Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1,216 patients over 11 years: a cross-sectional study

Abstract BACKGROUND: Endoscopic thoracic sympathectomy is the definitive surgical treatment for hyperhidrosis and a nationwide study has suggested that cultural and socioeconomic factors play a role in the numbers of operations performed. Thus, there is a need to evaluate local data in order to understand the local epidemiology and trends in hyperhidrosis treatment. OBJECTIVE: To study the epidemiology of sympathectomy for treating hyperhidrosis in São Paulo, the largest city in Brazil. DESIGN AND SETTING: Population-based retrospective cross-sectional study. METHODS: Data on sympathectomies for treating hyperhidrosis between 2008 and 2018 were assessed from the database of the Municipal Health Department of São Paulo, Brazil. RESULTS: 65.29% of the patients were female, 66.2% were aged between 20 and 39 years and 37.59% had registered with addresses outside São Paulo. 1,216 procedures were performed in the city of São Paulo from 2008 to 2018, and 78.45% of them were in only two public hospitals. The number of procedures significantly declined over the years (P = 0.001). 71.63% of the procedures were associated with 2-3 days of hospital stay, only 78 intensive care unit days were billed and we did not observe any intra-hospital death. CONCLUSION: The profile of patients operated on in São Paulo (young women) is similar to that described in other populations. Sympathectomy is a very safe procedure, with no mortality in our series. There was a decreasing trend in the number of surgeries over the years.

Epidemiological analysis of lower limb revascularization for peripheral arterial disease over 12 years on the public healthcare system in Brazil / Análise epidemiológica da revascularização de membros inferiores para doença arterial periférica em 12 anos no sistema público de saúde do Brasil

Abstract Background Worldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people. Objectives Our objective was to analyze surgical treatment for PAD provided on the Brazilian Public Healthcare System over 12 years using publicly available data. Methods The study was conducted with analysis of data available on the Brazilian Health Ministry's database platform, assessing distributions of procedures and techniques over the years and their associated mortality and costs. Results A total of 129,424 procedures were analyzed (performed either for claudication or critical ischemia, proportion unknown). The vast majority of procedures were endovascular (65.49%) and this disproportion exhibited a rising trend (p<0.001). There were 3,306 in-hospital deaths (mortality of 2.55%), with lower mortality in the endovascular group (1.2% vs. 5.0%, p=0.008). The overall governmental expenditure on these procedures was U$ 238,010,096.51, and endovascular procedures were on average significantly more expensive than open surgery (U$ 1,932.27 vs. U$ 1,517.32; p=0.016). Conclusions Lower limb revascularizations were performed on the Brazilian Public Healthcare System with gradually increasing frequency from 2008 to 2019. Endovascular procedures were vastly more common and were associated with lower in-hospital mortality rates, but higher procedure costs.

Resumo Contexto A doença arterial periférica (DAP) é uma doença com alta morbidade global, afetando mais de 200 milhões de pessoas. Objetivos Neste estudo, analisamos o tratamento cirúrgico para DAP no sistema público de saúde do Brasil no período de 12 anos, com base em dados publicamente disponíveis. Métodos O estudo foi conduzido a partir da análise de dados disponíveis na plataforma do Departamento de Informática do Sistema Único de Saúde (DATASUS), do Ministério da Saúde, avaliando a distribuição da técnica cirúrgica utilizada, a mortalidade e o custo ao longo dos anos. Resultados Um total de 129.424 procedimentos foram analisados (para claudicantes e isquemia crítica, em proporção desconhecida). A maiora dos procedimentos foi via endovascular (65,49%), com tendência de aumento nessa desproporção (p < 0,001). Houve 3.306 mortes intra-hospitalares (mortalidade de 2,55%) com menor mortalidade no grupo endovascular (1,2% vs. 5,0%; p = 0,008). O investimento governamental total para esses procedimentos foi de US$ 238.010.096,51, e os procedimentos endovasculares foram significativamente mais caros que a cirurgia aberta convencional (US$ 1.932,27 vs. US$ 1.517,32; p = 0,016). Conclusões No sistema público de saúde brasileiro, as revascularizações de membros inferiores ocorreram com frequência crescente entre 2008 e 2019. Os procedimentos endovasculares foram mais comuns e relacionados a menor mortalidade intra-hospitalar, mas a maiores custos.

