Diagnostic Capability of Intra-Articular Injections for Femoroacetabular Impingement Syndrome: A Systematic Review.

OBJECTIVE: To review and critically appraise available literature concerning the diagnostic capability of intra-articular injections for femoroacetabular impingement (FAI) syndrome. DESIGN: Systematic review. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Studies assessing pain relief following intra-articular injections for the diagnosis of FAI syndrome, compared with arthroscopy as diagnostic reference standard, were considered eligible. Searches were performed across 8 databases, and the risk of bias was evaluated through the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS: From 489 articles identified, 4 were included for analysis. Intra-articular injections were composed of anesthetic agents (such as lidocaine, bupivacaine, and ropivacaine), combined or not with corticosteroids (triamcinolone and betamethasone). All studies were judged as "at risk of bias", and a substantial heterogeneity was found considering assessment methods and pain relief thresholds for a positive response to intra-articular injections. Overall, 2 studies reported that intra-articular injections presented a high accuracy in determining the presence of FAI syndrome. However, the remaining 2 studies indicated that intra-articular injections might present restricted diagnostic capability to discriminate FAI syndrome from healthy individuals or those with other hip pathologies. CONCLUSIONS: Based on limited evidence, the diagnostic capability of intra-articular injections for FAI syndrome cannot be supported. It remains unclear which pain relief thresholds are related to a higher diagnostic capability. The combination of anesthetics with corticosteroids should also be further explored, including multiple pain assessments for evaluation of prolonged effects.

Computed tomography of pulmonary changes in rheumatoid arthritis: carcinoembryonic antigen (CEA) as a marker of airway disease.

Rheumatoid arthritis (RA) classically affects the joints, but can present extra-articular manifestations, including pulmonary disease. The present study aimed to identify possible risk factors or laboratory markers for lung involvement in RA, particularly the presence of rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA), and tumor markers, by correlating them with changes observed on chest high-resolution computerized tomography (HRCT). This cross-sectional study involved RA patients who were examined and questioned by a specialist physician and later subjected to chest HRCT and blood collection for measurement of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), ACPA (anti-vimentin and/or anti-CCP3), and the tumor markers carcinoembryonic antigen (CEA), CA 125, CA 15-3, and CA 19-9. A total of 96 patients underwent chest HRCT. The most frequent findings were bronchial thickening (27/28.1 %) and bronchiectasis (25/26 %). RF was present in 63.2 % of patients (55/87), and ACPA (anti-vimentin or anti-CCP3) was present in 72.7 % of patients (64/88). CEA levels were high in 14 non-smokers (37.8 %) and 23 smokers (62.2 %). CA-19-9 levels were high in 6 of 86 patients (7.0 %), CA 15-3 levels were high in 3 of 85 patients (3.5 %), and CA 125 levels were high in 4 of 75 patients (5.3 %). Multivariate analysis indicated a statistically significant association between high CEA levels and the presence of airway changes in patients with RA (p = 0.048). CEA can serve as a predictor of lung disease in RA and can help identify individuals who require more detailed examination for the presence of respiratory disorders.

An investigation into the relationship between anti-Helicobacter pylori and anti-Saccharomyces cerevisiae antibodies in patients with axial spondyloarthritis and Crohn disease.

Spondyloarthritis (SpA) is a musculoskeletal inflammatory disease linked with immune responses to intestinal microbiota, and subclinical intestinal ulcerations that are closely related to inflammatory bowel diseases. Helicobacter pylori is a common cause of gastroduodenal ulceration, and anti-Saccharomyces cerevisiae antibodies (ASCA) are associated with intestinal inflammation in both Crohn disease (CD) and SpA. We investigated the relationship between H. pylori and ASCA. Ninety-one patients with axial SpA and forty with CD were included. ASCA IgG/IgA and anti-H. pylori IgG titers were assessed by ELISA. The proportion of ASCA+ patients in the positive and negative anti-H. pylori IgG groups with SpA and CD were compared using Chi-square tests, and correlations were evaluated using the Spearman's coefficient. Anti-H. pylori IgG titers were significantly negatively correlated with the ASCA IgG (r = -0.563, p < 0.001) and IgA (r = -0.342, p = 0.019) titers in the axial SpA patients. The same pattern of negative correlation was also observed in the CD patients. Anti-H. pylori+ serology was significantly more frequent in axial SpA patients than in those with CD (52.4 vs. 18.4 %, p < 0.001), while ASCA+ serology was significantly more frequent in CD patients than in SpA patients. A negative correlation between the anti-H. pylori titers and ASCA was found for axial SpA and CD. Anti-H. pylori+ serology was more frequent in SpA than in CD, while ASCA positivity was more frequent in CD patients than in those with SpA. A possible influence of H. pylori on the development of ASCA needs further investigation.

