The economic impact of asthma on private healthcare system in Brazil: Economic impact of asthma in Brazil.

To assess healthcare resource utilization and costs of patients with asthma in Brazilian Supplementary Healthcare System, focusing on hospitalization data. Retrospective cohort study, using data from an administrative database of a private company (Orizon). Patients aged ≥ 12 years with at least one record of emergency visit/hospitalization in the database with the ICD-10 J45 between January/2010 and June/2015 were included and followed until June/2016, death or inactivation of health plan. Sociodemographic characteristics, emergency visit and hospital admission per patient per year (exacerbation rate), physician visit with a procedure, exams, length of hospitalization (with/without intensive care unit (ICU)), and in-hospital treatments were assessed. A total of 54,568 patients were included in this analysis. Regarding resource utilization, emergency visit and hospital admission rates of 0.34 and 0.04 per person-year were observed, respectively. Mean length of hospital stay were 8.82 (SD = 36.48), 5.24 (SD = 19.06) and 19.53 (63.89) days for hospitalizations in general, without and with ICU, respectively. An exacerbation rate of 0.36 per person year was observed with a mean cost per episode of 3178 Brazilian Real (BRL) (SD = 31,667). Mean cost related to emergency department visits was estimated at 293 BRL (SD = 328). Hospitalization costs were stratified by the need of ICU and values observed were of 9307 BRL (SD = 18,979) without ICU, and 75,252 BRL (SD = 174,248) with ICU need. Asthma exacerbations may cost ~75,000 BRL for an ICU-dependent event in the Supplementary Healthcare System. To improve disease control may reduce disease burden for both healthcare system and patients.

Analysis of risk factors for extubation failure in subjects submitted to non-emergency elective intracranial surgery.

BACKGROUND: Extubation failure is defined as the re-institution of respiratory support ranging from 24 to 72 hours following scheduled extubation and occurs in 2% to 25% of extubated patients. The aim of this study was to determine clinical and surgical risk factors that may predict extubation failure in patients submitted to non-emergency intracranial surgery. METHODS: This was a prospective observational cohort study. The study was carried out on 317 subjects submitted to non-emergency intracranial surgery for tumors, aneurysms, and arteriovenous malformation. Preoperative assessment was performed and subjects were followed up for the determination of extubation failure until either discharge from hospital or death. RESULTS: Twenty-six (8.2%) of the 317 subjects experienced extubation failure following surgery. The following variables were considered for the multivariate analysis: level of consciousness at the time of extubation, duration of mechanical ventilation prior to extubation, sex and the use of intraoperative mannitol. The multivariate analysis determined that the most important variable for extubation failure was the level of consciousness at the time of extubation (P = .001), followed by female sex, which also showed to be significant (P = .006). CONCLUSIONS: Lower level of consciousness (GCS 8T-10T) and female sex were considered risk factors for extubation failure in subjects submitted to elective intracranial surgery.

Impact of asthma control on different age groups in five Latin American countries.

BACKGROUND: Asthma is a chronic airway inflammatory condition of the airway and is classified as controlled, partially controlled, and uncontrolled. Patients with uncontrolled asthma are at greater risk for hospitalizations and visits to emergencies, and the condition has greater impact on their daily lives. The aim of this study was to evaluate asthma control, the use of health resources, and asthma's impact on the activities of daily living of patients with different age groups in 5 Latin American countries. METHODS: This was a retrospective analysis of The Latin America Asthma Insights and Management (LA AIM) study carried out in Argentina, Brazil, Mexico, Venezuela, and Puerto Rico. Asthmatics were splited into 3 age groups: 12-17, >17-40 and > 40 years old. An interview face to face was carried out and patients answered a questionnaire of 53 questions related to 5 main domains of asthma: symptoms, impact of asthma on daily living activities, patients' perceptions of asthma control, exacerbations, and treatment/medication. RESULTS: A total of 2167 asthmatics were interviewed. There was a low percentage of controlled patients (mean 9%) in all 3 groups with no particular difference among the five countries, but Venezuelan patients had a 71% chance of having uncontrolled asthma (p < 0.001). CONCLUSION: In the 3 age groups, patients experienced poor asthma control, with no significant differences among the countries. Patients who used control medication had a greater chance of controlling their asthma, and those who had emergency health care visits had a greater chance of having uncontrolled asthma.