Surgical repair of abdominal aortic aneurysms on the public health system in the largest city in Brazil: a descriptive analysis of in-hospital data on 2693 procedures over 10 years / Correção cirúrgica do aneurisma de aorta abdominal em 2. 693 procedimentos ao longo de 10 anos no sistema público de saúde: uma análise descritiva na maior cidade brasileira

Abstract Background From 1990 to 2015, mortality from aortic aneurysms increased 16.8% in Brazil. São Paulo is the largest city in Brazil and about 5 million people depend on the public health system there. Objectives To conduct an epidemiological analysis of abdominal aortic aneurysm surgeries in the city of São Paulo. Methods Infra-renal aortic aneurysm procedures performed over a decade (from 2008 to 2017) were studied using publicly-available platforms from the Unified Health System and DATASUS. Results 2693 procedures were analyzed; 66.73% were endovascular; 78.7% of patients were male; 70.7% were aged 65 years or more; 64.02% were elective hospital admissions. There were 288 in-hospital deaths (mortality: 10.69%). In-hospital mortality was lower for endovascular surgery than for open surgery; both for elective (4.13% versus 14.42%) and urgent (9.73% versus 27.94%) (p = 0.019) admissions. The highest volume hospital (n = 635) had the lowest in-hospital mortality (3.31%). USD 24,835,604.84 was paid; an average of $ 2,318.63 for elective open, $ 3,420.10 for emergency open, $ 12,157.35 for elective endovascular and $ 12,969.12 for urgent endovascular procedures. Endovascular procedure costs were statistically higher than the values paid for open surgeries (p <0.001). Conclusions Endovascular surgeries were performed twice as often as open surgeries; they had shorter hospital stays and lower mortality.

Resumo Contexto No Brasil, a mortalidade por aneurisma de aorta aumentou 16,8% de 1990 a 2015. São Paulo é a maior cidade do Brasil, e cerca de 5 milhões de pessoas dependem do sistema público de saúde. Objetivos Análise epidemiológica das cirurgias do aneurisma de aorta abdominal na cidade de São Paulo. Métodos As cirurgias para correção do aneurisma de aorta infrarrenal realizadas no período de uma década (de 2008 a 2017) foram estudadas utilizando-se plataformas publicamente disponíveis do Sistema Único de Saúde e do Departamento de Informática do Sistema Único de Saúde. Resultados Foram analisados ​​2.693 procedimentos, entre os quais 66,73% eram endovasculares. Entre os pacientes, houve predominância do sexo masculino (78,7%) e daqueles com 65 anos ou mais (70,7%). Um total de 64,02% eram admissões hospitalares eletivas. Ocorreram 288 óbitos hospitalares (mortalidade: 10,69%). A mortalidade durante a internação foi menor para cirurgia endovascular do que para cirurgia aberta tanto no contexto eletivo (4,13% versus 14,42%) quanto urgente (9,73% versus 27,94%) (p = 0,019). O maior volume (n = 635) apresentou menor mortalidade intra-hospitalar (3,31%). Foi pago um total de $24.835.604,84, sendo uma média de $2.318,63 para cirurgia abertura eletiva, $3.420,10 para cirurgia abertura de emergência, $12.157,35 para cirurgia endovascular eletiva e $12.969,12 para cirurgia endovascular na urgência. Os custos dos procedimentos endovasculares foram estatisticamente superiores aos valores pagos para as cirurgias abertas (p < 0,001). Conclusões Foram realizadas duas vezes mais cirurgias endovasculares do que abertas, as quais apresentaram menor tempo de internação e menor mortalidade.

Quantitative assessment of pilot-endured workloads during helicopter flying emergencies: an analysis of physiological parameters during an autorotation.

