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1.
Respir Med ; 145: 95-100, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30509723

RESUMO

BACKGROUND: Asthma is a syndrome with multiple phenotypes. Peripheral blood eosinophil counts might be the ideal biomarker to identify subjects with eosinophilic asthma. It is available, inexpensive, and it is associated with eosinophilia in sputum. OBJECTIVE: The aim of this study was to evaluate whether blood eosinophilia is associated with asthma severity and to evaluate whether blood eosinophilia is associated with lack of control of asthma symptoms and airway obstruction. METHODS: Case control study. The cases were subjects recruited from a cohort of patients with severe asthma, in Salvador-BR, demanding continuous inhaled corticosteroids and LABA. There were two control groups: 1) subjects with mild/moderate asthma, 2) subjects with no asthma. Subjects enrolled in the study answered questionnaires, had their blood and stool samples collected, performed spirometry and SPT. We established a cutoff ≥ 260 cells/mm3 for blood eosinophilia. RESULTS: We evaluated 544 subjects in the case group, 452 subjects with mild to moderate asthma and 450 subjects with no asthma. The subjects of the case group had higher odds of presenting the eosinophilic phenotype in comparison to subjects with mild to moderate asthma [OR 1.60 95CI(1.19-2.16)] and no asthma [OR 3.93; 95CI(2.90-5.33)]. The eosinophilic phenotype, according to blood count, is associated with uncontrolled asthma [OR 1.56; 95CI(1.06-2.28)], but it is not associated with airway obstruction [OR 0.87; 95CI(0.61-1.24)]. CONCLUSION: We conclude that the blood eosinophilia is a biomarker associated with asthma severity and poor symptom control, but we found no association with reduced lung function.


Assuntos
Asma/diagnóstico , Asma/etiologia , Eosinófilos , Contagem de Leucócitos , Eosinofilia Pulmonar/complicações , Eosinofilia Pulmonar/diagnóstico , Adulto , Biomarcadores/sangue , Brasil , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , População Urbana
3.
Rev Paul Pediatr ; 34(4): 460-468, 2016 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27321919

RESUMO

OBJECTIVE: To determine the prevalence of overweight and obesity in schoolchildren aged 10 to 16 years and its association with dietary and behavioral factors. METHODS: Cross-sectional study that evaluated 505 adolescents using a structured questionnaire and anthropometric data. The data was analyzed through the T Test for independent samples and Mann-Whitney Test to compare means and medians, respectively, and Chi2 Test for proportions. Prevalence Ratio (RP) and the 95% confidence interval was used to estimate the degree of association between variables. The logistic regression was employed to adjust the estimates to confounding factors. The significance level of 5% was considered for all analysis. RESULTS: Excess weight was observed in 30.9% of the schoolchildren: 18.2% of overweight and 12.7% of obesity. There was no association between weight alterations and dietary/behavioral habits in the bivariate and multivariate analyses. However, associations were observed in relation to gender. Daily consumption of sweets [PR=0.75 (0.64-0.88)] and soft drinks [PR=0.82 (0.70-0.97)] was less frequent among boys; having lunch daily was slightly more often reported by boys [OR=1.11 (1.02-1.22)]. Physical activity practice of (≥3 times/week) was more often mentioned by boys and the association measures disclosed two-fold more physical activity in this group [PR=2.04 (1.56-2.67)] when compared to girls. Approximately 30% of boys and 40% of girls stated they did not perform activities requiring energy expenditure during free periods, with boys being 32% less idle than girls [PR=0.68 (0.60-0.76)]. CONCLUSIONS: A high prevalence of both overweight and obesity was observed, as well as unhealthy habits in the study population, regardless of the presence of weight alterations. Health promotion strategies in schools should be encouraged, in order to promote healthy habits and behaviors among all students.


Assuntos
Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Criança , Estudos Transversais , Exercício , Comportamento Alimentar , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Prevalência
4.
Cien Saude Colet ; 20(10): 3191-8, 2015 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26465860

RESUMO

Since the introduction of highly active antiretroviral therapy (HAART) in 1996, there have been worldwide shifts in the causes of hospitalization for patients with HIV/AIDS. The aim of this study was to describe the characteristics of HIV/AIDS patient hospitalizations between 1997 and 2012. This cross-sectional study used a hospital database that centralizes records of admissions in 31 hospitals, both public and private, across 26 municipalities in the interior of São Paulo. In order to verify associations between the variables, we used the prevalence ratio (PR) and a 95% confidence interval. Among 9,797 adults and children, 10,696 admissions were registered, which was equal to 1.09 admissions per patient. Most (62%) of the patients were male, and the predominant age group was 21 and 50 years (63.5%). Mortality was higher among male patients from all age groups (PR= 1.42 [95% CI: 1.28-1.57]; p < 0.05). The main cause of hospitalization (54.5% of the total) was infectious disease, whether opportunistic or not. This was true, even in the post-HAART era. Furthermore, gender and age differences were noted in patient mortality rates.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Hospitalização , Síndrome de Imunodeficiência Adquirida , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Crit Rev Oncol Hematol ; 94(3): 261-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25797826