Lyme disease and Whipple's disease: a comprehensive review for the rheumatologist.

Despite their rarity, Lyme disease and Whipple's disease are of significant importance in rheumatology, as both can manifest as chronic arthritis, presenting challenges in the differential diagnosis of inflammatory arthropathies. In Lyme disease, arthritis typically emerges as a late manifestation, usually occurring six months after the onset of erythema migrans. The predominant presentation involves mono- or oligoarthritis of large joints, with a chronic or remitting-recurrent course. Even with appropriate antimicrobial treatment, arthritis may persist due to inadequate immunological control triggered by the disease. In contrast, Whipple's disease may present with a migratory and intermittent seronegative poly- or oligoarthritis of large joints, preceding classic gastrointestinal symptoms by several years. Both disorders, particularly Whipple's disease, can be misdiagnosed as more common autoimmune rheumatic conditions such as rheumatoid arthritis and spondyloarthritis. Epidemiology is crucial in suspecting and diagnosing Lyme disease, as the condition is transmitted by ticks prevalent in specific areas of the United States, Europe, and Asia. On the contrary, the causative agent of Whipple's disease is widespread in the environment, yet invasive disease is rare and likely dependent on host genetic factors. In addition to erythema migrans in Lyme disease and gastrointestinal manifestations in Whipple's disease, neurological and cardiac involvement can further complicate the course of both. This article offers a comprehensive review of the epidemiological, pathophysiological, clinical, and therapeutic aspects of both diseases.

Cultural adaptation of the National Institutes of Health--chronic prostatitis symptom index (NIH-CPSI)--to Brazilian spoken Portuguese: NIH-CPSI (Braz).

OBJECTIVES: To create a Brazilian version of the National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) using a cross-cultural adaptation process. MATERIALS AND METHODS: The nine items of the NIH-CPSI were translated to Portuguese, by two independent translators, of native Portuguese language origin, and it was obtained a single version, that was retranslated to English by two English native spoken translators, in order to correct any discrepancies. Those versions were compared to the original text, the modifications were applied and it was created a final version in Portuguese. That was pre-tested and applied to 30 patients with pain or perineal or ejaculatory disorder. To each item of the pre-final version it was assigned a score according to the grade of understanding and clarity in order to implement the adequate corrections. The final version in Portuguese was submitted to evaluations including face validation and psychometric proprieties of reproducibility and internal consistency, respectively evaluated by the (p) Pearson correlation coefficient and α Cronbach coefficient. RESULTS: All items applied to 30 patients during pre-test phase had a grade higher than 8 of understanding and clarity, and were considered clearly understandable by the patients. However, at face validation evaluation, there was an inconsistency of item three that was redone. The final produced version, called NIH-CPSI (Braz) showed good reproducibility (p = 0.89-0.99) and internal consistency (α Cronbach coefficient = 0.85-0.93). CONCLUSIONS: NIH-CPSI was adapted to Brazilian spoken Portuguese and its original proprieties were maintained, being a valid instrument for evaluations of symptoms of chronic prostatitis in Brazilian patients.

Resolution of adalimumab-induced psoriasis after vitamin D deficiency treatment.