The procedures to be performed after sudden engine failure of a single-engine helicopter impose high workload on pilots. The maneuver to regain aircraft control and safe landing is called autorotation. The safety limits to conduct this maneuver are based on the aircraft height versus speed diagram, which is also known as "Dead Man's Curve". Flight-test pilots often use subjective methods to assess the difficulty to conduct maneuvers in the vicinity of this curve. We carried out an extensive flight test campaign to verify the feasibility of establishing quantitative physiological parameters to better assess the workload endured by pilots undergoing those piloting conditions. Eleven pilots were fully instrumented with sensors and had their physiological reactions collected during autorotation maneuvers. Our analyses suggested that physiological measurements (heart rate and electrodermal activity) can be successfully recorded and useful to capture the most effort-demanding effects during the maneuvers. Additionally, the helicopter's flight controls displacements were also recorded, as well as the pilots' subjective responses evaluated by the Handling Qualities Rate scale. Our results revealed that the degree of cognitive workload was associated with the helicopter's flight profile concerning the Height-Speed diagram and that the strain intensity showed a correlation with measurable physiological responses. Recording flight controls displacement and quantifying the pilot's subjective responses show themselves as natural effective candidates to evaluate the intensity of cognitive workload in such maneuvers.

COVID-19 information exposure in digital media and implications for employees in the health care sector: findings from an online survey.

OBJECTIVE: To estimate coronavirus disease 2019-related information consumption and related implications for health care professionals (medical and nonmedical personnel) during the pandemic. METHODS: A cross-sectional on-line survey was distributed to employees of a major health care institution located in São Paulo, Brazil between April 3 and April 10, 2020. Data were analyzed using descriptive statistics. RESULTS: The sample comprised 2,646 respondents. Most participants (44.4%) reported excessive or almost excessive access to information about the novel coronavirus and 67.6% reported having increased their average time spent on social media. When asked how frequently they consider it was easy to determine the reliability of information, "sometimes" corresponded to 43.2% of the answers in contrast to 14.6% responding "always". Answers related to potential signs of information overload associated with the pandemic indicated that 31% of respondents felt stressed by the amount of information they had to keep up with almost every day or always. Overall, 80.0% of respondents reported having experienced at least one of the following symptoms: headache, eye twitching, restlessness or sleeping difficulty. The frequency of symptoms was higher among participants with a more negative information processing style regarding when dealing with large volumes of information relative to those with a positive information processing style. Likewise, symptoms were more frequently reported by participants who had increased their social media access relative to those reporting reduced access during the pandemic. CONCLUSION: Our survey provides a description of how health professionals consume COVID-19 related information during the pandemic, and suggests that excessive information exposure and high processing demands may impose psychological distress and affect mental health.

GeoSES: A socioeconomic index for health and social research in Brazil.

The individual's socioeconomic conditions are the most relevant to predict the quality of someone's health. However, such information is not usually found in medical records, making studies in the area difficult. Therefore, it is common to use composite indices that characterize a region socioeconomically, such as the Human Development Index (HDI). The main advantage of the HDI is its understanding and adoption on a global scale. However, its applicability is limited for health studies since its longevity dimension presents mathematical redundancy in regression models. Here we introduce the GeoSES, a composite index that summarizes the main dimensions of the Brazilian socioeconomic context for research purposes. We created the index from the 2010 Brazilian Census, whose variables selection was guided by theoretical references for health studies. The proposed index incorporates seven socioeconomic dimensions: education, mobility, poverty, wealth, income, segregation, and deprivation of resources and services. We developed the GeoSES using Principal Component Analysis and evaluated its construct, content, and applicability. GeoSES is defined at three scales: national (GeoSES-BR), Federative Unit (GeoSES-FU), and intra-municipal (GeoSES-IM). GeoSES-BR dimensions showed a good association with HDI-M (correlation above 0.85). The model with the poverty dimension best explained the relative risk of avoidable cause mortality in Brazil. In the intra-municipal scale, the model with GeoSES-IM was the one that best explained the relative risk of mortality from circulatory system diseases. By applying spatial regressions, we demonstrated that GeoSES shows significant explanatory potential in the studied scales, being a compelling complement for future researches in public health.