RESUMO

BACKGROUND: Chronic lymphocytic leukemia (CLL) is a disease of the lymphoid system, in which the most common therapy is fludarabine plus cyclophosphamide (FC). The addition of rituximab to FC has been used, a combination known as FCR. OBJECTIVES: To perform a systematic review with meta-analysis of clinical trials between 2000 and 2012 comparing FC and FCR in patients with CLL. MATERIAL AND METHODS: Electronic databases were searched using keywords related to the objectives of this review. The outcomes examined were progression-free survival and complete remission. RESULTS: The progression-free survival and the overall survival showed significant difference between the two regimens, with complete remission being more frequent in FCR-treated patients (odds ratio=2.58; 95% CI: 2.13-3.13). Patients treated with FCR showed significantly higher neutropenia and serious adverse reactions. CONCLUSION: Despite the favorable results of the FCR regimen on outcomes including complete remission, progression-free survival, and overall survival, there is a lack of methodological rigor and appropriate analyses in many of these studies, and thus, there is a need for further studies examining the effect of rituximab in CLL patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Anticorpos Monoclonais Murinos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ciclofosfamida/administração & dosagem , Humanos , Leucemia Linfocítica Crônica de Células B/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Rituximab , Resultado do Tratamento , Vidarabina/administração & dosagem , Vidarabina/análogos & derivados
6.
Value Health Reg Issues ; 8: 62-68, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29698173

RESUMO

OBJECTIVE: To analyze the budget impact of using the picture archiving and communication system (PACS) in comparison to the screen/film system. METHODS: The budget impact analysis was conducted on the basis of registry data from the Clinics Hospital of the Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil. The budget impacts were compared between the PACS, with high- and low-cost PACS architectures, and the screen/film system by considering reference and alternative scenarios over the course of 5 years. RESULTS: The budget impact associated with the use of PACS was lower than that associated with the use of the screen/film system in all the evaluated scenarios. The low-cost PACS architecture (mini-PACS) had an even lower budget impact, especially in the scenario in which a simulation of lower numbers of medical examinations was performed. CONCLUSIONS: The screen/film system had a high budget impact in all the scenarios evaluated, wherein its costs were higher than the available budget. In contrast, the PACS (high- and low-cost architectures) showed a budget impact that allowed for savings in resources, especially the mini-PACS. Therefore, we recommend the implementation and use of the PACS in health services with any volume of examinations performed.

7.
Cien Saude Colet ; 19(4): 1263-74, 2014 Apr.
Artigo em Português | MEDLINE | ID: mdl-24820609

RESUMO

Male culture values involve risk behaviors to health, since the way men perceive and experience their masculinity is one of the most influential shapers of falling sick and dying. The scope of this study was to identify the factors associated with the demand for health services and differences between the sexes by selecting users of health services. The dependent variables were sex of the user (cultural indicator) and failure to seek out health services. Independent variables included socio-demographic and clinical-epidemiological characteristics. The Prevalence Ratio studied by univariate and multivariate analysis was used in the analysis of the association between variables. The factors associated with non-demand for health services included: being male, hours of operation of health care facilities, working hours of the user and not having any disease. By multivariate analysis the factors facilitating demand for health services (protection) were: being female aged 26 to 49 years. Effective consolidation of a health care model that questions the contradiction that exists between the epidemiological data regarding men's health and the position of the health services using common sense regarding the apparent invulnerability of men to falling sick is of great relevance.


Assuntos
Serviços de Saúde/provisão & distribução , Relações Interpessoais , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
9.
Eur J Pediatr ; 172(4): 493-9, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23271491

RESUMO

UNLABELLED: According to the World Health Organisation, community-acquired pneumonia is the main cause of paediatric death, accounting for 20 % of deaths in children younger than 5 years old, and 90 % of these deaths occur in non-industrialised countries. This study has as objective to evaluate the influence of socio-economic, environmental and breastfeeding factors on the occurrence of pneumonia. An unmatched case-control study was conducted in children aged 6 months to 13 years old at a children's hospital in Brazil. Multivariate analysis by logistic regression was performed to determine the variables used to predict pneumonia. A total of 252 children were selected. In the adjusted (by age) multivariate analysis, the following variables were associated with community-acquired pneumonia: (a) protective factors: breastfeeding >3 months, absence of other unrelated comorbidities, non-smoking mother, being the only child, child's age >5 years and mother's age >19 years old; (b) risk factors: maternal education <8 years and child's birth order [≥second]. In the multivariate analysis, considering only children from 6 months to 5 years old, the following variables were associated with community-acquired pneumonia: (a) protective factors: breastfeeding >3 months, non-smoking mother and no smokers in the child's bedroom; (b) risk factors: maternal education <8 years and prenatal complications. CONCLUSION: These findings contribute favourably to effectively minimising the risk factors related to the disease process and natural history of community-acquired pneumonia.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Hospitalização , Pneumonia/epidemiologia , Fumar/efeitos adversos , Adolescente , Fatores Etários , Brasil , Estudos de Casos e Controles , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
10.
Cad Saude Publica ; 29 Suppl 1: S179-86, 2013 Nov.
Artigo em Português | MEDLINE | ID: mdl-25402247