Tumoral necrosis factor alpha blockers are very efficient in the treatment of many inflammatory systemic diseases, including rheumatoid arthritis and psoriasis. However, a paradoxical arouse of psoriasiform lesions may occur in a few patients taking anti-TNFα. The etiology of this rare side effect is still a mystery, and its treatment may be difficult. The authors report the resolution of adalimumab-induced psoriasis in a woman with rheumatoid arthritis after the use of high vitamin D(3) doses for the treatment of vitamin D deficiency. This is the first report of resolution of anti-TNFα-induced psoriasiform lesions by high doses of vitamin D(3) in a patient with rheumatoid arthritis and vitamin D deficiency. This case raises interesting questions on the role of vitamin D deficiency in the pathogenesis of this side effect and on the possible usefulness of high-dose vitamin D(3) in its treatment.

Paget's disease of bone: analysis of 134 cases from an island in Southern Brazil: another cluster of Paget's disease of bone in South America.

Paget's disease of bone (PDB) exhibits a marked geographic variation. In Brazil, the prevalence of PDB is unknown and only a few clinical data are available. The aim is to determine clinical, laboratory, imaging and response to treatment data in a large PDB case series in the city of Florianopolis, Brazil. We have performed a retrospective study based on charts reviews of all patients with PDB followed at the University Hospital of the Federal University of Santa Catarina and at five different private rheumatology outpatient offices in Florianopolis, between 1995 and 2009. One hundred and thirty-four patients with PDB were identified. Mean age at diagnosis was 63.2 ± 10.5 years, 67.2% were women, and 91.1% were Caucasian. Positive family history was reported in only 8.2%. Polyostotic disease was found in 75.0% of the cases, bone pain in 77.9%, and bone deformities in 15.9%. Higher levels of AP were significantly associated with polyostotic disease and skull involvement. Pelvic bones were the most frequently affected (53.7%). Complications included deafness in 8.2%, bone fractures in 3.0%, hydrocephalus in 2.2%, and cauda equina syndrome in 0.7% of the cases. Treatment with zoledronic acid achieved the best response with only 2.9% failing to respond adequately. According to literature data, PDB in South America seems to be characterized by an overall low prevalence, but with localized clusters with higher prevalence. The authors have described a cluster of PDB in Florianopolis, in Southern Brazil. Further properly designed studies are necessary to clarify the PDB epidemiology in South America.

Correlation of the rise and fall in COVID-19 cases with the social isolation index and early outpatient treatment with hydroxychloroquine and chloroquine in the state of Santa Catarina, southern Brazil: A retrospective analysis.

BACKGROUND: To contribute to the understanding of the coronavirus disease (COVID-19) pandemic, this study evaluated the correlations of the frequencies of COVID-19 cases, hospitalisations due to COVID-19, and deaths due to COVID-19 with social isolation indices and outpatient prescriptions of hydroxychloroquine and chloroquine in the state of Santa Catarina, southern Brazil. METHODS: This was an analytical, observational, retrospective study based on secondary data that were obtained from public Brazilian databases and covered the period from March 1, 2020 to October 31, 2020 (epidemiological weeks 10-44). Data on weekly COVID-19 cases, hospitalisations and deaths due COVID-19, sales of chloroquine and hydroxychloroquine, and social isolation indices were obtained. Associations between the variables were tested using multiple linear regression analysis. RESULTS: In all regions of Santa Catarina, there were almost simultaneous peaks of COVID-19 pandemic in weeks 28-31, followed by a sudden decrease. Social isolation indices were not associated with the outcomes; sales of chloroquine and hydroxychloroquine were significant predictors of all outcomes (p < 0.001). COVID-19 prevalence was significantly different across the state regions when COVID-19 cases started to decline (p < 0.001). DISCUSSION: Collective immunity and social isolation may not have been the only causes for the reduction of the COVID-19 pandemic observed in Santa Catarina. The results of this study were compatible with the hypothesis that early treatment of COVID-19 cases with chloroquine or hydroxychloroquine may contribute to reducing the transmissibility of COVID-19 in the population. This hypothesis needs to be further tested in future studies.