Combining neuropsychological tests to improve the assessment of arithmetic difficulties in children with ADHD / Combinando testes neuropsicológicos para melhorar a avaliação de dificuldades aritméticas em crianças com TDAH

Abstract Objective: To compare the ways of evaluating arithmetic skills in Brazilian children with ADHD by combining three validated neuropsychological tests and determining whether they are sensitive to the methylphenidate treatment. Methods: Forty-two children (9‒12 years old) participated in the present study: 20 were children with ADHD (DSM-IV) and 22 were age-matched controls. A classification criterion was used for each test separately and one, for their combination to detect the presence of arithmetic difficulties at two time points: baseline (time 1); and when children with ADHD were taking 0.3‒0.5 mg/kg of methylphenidate (time 2). The study also assessed children's subtraction performance, combining parts of these tests. Results: Separately, the tests were only sensitive to differences between groups without medication. However, by combining the three neuropsychological tests, we observed a difference and detected a reduction in arithmetic difficulties associated with the methylphenidate treatment. The same effects were found in subtraction exercises, which require a borrowing procedure. Conclusions: The present study detected arithmetic difficulties in Brazilian children with ADHD and the effects of methylphenidate. Given this improvement in sensitivity, combining tests could be a promising alternative when working with limited samples.

Resumo Objetivo: Comparar as formas de avaliar as habilidades aritméticas em crianças brasileiras com TDAH, combinando três testes neuropsicológicos validados, e verificar se são sensíveis ao tratamento com metilfenidato. Métodos: Quarenta e duas crianças (9‒12 anos) participaram deste estudo: 20 eram crianças com TDAH (DSM-IV) e 22 eram controles pareados por idade. Usamos um critério de classificação para cada teste separadamente e outro para a combinação entre eles, visando detectar a presença de dificuldades aritméticas em dois momentos: início (tempo 1) e quando as crianças com TDAH estavam tomando 0,3‒0,5 mg/kg de metilfenidato (tempo 2). O estudo também avaliou o desempenho dessas crianças em operações de subtração, combinando partes desses testes. Resultados: Separadamente, os testes foram sensíveis apenas às diferenças entre os grupos sem medicação. Entretanto, ao combinar os três testes neuropsicológicos, foi possível observar uma diferença e detectar uma redução das dificuldades aritméticas associadas ao tratamento com metilfenidato. Os mesmos efeitos foram encontrados em exercícios de subtração que exigem o procedimento de empréstimo. Conclusões: O estudo foi capaz de detectar dificuldades aritméticas em crianças brasileiras com TDAH e os efeitos do metilfenidato. Dada essa melhora na sensibilidade, combinar testes poderia ser uma alternativa promissora ao trabalhar com amostras limitadas.

Combining neuropsychological tests to improve the assessment of arithmetic difficulties in children with ADHD.

OBJECTIVE: To compare the ways of evaluating arithmetic skills in Brazilian children with ADHD by combining three validated neuropsychological tests and determining whether they are sensitive to the methylphenidate treatment. METHODS: Forty-two children (9‒12 years old) participated in the present study: 20 were children with ADHD (DSM-IV) and 22 were age-matched controls. A classification criterion was used for each test separately and one, for their combination to detect the presence of arithmetic difficulties at two time points: baseline (time 1); and when children with ADHD were taking 0.3‒0.5 mg/kg of methylphenidate (time 2). The study also assessed children's subtraction performance, combining parts of these tests. RESULTS: Separately, the tests were only sensitive to differences between groups without medication. However, by combining the three neuropsychological tests, we observed a difference and detected a reduction in arithmetic difficulties associated with the methylphenidate treatment. The same effects were found in subtraction exercises, which require a borrowing procedure. CONCLUSIONS: The present study detected arithmetic difficulties in Brazilian children with ADHD and the effects of methylphenidate. Given this improvement in sensitivity, combining tests could be a promising alternative when working with limited samples.