Anthropometric status of individuals with COPD in the city of São Paulo, Brazil, over time - analysis of a population-based study.

OBJECTIVE: To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). METHODS: This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. RESULTS: Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = -1.7 ± 8.1 and ΔBMI = -0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = -0.5 ± 5.4 and ΔBMI = -0.8 ± 3.3). CONCLUSIONS: Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.

Translation and cultural adaptation of the stroke impact scale 2.0 (SIS): a quality-of-life scale for stroke.

BACKGROUND: No specific quality-of-life scale for stroke patients has previously been translated and evaluated for reproducibility, for use in the Portuguese language. Internationally, the instrument for this purpose is the Stroke Impact Scale 2.0 (SIS). Use of of SIS enables comprehensive analysis on the impact of mild and moderate stroke on patients' lives. The aims here were to translate SIS into Portuguese, adapt it culturally, evaluate its reproducibility and correlate it with SF-36 among stroke patients. DESIGN AND SETTING: Translation and validation study. METHODS: The process of initial and retrograde translation was performed, in addition to cultural adaptation to the Brazilian language and culture. SIS was applied to 40 patients, who answered the questions three times. On the first day, the scale was applied twice by two independent researchers (to evaluate interobserver reproducibility). Fifteen days later, the scale was applied for a third time by another researcher (intraobserver reproducibility). The intraclass correlation coefficient (ICC) was used to measure the reproducibility of the SIS scale. RESULTS: The reproducibility of the whole scale was very good (ICC: 0.73 to 0.99). Intraobserver reproducibility in all domains was also very good (ICC: 0.85 to 0.95). Comparison of SIS with SF-36 showed that the domains of strength, mobility and activities of daily living (ADLs) correlated moderately with the functional capacity domain, as did the ADL domain with general health status. The other correlations were weak. The depression domain showed a moderate negative correlation with the memory and communication domains. CONCLUSION: The translation of the SIS 2.0 scale was easy to understand and it had good reproducibility among stroke patients.

Trend of self-reported asthma prevalence in Brazil from 2003 to 2013 in adults and factors associated with prevalence.

OBJECTIVES: To determine the trend of self-reported asthma diagnosed prevalence and to describe the factors associated with asthma in Brazilian adults. METHOD: Epidemiological cross-sectional study based on databases analysis from three national household surveys: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 and Pesquisa Nacional de Saúde (PNS) 2013. Participants between 18-45 years old were included. Trend analysis of asthma diagnosed prevalence was conducted using a logistic general linear model. A hierarchical logistic regression model was used to select factors significantly associated with asthma prevalence. RESULTS: Asthma diagnosed prevalence was 3.6% (2003), 3.7% (2008) and 4.5% (2013), showing a statistically significant increased trend. Asthma diagnosed prevalence also increased when analysed by gender (annual change for men: 2.47%, p < 0.003; women: 2.16%, p < 0.001), urban area (annual change for urban: 2.15%, p < 0.001; rural: 2.69%, p = 0.072), healthcare insurance status (annual change without healthcare insurance: 2.18%, p < 0.001; with healthcare insurance: 1.84%, p = 0.014), and geographic regions (annual change North: 4.68%, p < 0.001; Northeast: 4.14%, p < 0.001; and Southeast: 1.84%, p = 0.025). Female gender, obesity, living in urban areas and depression were associated with asthma diagnosed prevalence. DISCUSSION: PNAD and PNS surveys allow for a very large, representative community-based sample of the Brazilian adults to investigate the asthma prevalence. From 2003 to 2013, the prevalence of self-reported physician diagnosis of asthma increased, especially in the North and Northeast regions. Gender, region of residence, household location (urban/rural), obesity, and depression diagnosis seem to play significant roles in the epidemiology of asthma in Brazil.

The impact of COPD on the private healthcare system in Brazil: an economic analysis / Impacto da DPOC no sistema de saúde privado no Brasil: uma análise econômica