Cross-cultural adaptation and content validity of the the patient decision aid "Making Choices: Feeding Options for Patients with Dementia" to Brazilian Portuguese language. / Adaptação transcultural e validade de conteúdo do instrumento de apoio à decisão "Making Choices: Feeding Options for Patients with Dementia" para a língua portuguesa do Brasil.

PURPOSE: Cross-cultural adaptation to Brazilian Portuguese and evaluation of content validity of a patient decision aid to help in choosing the feeding route for patients with severe dementia entitled "Making Choices: Feeding Options for Patients with Dementia". METHODS: The cross-cultural adaptation involved two independent translations, synthesis of translations, two independent back-translations, their synthesis, and pretest with 30 caregivers. Content validation was based on analyzes of 35 Brazilian specialists (physicians, speech-language therapists and nurses experienced in caring for patients with severe dementia) through measures of content validity index and concordance between multiple judges by Fleiss' kappa. RESULTS: The level of comprehension of the instrument by caregivers in the pretest was almost perfect. The specialists committee considered the contents of the instrument valid, in a statistically significant way. CONCLUSION: The patient decision aid in Brazilian Portuguese entitled "Fazendo escolhas: opções de alimentação para pacientes com demência" obtained evidence of cross-cultural equivalence and content validity for use in the Brazilian population. Further studies are needed to assess its effects on the decision-making process in our population.

OBJETIVO: Realizar adaptação transcultural para o português brasileiro e verificar a validade de conteúdo de um instrumento de apoio à decisão originalmente produzido em língua inglesa (Making Choices: Feeding Options for Patients with Dementia), para auxiliar a escolha da via de alimentação de pacientes com disfagia por demência em estágio grave. MÉTODO: Foi realizada a adaptação transcultural com duas traduções independentes do instrumento original, síntese das traduções, duas retrotraduções independentes, nova síntese e pré-teste com 30 cuidadores para produção da versão final em língua portuguesa. A validação de conteúdo da versão final foi realizada com a análise por um comitê de 35 especialistas (médicos, fonoaudiólogos e enfermeiros brasileiros com experiência no manejo de pacientes com demência em estágio grave) e baseada no índice de validade de conteúdo e na concordância entre múltiplos avaliadores pelo kappa de Fleiss. RESULTADOS: O nível de compreensão do instrumento pelos cuidadores foi adequado em todas as suas seções e seu conteúdo foi considerado válido pelo comitê de especialistas, de forma estatisticamente significativa. CONCLUSÃO: O instrumento produzido de apoio à decisão para a escolha da via de alimentação em pacientes com demência grave e disfagia, denominado "Fazendo escolhas: opções de alimentação para pacientes com demência" obteve evidências de equivalência transcultural e de validade de conteúdo para uso na população brasileira. Novos estudos são necessários para avaliar seus efeitos sobre o processo de tomada de decisão em nossa população.

An investigation about chronic prostatitis in ankylosing spondylitis.

BACKGROUND: Chronic prostatitis has been a common disease reported with high frequency in ankylosing spondylitis (AS) even from decades ago. Infectious (Chlamydia trachomatis) or non-infectious (uric acid) prostatitis can hypothetically trigger vertebral inflammation in AS. This study aimed to assess the features of chronic prostatitis in patients with AS compared to healthy controls. METHODS: A cross-sectional study including male patients with AS and healthy controls who agreed to undergo a prostate examination was conducted. Structured clinical interviews, prostate physical examinations, and cytological, biochemical, and microbiological tests on urinary samples collected before and after standardized prostatic massage (pre- and post-massage test) were performed. RESULTS: Ninety participants (45 AS patients, mean age: 52.5 ± 10.0 years, with longstanding disease, 12.4 ± 6.9 years, and 45 controls, mean age: 52.8 ± 12.1 years) were included. National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) scores were similar in the AS and control groups (4.0 [1.0-12.0] vs. 5.0 [1.0-8.5], p = 0.994). The frequencies of symptoms of chronic prostatitis (NIH-CPSI Pain Domain ≥4) were also similar in both groups (23.3% vs. 22.7%, p = 0.953). Results of polymerase chain reaction tests for Chlamydia trachomatis were negative in all tested urinary samples, and uric acid concentrations and leukocyte counts were similar in all pre- and post-massage urinary samples. CONCLUSIONS: In this study, chronic prostatitis occurred in male patients with AS, but its frequency and characteristics did not differ from those found in the healthy male population of similar age.

