Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of Tocantins, Brazil.

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.

Physician's experience on managing asthma in adolescents: results of the International AMADO (Asthma Management in ADOlescents) survey.

BACKGROUND: Worldwide prevalence of asthma seems to be increasing in adolescents, but limited data is available regarding the management of asthma in this age group. OBJECTIVE: Therefore, we conducted an international survey focused on physicians who manage asthma in order to understand how Asthma Management in ADOlescents (AMADO) is currently performed. METHODS: The AMADO survey is a web-based global survey of physician's attitudes towards the management of asthma in adolescents, circulated for 17 weeks. The survey had an anonymous and voluntary standard. The questionnaire consisted in 27 questions covering the training background of respondents, difficulties in diagnosis, and in management of asthma in adolescents. RESULTS: Two hundred forty-four responses were received from 46 countries, from all continents. Most (65%) of participants indicated allergy as being their main specialty. The majority of participants (62%) had more than 5 years of clinical practice, but 62% have no formal training in management of adolescents with asthma. Most of participants (96%) indicated having at least one case of asthma in adolescents per month. 60% of respondents mentioned that the asthmatic adolescents only had the consultation due to the family imposition. All respondents mentioned having difficulties in the management of asthma in adolescents due to patient poor adherence. Overall, 44% of participants have no specific health care resources for adolescents in their departments. Main suggestions from the participants were: optimization of time and personalized communication to these cohort, and standardization of multidisciplinary actions to improve adherence to asthma control treatment. CONCLUSION: Management of asthma in adolescents is still a challenge in clinical practice. The results from this survey helped us to identify the key issues to improve clinical outcomes in the future. This survey is the first step of the international AMADO initiative, which intends to optimize diagnosis and control of asthma and prevent avoidable deaths.

Exposição ambiental e risco à saúde - Brasil / Environmental exposure and health risks in Brazil

Objetivo: Identificar possíveis fatores sociodemográficos, econômicos, de saúde, ambientais e de hábitos de vida associados a efeitos adversos sobre a saúde de moradores em três cidades brasileiras. Método: Estudo transversal com abordagem quantitativa realizado nas cidades de Imperatriz (Maranhão), Palmas (Tocantins) e Salvador (Bahia). Participaram 975 pacientes (18 a 75 anos) atendidos em unidades básicas de saúde no período de junho de 2021 a junho de 2022. Esses indivíduos foram selecionados aleatoriamente (amostra de conveniência). Foi aplicado o questionário padronizado sobre fatores sociodemográficos e exposição a fatores ambientais, assim como o de hábitos de vida. Empregou-se a situação de saúde (excelente/boa x regular/ má/péssima) como desfecho, foi realizada análise multivariada seguida por regressão logística respeitando-se cada município individualmente e o seu coletivo. Os dados foram apresentados como odds ratio (OR) e intervalos de confiança de 95% (IC95%). Resultados: Em todas as cidades houve predomínio de pacientes do sexo feminino: 58,3% em Imperatriz, 67,5% em Tocantins e 65,4% em Salvador. A prevalência de tabagismo (presente e/ou passado) foi significantemente mais elevada em Salvador, assim como a de consumo de álcool. Houve maior referência de saúde regular/má/péssima entre os moradores de Imperatriz, apesar de em Salvador haver o maior relato de comorbidades. Os fatores ambientais associados à condição precária de saúde, em ambos os modelos de análise, foram: ter sido exposto durante a infância a fogão a lenha/carvão/querosene/outro; passar mais de duas horas na cozinha, com fogão em funcionamento; e residir próximo a uma fonte poluidora. Morar em Imperatriz revelou chance 1,8 vezes maior de ter saúde debilitada quando comparado aos moradores de Salvador, e de 1,7 vezes para os de Palmas. Conclusões: Profissionais de saúde deverão orientar a população quanto as questões socioambientais que interferem nos índices de saúde. Os dados demográficos, ambientais e econômicos podem interferir nas condições de saúde.