Objective: To assess healthcare resource utilization and hospitalization costs of patients with chronic obstructive pulmonary disease (COPD) exacerbations in the Brazilian private healthcare system. Methods: A retrospective cohort study, considering data from an administrative database of a private company (Orizon). Patients aged ≥40 years old and with at least one COPD-related claim identified by the ICD-10 code (J40 to J44) at any time during the eligibility period (January/2010 to December/2013) were included in the analysis. Follow-up was performed until December/2014, death or inactivation of a health plan. Sociodemographic characteristics, number of emergency visits, hospital admissions (number and length of stay), length of hospital stay in an intensive care unit (ICU), number of severe COPD exacerbations, therapeutic approach, and hospitalization costs were assessed. Results: The analysis included 8,254 COPD patients. Emergency visits, hospital admission, and exacerbation rates were 0.4, 0.2, and 0.1 per person-year, respectively. The mean length of hospital stays and the length of stay of patients requiring or not ICU stay were 16.6 (SD = 77.0), 8.7 (SD = 36.9), and 27.6 (SD = 109.7), respectively. Mean costs associated to emergency department visits and hospitalizations were 258.2 BRL (SD = 383.1) and 38,165.4 BRL (SD = 124,683.5), respectively. Hospitalizations costs without ICU stay were 11,810.1 BRL (SD = 31,144.1) and 74,585.3 BRL (SD = 182,808.1) for those with ICU utilization. Conclusion: Costs for COPD management during disease exacerbation are very high and may reach almost 75 thousand BRL per hospitalization. The prevention of COPD exacerbations and better disease control may reduce the economic burden on the private healthcare system in Brazil.

Objetivo: Avaliar a utilização de recursos e custos de pacientes com exacerbação da doença pulmonar obstrutiva crônica (DPOC) no sistema de saúde suplementar (SSS) do Brasil. Métodos: Estudo de coorte retrospectiva, considerando banco de dados administrativo de uma empresa privada (Orizon). Pacientes com ≥40 anos e pelo menos um registro de admissão relacionado à DPOC identificado com CID-10 J40-J44, entre janeiro/2010 e dezembro/2013, foram incluídos e acompanhados até dezembro/2014, morte ou inativação no plano. Características sociodemográficas, número de visitas de emergência, admissões hospitalares (número e tempo de hospitalização), tempo de hospitalização em unidade de terapia intensiva (UTI), número de exacerbações graves, estratégias terapêuticas e custos hospitalares foram as variáveis analisadas. Resultados: A análise incluiu 8.254 pacientes com DPOC. As taxas de visita à emergência, internação hospitalar e exacerbação da doença foram de 0,4, 0,2 e 0,1 por pessoa-ano, respectivamente. Os tempos médios de hospitalização, hospitalização sem utilização de UTI e hospitalização com necessidade de UTI foram de 16,6 (DP = 77,0), 8,7 (DP = 36,9) e 27,6 (DP = 109,7) dias, respectivamente. Os custos médios relacionados à visita de emergência e por hospitalização foram de 258,2 BRL (DP = 383,1) e 38.165,4 BRL (DP = 124.683,5), respectivamente. Os custos para pacientes que não utilizaram UTI foram de 11.810,1 BRL (DP = 31.144,1) e de 74.585,3 BRL (DP = 182.808,1) para aqueles com necessidade desse serviço. Conclusão: Os custos para o manejo dos pacientes com exacerbação da DPOC são muito elevados, podendo chegar a 75.000 BRL por hospitalização. A prevenção de exacerbações e o melhor controle da doença podem reduzir esse impacto econômico no SSS.

Negative impact of asthma on patients in different age groups.

OBJECTIVE: To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). METHODS: From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. RESULTS: The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p < 0.001); "Have you discontinued your asthma relief or control medication in the last 12 months?" (p = 0.008). In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). CONCLUSIONS: In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance.

OBJETIVO: Avaliar o impacto da asma em pacientes segundo as faixas etárias de 12-17 anos, 18-40 anos e ≥ 41 anos no Brasil. MÉTODOS: Os dados de 400 pacientes com asma diagnosticada por um médico e residentes de quatro capitais estaduais brasileiras (São Paulo, Rio de Janeiro, Curitiba e Salvador) foram obtidos em um inquérito realizado em países da América Latina em 2011. Os dados foram coletados por meio de um questionário padronizado em entrevista presencial com os pacientes ou com os pais/responsáveis daqueles < 18 anos. As questões abordavam controle da asma, número de hospitalizações, número de consultas de urgência, absenteísmo na escola/trabalho e impactos da asma na qualidade de vida, sono e lazer. Os dados foram estratificados pelas faixas etárias selecionadas. RESULTADOS: Em comparação com os grupos de pacientes adultos, houve uma proporção significativamente maior no grupo 12-17 anos em relação a ter ao menos um episódio de asma grave que impediu o paciente a continuar a jogar ou a se exercitar nos últimos 12 meses (p = 0,012), absenteísmo escolar/trabalho nos últimos 12 meses (p < 0,001), e interrupção de medicação para controle ou prevenção da asma nos últimos 12 meses (p = 0,008). Além disso, 30,2% dos pacientes na faixa etária 12-17 anos relataram que esforços físicos normais eram atividades muito limitantes (p = 0,010 vs. outros grupos), enquanto 14% dos pacientes do grupo ≥ 41 anos descreveram as atividades sociais como muito limitantes (p = 0,011 vs. outros grupos). CONCLUSÕES: Nessa amostra, o impacto da asma foi maior nos pacientes com idade entre 12 e 17 anos do que nos adultos, e isso pode ser atribuído à baixa aderência ao tratamento.

