interações.
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Humanos , Feminino , Gravidez , Asma/etiologia , Hormônios Esteroides Gonadais/efeitos adversos , Complicações na Gravidez , Progesterona/efeitos adversos , Asma/fisiopatologia , Brasil , Menopausa , Fatores de Risco , Anticoncepcionais Orais/efeitos adversos , Terapia de Reposição Hormonal/efeitos adversosRESUMO
Introdução: Considerando que o Tocantins está entre os Estados brasileiros com maior número de ocorrência de incêndios florestais, os focos de queimadas nessa região assumem importância como fator causal, no que se refere ao aumento de internações por doenças respiratórias. Objetivo: Determinar a relação entre focos de calor (queimadas), índices pluviométricos, umidade relativa do ar e média de temperatura mensal com o número de internações hospitalares por doenças respiratórias no Hospital Infantil Público de Palmas (HIPP). Método: Foi realizado estudo transversal que comparou o número de focos de calor (queimadas), índices pluviométricos e umidade relativa do ar com o número de internações hospitalares por doenças respiratórias em um hospital infantil de Palmas - TO, no ano de 2012. Resultados: Do total de internações no HIPP por diversas causas, 42,24% foram decorrentes de doenças respiratórias. O índice pluviométrico chegou a 0 mm no terceiro trimestre, 54,9±42,6 mm no segundo, seguido por 194,8±149,9 mm no quarto e, finalmente, 249,2±128,9 mm no primeiro (p<0,04). Com relação à umidade, variou de 41,7±4,7% no terceiro trimestre para 65,6±7,9 % no segundo, 69,0±11,9% no quarto e 81,9±2,7% no primeiro (p<0,04). Aparentemente, a diferença no número de focos de incêndio não foi estatisticamente significativa. Foi observada correlação negativa entre o índice pluviométrico e o número de internações por doenças respiratórias, no total (R=-0,606; p<0,03) e por pneumonia (R=-0,735; p<0,01). Conclusão: Os fatores ambientais têm importância causal com o aumento de internações por doenças respiratórias; portanto, devem ser implementadas ações voltadas à saúde para melhora dos atendimentos dos pacientes nos períodos de seca.
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CONTEXT AND OBJECTIVE: Knowledge of the profile of allergen sensitization among children is important for planning preventive measures. The objective of this study was to assess the prevalence and profile of sensitization to inhaled allergens and food among children and adolescents in an outpatient population in the city of Palmas. DESIGN AND SETTING: Cross-sectional study at outpatient clinics in Palmas, Tocantins, Brazil. METHODS: Ninety-four patients aged 1-15 years who were attending two pediatric outpatient clinics were selected between September and November 2008. All of the subjects underwent clinical interviews and skin prick tests. RESULTS: A positive skin prick test was observed in 76.6% of the participants (72.3% for inhalants and 28.9% for food allergens). The most frequent allergens were Dermatophagoides pteronyssinus (34%), cat epithelium (28.7%), dog epithelium (21.3%), Dermatophagoides farinae (19.1%), Blomia tropicalis (18.1%), cow's milk (9.6%) and grasses (9.6%). A positive skin prick test correlated with a history of atopic disease (odds ratio, OR = 5.833; P = 0.002), a family history of atopic disease (OR = 8.400; P < 0.001), maternal asthma (OR = 8.077; P = 0.048), pet exposure (OR = 3.600; P = 0.012) and cesarean delivery (OR = 3.367; P = 0.019). CONCLUSION: Dermatophagoides pteronyssinus was the most frequent aeroallergen and cow's milk was the most prevalent food allergen. There was a positive correlation between a positive skin prick test and several factors, such as a family history of atopic disease, maternal asthma, pet exposure and cesarean delivery.
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Alérgenos/imunologia , Hipersensibilidade Imediata/epidemiologia , Hipersensibilidade Imediata/imunologia , Adolescente , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/imunologia , Humanos , Lactente , Masculino , Prevalência , Fatores de Risco , Sensibilidade e Especificidade , Testes CutâneosRESUMO
CONTEXT AND OBJECTIVE: Knowledge of the profile of allergen sensitization among children is important for planning preventive measures. The objective of this study was to assess the prevalence and profile of sensitization to inhaled allergens and food among children and adolescents in an outpatient population in the city of Palmas. DESIGN AND SETTING: Cross-sectional study at outpatient clinics in Palmas, Tocantins, Brazil. METHODS: Ninety-four patients aged 1-15 years who were attending two pediatric outpatient clinics were selected between September and November 2008. All of the subjects underwent clinical interviews and skin prick tests. RESULTS: A positive skin prick test was observed in 76.6% of the participants (72.3% for inhalants and 28.9% for food allergens). The most frequent allergens were Dermatophagoides pteronyssinus (34%), cat epithelium (28.7%), dog epithelium (21.3%), Dermatophagoides farinae (19.1%), Blomia tropicalis (18.1%), cow's milk (9.6%) and grasses (9.6%). A positive skin prick test correlated with a history of atopic disease (odds ratio, OR = 5.833; P = 0.002), a family history of atopic disease (OR = 8.400; P < 0.001), maternal asthma (OR = 8.077; P = 0.048), pet exposure (OR = 3.600; P = 0.012) and cesarean delivery (OR = 3.367; P = 0.019). CONCLUSION: Dermatophagoides pteronyssinus was the most frequent aeroallergen and cow’s milk was the most prevalent food allergen. There was a positive correlation between a positive skin prick test and several factors, such as a family history of atopic disease, maternal asthma, pet exposure and cesarean delivery. .
CONTEXTO E OBJETIVO: O conhecimento sobre o perfil da sensibilização a alérgenos em crianças é importante para o planejamento de medidas preventivas. O objetivo deste estudo foi avaliar a prevalência e perfil de sensibilização a alérgenos inalados e alimentares em crianças e adolescentes em uma população ambulatorial na cidade de Palmas. TIPO DE ESTUDO E LOCAL: Estudo transversal em unidades ambulatoriais em Palmas, Tocantins, Brasil. MÉTODOS: Foram selecionados 94 pacientes com idades entre 1 a 15 anos em 2 ambulatórios de pediatria entre setembro e novembro de 2008. Todos os sujeitos foram submetidos a entrevistas clínicas e testes cutâneos de puntura. RESULTADOS: Um teste cutâneo de puntura positivo foi observado em 76,6% dos participantes (72,3% para inalantes, 28,9% para alérgenos alimentares). Os alérgenos mais frequentes foram Dermatophagoides pteronyssinus (34%), epitélio de gato (28,7%), epitélio de cão (21,3%), Dermatophagoides farinae (19,1%), Blomia tropicalis (18,1%), leite de vaca (9,6%) e gramíneas (9,6%). Um teste cutâneo de puntura positivo foi relacionado à história de doença atópica (razão de chances RC = 5,833, P = 0,002), história familiar de atopia (RC = 8,400, P < 0,001), asma materna (RC = 8,077, P = 0,048), exposição a animal de estimação (RC = 3,600, P = 0,012) e parto cesáreo (RC = 3,367, P = 0,019). CONCLUSÃO: Dermatophagoides pteronyssinus foi o aeroalérgeno mais prevalente e, dentre alérgenos alimentares, o leite de vaca. Houve correlação positiva entre o teste cutâneo e alguns fatores, como história familiar de atopia, asma materna, exposição a animais domésticos e parto cesáreo. .