Objective: To identify potential sociodemographic, socioeconomic, health, environmental, and lifestyle factors associated with adverse health effects in residents of 3 Brazilian cities. Methods: This cross-sectional study with a quantitative approach was conducted in the cities of Imperatriz (Maranhão), Palmas (Tocantins), and Salvador (Bahia). A total of 975 patients aged 18 to 75 years treated at primary health care units from June 2021 to June 2022 were selected via convenience sampling. A standardized questionnaire on sociodemographic characteristics, exposure to environmental factors, and lifestyle habits was administered. The outcome measured was health status (excellent/good vs fair/bad/very poor). Multivariate analysis was performed using logistic regression, respecting each municipality individually and collectively. Data were presented as odds ratios (OR) and 95%CIs. Results: Women predominated in all cities: 58.3% in Imperatriz, 67.5% in Tocantins, and 65.4% in Salvador. The prevalence of smoking (present and/or past) was significantly higher in Salvador, as was the prevalence of alcohol consumption. Despite Salvador having the highest rate of comorbidities, residents of Imperatriz reported more instances of fair/poor/very poor health. Environmental factors significantly associated with poor health conditions in both analysis models included exposure to wood/ coal/kerosene/other stoves during childhood, spending more than 2 hours in the kitchen with a working stove, and living close to a pollution source. Residents of Imperatriz were 1.8 times and 1.7 times more likely to have poor health compared with residents of Salvador (a more developed center with more health resources) and Palmas, respectively. Conclusions: Health professionals should guide the population regarding socio-environmental issues affecting health indices. Demographic, environmental, and economic data can impact health conditions.

Influência da exposição ambiental na percepção do estado de saúde de indivíduos de cinco países latino-americanos / Effect of environmental exposure on the perceived health status of individuals from five Latin American countries

OBJETIVO: A relação entre exposição ambiental e risco à saúde é amplamente reconhecida e a avaliamos em cinco países da América Latina com condições culturais distintas, mas com Índices de Desenvolvimento Humano semelhantes. MÉTODOS: Estudo transversal envolvendo 3.016 indivíduos (18 a 75 anos) oriundos de: Argentina (n = 878), Brasil (n = 1.030), México (n = 272), Paraguai (n = 508) e Peru (n = 328). A seleção foi aleatória e todos responderam questionário padronizado (fatores sociodemográficos, fatores ambientais e hábitos de vida) derivado do Clinical Screening Tool for Air Pollution Risk. Segundo o estado atual de saúde, foram categorizados em: saúde regular/má/péssima ou excelente/boa. Tendo-a como desfecho, realizou-se análise multivariada.Os dados foram apresentados como razão de verossimilhança (RV) e intervalos de confiança de 95% (IC 95%), tendo-se 5% o nível de significância. RESULTADOS: Foram significantemente associados a pior percepção de situação de saúde: morar em qualquer um dos países, ter umidade na residência (OR = 1,68; IC 95%: 1,33-2,12), dirigir automóvel com janelas abertas (OR = 1,31; IC 95%: 1,03-1,65), ter baixa renda familiar (OR = 1,59; IC 95%: 1,26-2,01), nível educacional incompleto (OR = 1,54; IC 95%: 1,22-1,94), histórico pessoal/familiar de hipertensão arterial (OR = 2,25; IC 95%: 01,64-3,09), doença pulmonar obstrutiva crônica/asma (OR = 1,74; IC 95%: 1,28-2,36), diabete melito (OR = 3,74; IC 95%: 2,23-6,29), obesidade (OR = 1,84; IC 95%: 1,84-3,19) ou comorbidades oftalmológicas (OR = 1,89; IC 95%: 1,55-2,30); realizar exercícios ao ar livre (OR = 1,60; IC 95%: 1,31-1,96). CONCLUSÕES: Apesar das diferentes exposições a que foram submetidos, alguns fatores permanecem muito significativos, e ter baixa renda familiar, expor-se à poluição e ter antecedentes de doenças crônicas foram associados à percepção de condição ruim de saúde.