Validity of fibromyalgia survey questionnaire (2016) assessed by telephone interview and cross-cultural adaptation to Brazilian Portuguese language.

BACKGROUND: To verify the validity of the 2016-revised Fibromyalgia Survey Questionnaire (FSQ) by telephone interview compared to self-administration and to produce a valid version of FSQ in Brazilian Portuguese language. METHODS: The Brazilian version of FSQ was produced following the recommendations for cross-cultural adaptation. Validity of Brazilian FSQ self-administration was assessed by checking agreement of its results with fibromyalgia diagnosis according the 1990 American College of Rheumatology (ACR) criteria. Reproducibility and validity of FSQ by telephone were assessed by comparing its results with the previous FSQ self-administration. RESULTS: A Brazilian Portuguese version (FSQ-Brazil) was produced. FSQ-Brazil had good internal consistency (Cronbach's alpha between 0.73 and 0.94). Agreement between the results obtained by self-administration of FSQ-Brazil and by telephone interview was substantial or almost perfect for almost all questions about pain sites and all questions about other somatic symptoms (Cohen's kappa higher than 0.6). There were small but significant bias toward higher scores of widespread pain index and fibromyalgia severity scale in the telephone interview compared to self-administration. Fibromyalgia definition by self-administration and telephone interview with FSQ-Brazil both revealed substantial agreement with the diagnosis based on ACR 1990 criteria (Cohen's kappa 0.62 and 0.65; respectively). CONCLUSIONS: FSQ-Brazil demonstrated good internal consistency, reproducibility and validity both by self-administration and by telephone interview. However, caution must be taken with the interpretation of quantitative scores of widespread pain index and symptoms severity scale, which slightly differed according the method (self-administration or interview) in our study.

Medical schools in Brasil: population, economic and historical analysis.

OBJECTIVE: To describe the current distribution and historical evolution of undergraduate courses in medicine in Brasil. METHODS: Analytical cross-sectional study of secondary data. Through the Ministry of Education, the data of the medical courses were obtained, and through the Brazilian Institute of Geography and Statistics, the population and economic data of the Brazilian states were obtained. RESULTS: In Brasil, there were 298 medical courses (1,42 courses / million inhabitants) in January 2018, totaling 31,126 vacancies per year, with 9,217 gratuitous vacancies (29.6%) and 17,963 vacancies in the hinterland (57, 7%). In Brazilian states, there are positive and statistically significant (p <0.001) correlations of the variables: "vacancies" and "population" (R 0.92); "vacancies" and "gross domestic product" ("GDP") (R 0.83); "percentage of vacancies in the hinterland" and "population in the hinterland" (R 0.71) and "percentage of vacancies in the hinterland" and "GDP" (R 0.64). There was a negative and statistically significant correlation between "gratuitous vacancy percentage" and "GDP" (R -0.54, p = 0.003). More paid courses than gratuitous courses and more courses in the hinterland than in the capitals have been created since 1964, in proportions that have remained similar since then, but in higher numbers since 2002. CONCLUSIONS: The distribution of medical courses in Brasil correlates with the population and economical production of each state. The expansion of Brazilian medical education, which has been accelerated since 2002, is based mainly on paid courses in the hinterland, in the same pattern since 1964.

Behçet's disease: clinical value of the video capsule endoscopy for small intestine examination.

We described a pilot study using Video capsule endoscopy (VCE) aiming the assessment of small bowel in Behçet's disease (BD). Ten patients with BD and abdominal complaints underwent VCE with Given Pillcam SB (Given Imaging Ltd., Yoqneam). VCE revealed small bowel lesions in all ten subjects. Five patients had active symptoms of BD while five others had clinically inactive disease. Jejune was the most frequently affected GI segment being involved in eight cases, four from each group. We suggest that small bowel involvement may be frequent in BD patients, even in the absence of oral ulcerations.