RESUMO

The demographic and epidemiological transitions tend to increase the role of hospitals in medical care. Within such organizations, effective, safe, and cost-effective health technologies ensure better quality of care and increase users' survival, thus emphasizing the importance of evaluation of such hospital-based technologies. This article aims to present a model for the evaluation and incorporation of technology in a teaching hospital that provides high-complexity care. The article describes an approach to methods/processes assessment that can be used easily by any hospital. The model allowed proper health technology assessment (HTA), thereby legitimizing decisions on technology incorporation by the hospital administration with high levels of acceptance and adoption by the clinical staff, suggesting that hospital-based HTA (provided that it is well-structured, with the support of institutional administration) can be a powerful tool for dissemination and valorization of HTA culture in an environment with the widest use and the greatest impact on the health system's budget.


Assuntos
Tomada de Decisões , Hospitais Universitários , Avaliação da Tecnologia Biomédica/métodos , Brasil , Humanos
11.
J Trop Pediatr ; 56(3): 212-3, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19793895

RESUMO

Rotaviruses are the main etiological agents of acute infectious diarrhea in children. Thus, the objective of this study is to contribute to the information about the rotavirus variants circulating in Brazil. A cross-sectional study was conducted on 124 fecal samples collected from children up to the age of 5 years, with acute gastroenteritis. Thirty-one samples were positive for rotavirus A. Regarding the G genotyping, 16 (80%) were classified as G1 and regarding P genotyping all strains were classified as P[8]. The determination of the prevalence of rotavirus infection and the characterization of the viral strains circulating are expected to contribute to the information we have about the molecular biology and epidemiology of disease.


Assuntos
Diarreia/virologia , Gastroenterite/virologia , Infecções por Rotavirus/virologia , Rotavirus/genética , Brasil/epidemiologia , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Eletroforese em Gel de Poliacrilamida , Fezes/virologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Genótipo , Humanos , Lactente , Masculino , Prevalência , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rotavirus/classificação , Rotavirus/isolamento & purificação , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/epidemiologia
12.
Immunol Lett ; 124(2): 88-94, 2009 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-19433108

RESUMO

In spite of the observation of mutual inhibitory properties of TH1 and TH2 CD4+ cells, a group of patients developed simultaneously immediate and delayed-type hypersensitivity reactions that are theoretically antagonistic. Patients presenting concomitant hypersensitivity reactions were evaluated for cytokine production. PBMC from 45 patients and 13 non-atopic individuals were cultured with mite allergen and mitogen and the supernatants obtained were evaluated for cytokine production by ELISA. The analysis of the cytokines levels revealed increased production of pro-inflammatory cytokine TNF-alpha in the non-atopic individuals after specific and mitogen stimulus. The IL-4 was largely observed on serum samples and IL-5 levels were higher in the double sensitized group (group DerpNi) after PHA stimulus. The IL-13 levels were increased in sensitized groups (Derp and DerpNi groups) after PHA stimuli. Atopic patients (Derp and DerpNi groups) presented lowest levels IFN-gamma and the analysis of TGF-beta production after rDER P I stimulation have shown increased levels among sensitized patients to Dermatophagoides pteronyssinus mite. IL-10 levels did not differ after antigen stimulation but basal production was higher on Derp and DerpNi groups. Furthermore, negative correlations were observed between IFN-gamma levels and IL-4, IL-13 and IL-10. This study has shown patients able to react, concomitantly, to the two types of antigens - rDER P I and NiSO4, present distinct pattern of cytokine production. The increased levels of IL-13 in the sensitive individuals to mite antigen (rDER P I) and IFN-gamma in NiSO4 sensitized individuals confirm the role of the type TH2 response in the atopies and TH1 type in DCA.


Assuntos
Citocinas/imunologia , Hipersensibilidade Tardia/imunologia , Hipersensibilidade Imediata/imunologia , Leucócitos Mononucleares/imunologia , Células Th1/imunologia , Células Th2/imunologia , Adulto , Alérgenos/imunologia , Animais , Antígenos de Dermatophagoides/farmacologia , Proteínas de Artrópodes , Células Cultivadas , Cisteína Endopeptidases , Citocinas/biossíntese , Dermatophagoides pteronyssinus/imunologia , Feminino , Humanos , Hipersensibilidade Tardia/metabolismo , Hipersensibilidade Imediata/metabolismo , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/metabolismo , Masculino , Pessoa de Meia-Idade , Níquel/farmacologia , Fito-Hemaglutininas/farmacologia , Proteínas Recombinantes/farmacologia , Testes Cutâneos , Células Th1/efeitos dos fármacos , Células Th1/metabolismo , Células Th2/efeitos dos fármacos , Células Th2/metabolismo
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