OBJECTIVE: The relationship between environmental exposure and health outcomes is well known.We investigated this relationship in five Latin American countries with different cultural backgrounds but similar Human Development Indexes. METHODS: This was a cross-sectional study involving 3,016 individuals (18 to 75 years old) from Argentina (n=878), Brazil (n=1030), Mexico (n=272), Paraguay (n=508), and Peru (n=328). Participants were randomly selected and responded to a standardized questionnaire (including sociodemographic and environmental factors and lifestyle habits) derived from a clinical screening tool for air pollution risk. Based on their current health status, participants were categorized as having regular/bad/very bad or excellent/good health. Multivariate analysis was conducted, and data were presented as likelihood ratios and 95% confidence intervals (95%CI).The significance level was set at 5%. RESULTS: Living in any of the study countries; indoor humidity (OR=1.68; 95%CI: 1.33-2.12); driving with the windows open (OR=1.31; 95%CI: 1.03-1.65); low family income (OR=1.59; 95%CI: 1.26-2.01); incomplete education (OR=1.54; 95%CI: 1.22-1.94); personal/family history of hypertension (OR=2.25; 95%CI: 01.643.09), chronic obstructive pulmonary disease/asthma (OR=1.74; 95%:CI: 1.28-2.36), diabetes (OR=3.74; 95%CI:2.23-6.29), obesity (OR=1.84; 95%CI: 1.84-3.19), or ocular comorbidities (OR=1.89; 95%CI: 1.55-2.30); and exercising outdoors (OR=1.60; 95%CI: 1.31-1.96) were significantly associated with a worse perceived health status. CONCLUSIONS: Despite the different exposures to which participants were subjected, some factors remain very significant. Low family income, exposure to pollution, and a history of chronic diseases were associated with the perception of a poor health condition.

Proportion of doctors who stayed in the state of Tocantins after finishing medical residency: preliminary results from a cross-sectional study.

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

Association between asthma and female sex hormones.

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.

Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of Tocantins, Brazil

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.

Prevalence of the Settlement of Medical Residences in the State of Tocantins in the Period 2013-2017 / Prevalência de Fixação dos Egressos das Residências Médicas no Estado do Tocantins, no Período de 2013-2017

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.

Proportion of doctors who stayed in the state of Tocantins after finishing medical residency: preliminary results from a cross-sectional study

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

Prevalence of allergen sensitization, most important allergens and factors associated with atopy in children.

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.

Association between asthma and female sex hormones / Associação entre asma e hormônios sexuais femininos

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.

Prevalence of allergen sensitization, most important allergens and factors associated with atopy in children / Prevalencia de sensibilizacao a alergenos, alergenos mais relevantes e fatores associados com a atopia em criancas

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. .

Há relação entre internações hospitalares por doenças respiratórias, mudanças climáticas e focos de queimadas numa população pediátrica? / Is there relationship between hospital admissions for respiratory diseases, climate changes and fire outbreaks in the pediatric population?

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.

Teste de provocação nasal em rinite de etiologia indeterminada / Nasal challenge in unknown etiological rhinitis

Objetivo: Avaliar a resposta imediata ao teste de provocação nasal (TPN) em pacientes com rinite de etiologia a esclarecer no Serviço de Alergia e Imunologia do Hospital do Servidor Público Estadual de São Paulo. Pacientes e Método: Selecionamos 37 pacientes com rinite a esclarecer com relato de desencadeante específico (poeira doméstica) e apresentando exames discordantes: IgE sé rica normal ou elevada, teste cutâneo/RAST negativo. Os pacientes foram divididos em dois grupos: o primeiro formado por pacientes com IgE aumentada e o segundo com IgE normal. Realizamos o TPN com extratos de Dermatophagoides pteronyssinus (Dp) e B/omia tropica/is (Bt), em concentrações crescentes, após a aplicação de solução salina 0,9. Consideramos a resposta nasal positiva pela nota clínica maior ou igual a cinco e redução do pico de fluxo nasal (PFN) maior ou igual a 30

Reação a contraste iodado IgE mediada. Relato de caso / Iodinated contrast media reaction IgE-mediated. Case report

Objetivo: Apresentar caso clínico de possível reação a contraste iodado mediada por IgE. Método: Descrição clínica do caso e informações sobre a indicação e método utilizado para a realização do teste cutâneo imediato para contraste iodado com leitura após 20 minutos. Foi administrado o mesmo contraste em cinco pessoas voluntárias sem história prévia de reação adversa ao contraste para afastar a hipótese de resultado falso positivo. Resultados: O teste cutâneo da paciente em estudo foi positivo com formação de pápula de 5 mm para o iobitridol 300, histamina (solução milesimal) 6 mm, controle com solução salina negativo. Todas as pessoas que foram voluntárias, apresentaram testes negativos. Conclusões: Este estudo demonstra a importância da realização do teste cutâneo ao contraste iodado em pacientes com história clínica compatível de reação alérgica, pois apesar de raras estas reações podem ser IgE mediada, permitindo uma condução mais apropriada do caso.