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery.

CONTEXT AND OBJECTIVE: Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. DESIGN AND SETTING: Prospective study in a tertiary-level university hospital. METHODS: Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. RESULTS: Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. CONCLUSIONS: There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

Incidence of chronic obstructive pulmonary disease based on three spirometric diagnostic criteria in Sao Paulo, Brazil: a nine-year follow-up since the PLATINO prevalence study.

CONTEXT AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a respiratory disease of high prevalence and socioeconomic impact worldwide. It affects approximately 16% of the population of São Paulo. The incidence of COPD is still unknown in Brazil. The aim of this study was to estimate new cases of COPD in a population-based sample in São Paulo, Brazil, using three different spirometric diagnostic criteria, and to assess the concordance between these criteria. DESIGN AND SETTING: Prospective cohort study, in the city of São Paulo, Brazil. METHODS: A questionnaire was applied and anthropometry and pre and post-bronchodilator spirometry were performed on the same subjects as in the initial PLATINO study (2003) in São Paulo. Data from this follow-up study were added to the original database of the initial phase. Incident COPD cases refer to subjects who developed the disease in accordance with each spirometric criterion during the nine-year follow-up period. The Statistical Package for the Social Sciences, version 17.0 (SPSS Inc., Chicago, IL, USA) was used in the analysis and the significance level was set at P < 0.05. RESULTS: 613 subjects participated in the follow-up. New COPD cases ranged in frequency from 1.4% to 4.0%, depending on the diagnostic criterion used. The concordance between the criteria ranged from 35% to 60%. CONCLUSION: The incidence of COPD after a nine-year follow-up was high, but varied according to the spirometric criterion used. The agreement between the criteria for identifying new cases of the disease ranged from 35% to 60%.

Level of asthma control and its relationship with medication use in asthma patients in Brazil.

OBJECTIVE: To assess asthma patients in Brazil in terms of the level of asthma control, compliance with maintenance treatment, and the use of rescue medication. METHODS: We used data from a Latin American survey of a total of 400 asthma patients in four Brazilian state capitals, all of whom completed a questionnaire regarding asthma control and treatment. RESULTS: In that sample, the prevalence of asthma was 8.8%. Among the 400 patients studied, asthma was classified, in accordance with the Global Initiative for Asthma criteria, as controlled, partially controlled, and uncontrolled in 37 (9.3%), 226 (56.5%), and 137 (34.3%), respectively. In those three groups, the proportion of patients on maintenance therapy in the past four weeks was 5.4%, 19.9%, and 41.6%, respectively. The use of rescue medication was significantly more common in the uncontrolled asthma group (86.9%; p < 0.001). CONCLUSIONS: Our findings suggest that, in accordance with the established international criteria, asthma is uncontrolled in the vast majority of asthma patients in Brazil. Maintenance medications are still underutilized in Brazil, and patients with partially controlled or uncontrolled asthma are more likely to use rescue medications and oral corticosteroids.

Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities.

OBJECTIVE: To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil. METHODS: We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication. RESULTS: Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men. CONCLUSIONS: Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life.