COVID-19 information exposure in digital media and implications for employees in the health care sector: findings from an online survey / Exposição às informações sobre COVID-19 em mídias digitais e suas implicações para funcionários do setor de saúde: resultados de uma pesquisa on-line

ABSTRACT Objective: To estimate coronavirus disease 2019-related information consumption and related implications for health care professionals (medical and nonmedical personnel) during the pandemic. Methods: A cross-sectional on-line survey was distributed to employees of a major health care institution located in São Paulo, Brazil between April 3 and April 10, 2020. Data were analyzed using descriptive statistics. Results: The sample comprised 2,646 respondents. Most participants (44.4%) reported excessive or almost excessive access to information about the novel coronavirus and 67.6% reported having increased their average time spent on social media. When asked how frequently they consider it was easy to determine the reliability of information, "sometimes" corresponded to 43.2% of the answers in contrast to 14.6% responding "always". Answers related to potential signs of information overload associated with the pandemic indicated that 31% of respondents felt stressed by the amount of information they had to keep up with almost every day or always. Overall, 80.0% of respondents reported having experienced at least one of the following symptoms: headache, eye twitching, restlessness or sleeping difficulty. The frequency of symptoms was higher among participants with a more negative information processing style regarding when dealing with large volumes of information relative to those with a positive information processing style. Likewise, symptoms were more frequently reported by participants who had increased their social media access relative to those reporting reduced access during the pandemic. Conclusion: Our survey provides a description of how health professionals consume COVID-19 related information during the pandemic, and suggests that excessive information exposure and high processing demands may impose psychological distress and affect mental health.

RESUMO Objetivo: Estimar o consumo de informações relacionadas com doença do novo coronavírus e seus efeitos em profissionais do setor da saúde durante a pandemia. Métodos: Um questionário on-line foi distribuído para funcionários de uma instituição de saúde em São Paulo, Brasil, entre 3 e 10 de abril de 2020. Os dados foram analisados com estatísticas descritivas. Resultados: Foram incluídos nas análises 2.646 participantes. A maioria (44,4%) reportou ter acessado uma quantidade excessiva ou próxima de excessiva sobre o novo coronavírus, e 67,6% reportaram ter aumentado seu tempo médio em mídias sociais. Quando perguntados se era fácil determinar o que era informação confiável, 43,2% responderam "às vezes", comparados com 14,6% que responderam "sempre". Sobre os possíveis sinais de sobrecarga de informação associada com a pandemia, 31% sempre ou quase todos os dias se sentiram estressados com a quantidade de informações que tinham que acompanhar. Entre os respondentes, 80,0% reportaram sentir pelo menos um sintoma como dor de cabeça, espasmos oculares, inquietação ou dificuldade para dormir. Participantes com um estilo mais negativo de lidar com muitas informações também reportaram maior proporção de sintomas que os participantes com estilo positivo. De forma semelhante, participantes que aumentaram seu acesso a mídias sociais reportaram maior proporção de sintomas do que os que diminuíram seu acesso durante a pandemia. Conclusão: Nossa pesquisa fornece uma descrição de como os indivíduos consomem informações relacionadas com a doença do novo coronavirus durante a pandemia e sugere que a exposição a uma quantidade excessiva de informações e as elevadas demandas podem impor sofrimento psicológico e afetar a saúde mental.

Tumor growth analysis by magnetic resonance imaging of the C6 glioblastoma model with prospects for the assessment of magnetohyperthermia therapy.

OBJECTIVE: The objective was to establish a pattern of tumor growth of the C6 model of glioblastoma multiform in Wistar rats via magnetic resonance imaging (MRI) for the subsequent verification of tumor volume reduction due to magnetic hyperthermia therapy. METHODS: Young male Wistar rats weighing between 250 and 300 g were used for the C6 model. After the rats were anesthetized (55 mg/ kg ketamine and 11 mg/kg xylazine), C6 lineage tumorigenic cells suspended in culture medium (10(5) cells in 10 microl) were stereotaxically injected into the right frontal cortex (bregma coordinates: 2.0 mm anteroposterior, 3.0 mm laterolateral, and 2.5 mm depth) of the rats using a Hamilton syringe. For the control group, the rats were injected with culture medium without cells. MRI scans were performed at 14, 21, and 28 d after the injection using a 2.0 T MRI scanner (Bruker BioSpec, Germany). The animals were anesthetized with 55 mg/kg ketamine and 11 mg/kg xylazine before being examined. Coronal multilayers were acquired using a standard spin echo sequence with the following parameters: repetition/echo time = 4.000 ms/67.1 ms, field of view = 3.50, matrix = 192, slice thickness = 0.4 mm, and slice separation = 0 mm. RESULTS: The MRI analysis enabled a clear visualization of the tumor mass, and it was possible to establish the tumor volume parameters on the various days that were examined. The volume at 14 d after induction was 13.7 +/- 2.5 mm3. On days 21 and 28, the tumor volumes were 31.7 +/- 6.5 mm3 and 122.1 +/- 11.8 mm3, respectively. CONCLUSION: These results demonstrated that it is possible to evaluate the C6 model tumor volume in rats, which will allow for the future implementation and verification of magnetic hyperthermia therapy.