Determinants of quality of life in Paget's disease of bone.

OBJECTIVE: To evaluate the parameters associated with quality of life in patients with Paget's disease of bone. METHODS: Patients with Paget's disease of bone were evaluated with SF-36 and WHOQOL-bref questionnaires. Patients with other diseases that could cause significant impairment of their quality of life were excluded. We searched for correlations between the results and: age, time from diagnosis, type of involvement, pain related to Paget's disease of bone, limitation to daily activities, deformities, bone specific alkaline phosphatase, the extent of involvement and treatment. RESULTS: Fifty patients were included. Results of the SF-36 total score and its domains, physical and mental health, were significantly correlated with bone pain and deformities. Marital status was significantly correlated with the SF-36 total score and Mental Health Domain. BAP levels and disease extension were significantly correlated to SF-36 Physical Health Domain. After multivariate analysis, the only parameters that remained significantly associated with the SF-36 total score and to its Mental Health and Physical Health Domains were pain and marital status. The WHOQOL-bref total score was significantly associated with pain, physical impairment and deformities. WHOQOL-bref Domain 1 (physical) score was significantly associated with marital status, pain and deformities, while Domain 2 (psychological) score was associated with marital status, physical impairment and kind of involvement. After multivariate analysis, the presence of pain, deformities, and marital status were significantly associated with results of the WHOQOL-bref total score and its Domain 1. WHOQOL-bref domain 2 results were significantly predicted by pain and marital status. CONCLUSION: The main disease-related factor associated with SF-36 results in Paget's disease of bone patients was bone pain, while bone pain and deformities were associated with WHOQOL-bref.

An investigation about chronic prostatitis in ankylosing spondylitis

Abstract Background: Chronic prostatitis has been a common disease reported with high frequency in ankylosing spondylitis (AS) even from decades ago. Infectious (Chlamydia trachomatis) or non-infectious (uric acid) prostatitis can hypothetically trigger vertebral inflammation in AS. This study aimed to assess the features of chronic prostatitis in patients with AS compared to healthy controls. Methods: A cross-sectional study including male patients with AS and healthy controls who agreed to undergo a prostate examination was conducted. Structured clinical interviews, prostate physical examinations, and cytological, biochemical, and microbiological tests on urinary samples collected before and after standardized prostatic massage (pre- and post-massage test) were performed. Results: Ninety participants (45 AS patients, mean age: 52.5 ± 10.0 years, with longstanding disease, 12.4 ± 6.9years, and 45 controls, mean age: 52.8 ± 12.1 years) were included. National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) scores were similar in the AS and control groups (4.0 [1.0-12.0] vs. 5.0 [1.0—8.5], p = 0.994). The frequencies of symptoms of chronic prostatitis (NIH-CPSI Pain Domain ≥4) were also similar in both groups (23.3% vs. 22.7%, p = 0.953). Results of polymerase chain reaction tests for Chlamydia trachomatis were negative in all tested urinary samples, and uric acid concentrations and leukocyte counts were similar in all pre- and post-massage urinary samples. Conclusions: In this study, chronic prostatitis occurred in male patients with AS, but its frequency and characteristics did not differ from those found in the healthy male population of similar age.

Validity of fibromyalgia survey questionnaire (2016) assessed by telephone interview and cross-cultural adaptation to Brazilian Portuguese language