OBJETIVO: Avaliar o impacto da asma em relação ao sexo em uma amostra populacional de pacientes asmáticos no Brasil. MÉTODOS: Foram entrevistados pessoalmente 400 pacientes asmáticos com idade > 12 anos de uma amostra probabilística nacional por contato telefônico nas cidades de São Paulo, Rio de Janeiro, Curitiba e Salvador. Os indivíduos responderam um questionário de 53 questões relacionadas com cinco domínios da asma: sintomas; impacto da asma na vida; percepção do controle da asma; exacerbações; tratamento e medicação. RESULTADOS: Dos 400 pacientes entrevistados, 272 (68%) eram do sexo feminino. Em relação aos sintomas respiratórios, uma maior proporção de mulheres relatou se sentir extremamente incomodada com seus sintomas (tosse com secreção, sensação de aperto no peito, tosse/falta de ar/sensação de aperto no peito durante exercícios, falta de ar noturna e tosse noturna) do que os homens. Sintomas diurnos, como tosse, falta de ar, chiado e sensação de aperto no peito, foram mais comuns nas mulheres que nos homens. Além disso, a asma interferiu mais frequentemente nos esforços físicos normais, atividades sociais, durante o sono e na vida em geral nas mulheres. Sobre o impacto da asma na qualidade de vida, as mulheres relataram mais frequentemente que os homens que a asma causava uma sensação de falta de controle sobre a própria vida e que eram afetadas na forma como se sentiam em relação a si mesmas. CONCLUSÕES: As mulheres asmáticas apresentam mais sintomas e são mais afetadas em suas atividades diárias e qualidade de vida.

PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis.

OBJECTIVE: To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated "Projeto Latino-Americano de Investigação em Obstrução Pulmonar" (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase. METHODS: The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase. RESULTS: The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD. CONCLUSIONS: The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention.

Anthropometric status of individuals with COPD in the city of São Paulo, Brazil, over time - analysis of a population-based study / Análise evolutiva antropométrica em indivíduos com DPOC na cidade de São Paulo - estudo de base populacional

ABSTRACT Objective: To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). Methods: This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. Results: Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = −1.7 ± 8.1 and ΔBMI = −0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = −0.5 ± 5.4 and ΔBMI = −0.8 ± 3.3). Conclusions: Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.

RESUMO Objetivo: Avaliar a evolução dos dados antropométricos obtidos em uma pesquisa latino-americana realizada em duas fases (basal, em 2003, e seguimento, em 2012) na cidade de São Paulo. Métodos: Estudo de base populacional que avaliou indivíduos com idade ≥ 40 anos com o objetivo de definir a prevalência da DPOC e sua relação com alguns fatores de risco. A avaliação antropométrica incluiu medições de peso, altura, índice de massa corpórea (IMC) e circunferência abdominal. Foram avaliadas as mesmas variáveis na mesma população na fase de seguimento. Resultados: Dos 1.000 indivíduos incluídos inicialmente, 587 participaram da fase de seguimento; desses, 80 (13,6%) tinham DPOC. Entre a avaliação inicial e a de seguimento ambos os grupos (DPOC e não DPOC) apresentaram aumentos nas medidas antropométricas, mas esses somente foram significativos no grupo não DPOC. Os indivíduos com DPOC leve tiveram aumentos de peso e IMC (Δpeso = 1,6 ± 5,7 kg e ΔIMC = 0,7 ± 2,2 kg/m2) enquanto aqueles com doença moderada ou grave tiveram reduções dessas medidas (DPOC moderada: Δpeso = −1,7 ± 8,1 kg e ΔIMC = −0,4 ± 3,0 kg/m2; e DPOC grave ou muito grave (Δpeso = −0,5 ± 5,4 kg e ΔIMC = −0,8 ± 3,3 kg/m2). Conclusões: Entre as duas fases da pesquisa, os pacientes com DPOC leve tiveram aumento de peso e IMC, enquanto aqueles com doença mais grave apresentaram perda ponderal e redução do IMC.

Incidence, indication and complications of postoperative reintubation after elective intracranial surgery.

CONTEXT AND OBJECTIVE There are no reports on reintubation incidence and its causes and consequences during the postoperative period following elective intracranial surgery. The objective here was to evaluate the incidence of reintubation and its causes and complications in this situation. DESIGN AND SETTING Prospective cohort study, using data obtained at a tertiary university hospital between 2003 and 2006. METHODS 169 patients who underwent elective intracranial surgery were studied. Preoperative assessment was performed and the patients were followed up until hospital discharge or death. The rate of reintubation with its causes and complications was ascertained. RESULTS The incidence of reintubation was 12.4%, and the principal cause was lowered level of consciousness (71.5%). There was greater incidence of reintubation among females (P = 0.028), and greater occurrence of altered level of consciousness at the time of extubation (P < 0.0001). Reintubated patients presented longer duration of mechanical ventilation (P < 0.0001), longer stays in the intensive care unit (ICU) and in the hospital (P < 0.0001), greater incidence of pulmonary complications (P < 0.0001), greater need for reoperation and tracheostomy, and higher mortality (P < 0.0001). CONCLUSION The incidence of reintubation in these patients was 12.4%. The main cause was lowering of the level of consciousness. Female gender and altered level of consciousness at the time of extubation correlated with higher incidence of reintubation. Reintubation was associated with pulmonary complications, longer durations of mechanical ventilation, hospitalization and stay in the ICU, greater incidence of tracheostomy and mortality.