Return on Scientific Investment - RoSI: a PMO dynamical index proposal for scientific projects performance evaluation and management.

OBJECTIVE: To propose a measure (index) of expected risks to evaluate and follow up the performance analysis of research projects involving financial and adequate structure parameters for its development. METHODS: A ranking of acceptable results regarding research projects with complex variables was used as an index to gauge a project performance. In order to implement this method the ulcer index as the basic model to accommodate the following variables was applied: costs, high impact publication, fund raising, and patent registry. The proposed structured analysis, named here as RoSI (Return on Scientific Investment) comprises a pipeline of analysis to characterize the risk based on a modeling tool that comprises multiple variables interacting in semi-quantitatively environments. RESULTS: This method was tested with data from three different projects in our Institution (projects A, B and C). Different curves reflected the ulcer indexes identifying the project that may have a minor risk (project C) related to development and expected results according to initial or full investment. CONCLUSION: The results showed that this model contributes significantly to the analysis of risk and planning as well as to the definition of necessary investments that consider contingency actions with benefits to the different stakeholders: the investor or donor, the project manager and the researchers.

Return on Scientific Investment - RoSI: a PMO dynamical index proposal for scientific projects performance evaluation and management / Retorno sobre o Investimento Científico - RoSI: uma proposta de índice dinâmico PMO para avaliação de desempenho e gestão de projetos científicos

Objective: To propose a measure (index) of expected risks to evaluate and follow up the performance analysis of research projects involving financial and adequate structure parameters for its development. Methods: A ranking of acceptable results regarding research projects with complex variables was used as an index to gauge a project performance. In order to implement this method the ulcer index as the basic model to accommodate the following variables was applied: costs, high impact publication, fund raising, and patent registry. The proposed structured analysis, named here as RoSI (Return on Scientific Investment) comprises a pipeline of analysis to characterize the risk based on a modeling tool that comprises multiple variables interacting in semi-quantitatively environments. Results: This method was tested with data from three different projects in our Institution (projects A, B and C). Different curves reflected the ulcer indexes identifying the project that may have a minor risk (project C) related to development and expected results according to initial or full investment. Conclusion: The results showed that this model contributes significantly to the analysis of risk and planning as well as to the definition of necessary investments that consider contingency actions with benefits to the different stakeholders: the investor or donor, the project manager and the researchers.

Objetivos: Propor um novo índice adaptado de riscos esperados para avaliar, planejar e acompanhar projetos de pesquisa que dependem de financiamento e estrutura adequada para o seu desenvolvimento. Métodos: Uma grade de resultados aceitáveis em relação aos projetos de pesquisa com variáveis complexas foi aplicada como índice para mensurar o desempenho dos projetos. Para sua implementação foram utilizados o índice de ulcer como medida básica para acomodar as seguintes variáveis: custos, fator de impacto de publicação, levantamento de fundos e registro de patentes. Obteve-se uma ferramenta de modelagem aqui denominada "Retorno sobre Investimento Científico" (RoSI) que permitiu mensurar e acompanhar projetos de modo analítico, levando-se em conta o conjunto dos resultados esperados, as respectivas variáveis e suas interações analisadas num ambiente virtual semi-quantitativo. Resultados: O modelo foi testado para avaliação de três projetos da Instituição (projetos A, B, e C). Diferentes curvas refletem os índices de ulcer identificando o projeto de menor risco (projeto C) relacionado ao desenvolvimento e resultados esperados de acordo com o investimento inicial ou total considerado. Conclusão: O modelo contribuiu tanto para a quantificação dos riscos e planejamento, quanto para a definição de investimentos necessários que contemplem ações de contingência, beneficiando os diferentes stakeholders envolvidos: o financiador (investidor ou doador), o gestor e os pesquisadores.