Abstract Background: To verify the validity of the 2016-revised Fibromyalgia Survey Questionnaire (FSQ) by telephone interview compared to self-administration and to produce a valid version of FSQ in Brazilian Portuguese language. Methods: The Brazilian version of FSQ was produced following the recommendations for cross-cultural adaptation. Validity of Brazilian FSQ self-administration was assessed by checking agreement of its results with fibromyalgia diagnosis according the 1990 American College of Rheumatology (ACR) criteria. Reproducibility and validity of FSQ by telephone were assessed by comparing its results with the previous FSQ self-administration. Results: A Brazilian Portuguese version (FSQ-Brazil) was produced. FSQ-Brazil had good internal consistency (Cronbach's alpha between 0.73 and 0.94). Agreement between the results obtained by self-administration of FSQ-Brazil and by telephone interview was substantial or almost perfect for almost all questions about pain sites and all questions about other somatic symptoms (Cohen's kappa higher than 0.6). There were small but significant bias toward higher scores of widespread pain index and fibromyalgia severity scale in the telephone interview compared to self-administration. Fibromyalgia definition by self-administration and telephone interview with FSQ-Brazil both revealed substantial agreement with the diagnosis based on ACR 1990 criteria (Cohen's kappa 0.62 and 0.65; respectively). Conclusions: FSQ-Brazil demonstrated good internal consistency, reproducibility and validity both by self-administration and by telephone interview. However, caution must be taken with the interpretation of quantitative scores of widespread pain index and symptoms severity scale, which slightly differed according the method (self-administration or interview) in our study.(AU)

Medical schools in Brasil: population, economic and historical analysis

SUMMARY BACKGROUND To describe the current distribution and historical evolution of undergraduate courses in medicine in Brasil. METHODS Analytical cross-sectional study of secondary data. Through the Ministry of Education, the data of the medical courses were obtained, and through the Brazilian Institute of Geography and Statistics, the population and economic data of the Brazilian states were obtained. RESULTS In Brasil, there were 298 medical courses (1,42 courses / million inhabitants) in January 2018, totaling 31,126 vacancies per year, with 9,217 gratuitous vacancies (29.6%) and 17,963 vacancies in the hinterland (57, 7%). In Brazilian states, there are positive and statistically significant (p <0.001) correlations of the variables: "vacancies" and "population" (R 0.92); "vacancies" and "gross domestic product" ("GDP") (R 0.83); "percentage of vacancies in the hinterland" and "population in the hinterland" (R 0.71) and "percentage of vacancies in the hinterland" and "GDP" (R 0.64). There was a negative and statistically significant correlation between "gratuitous vacancy percentage" and "GDP" (R -0.54, p = 0.003). More paid courses than gratuitous courses and more courses in the hinterland than in the capitals have been created since 1964, in proportions that have remained similar since then, but in higher numbers since 2002. CONCLUSIONS The distribution of medical courses in Brasil correlates with the population and economical production of each state. The expansion of Brazilian medical education, which has been accelerated since 2002, is based mainly on paid courses in the hinterland, in the same pattern since 1964.

RESUMO OBJETIVO Descrever a distribuição e evolução histórica das vagas em cursos de graduação em medicina no Brasil. MÉTODOS Estudo transversal analítico de dados secundários. No Ministério da Educação obtiveram-se dados dos cursos de medicina e no Instituto Brasileiro de Geografia e Estatística foram obtidos dados populacionais e econômicos dos estados. RESULTADOS Havia no Brasil, até janeiro de 2018, 298 cursos de medicina (1,42 curso/milhão de habitantes), totalizando 31.126 vagas anuais, com 9.217 vagas gratuitas (29,6%) e 17.963 vagas no interior do País (57,7%). Nos estados há correlações positivas e significativas (p<0,001) das variáveis: "vagas em medicina" e "população" (R 0,92); "vagas em medicina" e "produto interno bruto" ("PIB") (R 0,83); "percentual de vagas em medicina no interior" e "população no interior" (R 0,71) e "percentual de vagas em medicina no interior" e "PIB" (R 0,64). Há correlação negativa e significativa entre "percentual de vagas gratuitas" e "PIB" (R -0,54, p=0,003). Passaram a ser criados mais cursos pagos do que gratuitos e mais cursos no interior do que nas capitais a partir de 1964 (p <0,001), e a relação curso/milhão de habitantes aumentou a partir de 2002 (p<0,001). CONCLUSÕES A distribuição de vagas em cursos de medicina no Brasil correlaciona-se à população e à produção econômica de cada estado. A expansão do ensino médico brasileiro, acelerada além do crescimento populacional a partir de 2002, é baseada principalmente em cursos pagos no interior dos estados brasileiros, característica inalterada desde 1964.