Level of asthma control and its impact on activities of daily living in asthma patients in Brazil.

OBJECTIVE: To evaluate the impact of asthma on activities of daily living and on health status in patients with controlled, partially controlled, or uncontrolled asthma in Brazil. METHODS: We used data related to 400 patients in four Brazilian cities (São Paulo, Rio de Janeiro, Salvador, and Curitiba), obtained in a survey conducted throughout Latin America in 2011. All study subjects were > 12 years of age and completed a standardized questionnaire in face-to-face interviews. The questions addressed asthma control, hospitalizations, emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. The level of asthma control was determined in accordance with the Global Initiative for Asthma criteria. RESULTS: Among the 400 respondents, asthma was controlled in 37 (9.3%), partially controlled in 226 (56.5%), and uncontrolled in 137 (34.2%). The numbers of patients with uncontrolled or partially controlled asthma who visited the emergency room, who were hospitalized, and who missed school/work were higher than were those of patients with controlled asthma (p = 0.001, p = 0.05, and p = 0.01, respectively). Among those with uncontrolled asthma, the impact of the disease on activities of daily living, sleep, social activities, and normal physical exertion was greater than it was among those with controlled or partially controlled asthma (p < 0.001). CONCLUSIONS: In Brazil, asthma treatment should be monitored more closely in order to increase treatment adherence and, consequently, the level of asthma control, which can improve patient quality of life and minimize the negative impact of the disease.

Translation and cultural adaptation of the stroke impact scale 2. 0 (SIS): a quality-of-life scale for stroke

ABSTRACT BACKGROUND: No specific quality-of-life scale for stroke patients has previously been translated and evaluated for reproducibility, for use in the Portuguese language. Internationally, the instrument for this purpose is the Stroke Impact Scale 2.0 (SIS). Use of of SIS enables comprehensive analysis on the impact of mild and moderate stroke on patients' lives. The aims here were to translate SIS into Portuguese, adapt it culturally, evaluate its reproducibility and correlate it with SF-36 among stroke patients. DESIGN AND SETTING: Translation and validation study. METHODS: The process of initial and retrograde translation was performed, in addition to cultural adaptation to the Brazilian language and culture. SIS was applied to 40 patients, who answered the questions three times. On the first day, the scale was applied twice by two independent researchers (to evaluate interobserver reproducibility). Fifteen days later, the scale was applied for a third time by another researcher (intraobserver reproducibility). The intraclass correlation coefficient (ICC) was used to measure the reproducibility of the SIS scale. RESULTS: The reproducibility of the whole scale was very good (ICC: 0.73 to 0.99). Intraobserver reproducibility in all domains was also very good (ICC: 0.85 to 0.95). Comparison of SIS with SF-36 showed that the domains of strength, mobility and activities of daily living (ADLs) correlated moderately with the functional capacity domain, as did the ADL domain with general health status. The other correlations were weak. The depression domain showed a moderate negative correlation with the memory and communication domains. CONCLUSION: The translation of the SIS 2.0 scale was easy to understand and it had good reproducibility among stroke patients.

Trend of self-reported asthma prevalence in Brazil from 2003 to 2013 in adults and factors associated with prevalence / Tendência da prevalência de asma autorreferida no Brasil de 2003 a 2013 em adultos e fatores associados à prevalência

ABSTRACT Objectives: To determine the trend of self-reported asthma diagnosed prevalence and to describe the factors associated with asthma in Brazilian adults. Method: Epidemiological cross-sectional study based on databases analysis from three national household surveys: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 and Pesquisa Nacional de Saúde (PNS) 2013. Participants between 18-45 years old were included. Trend analysis of asthma diagnosed prevalence was conducted using a logistic general linear model. A hierarchical logistic regression model was used to select factors significantly associated with asthma prevalence. Results: Asthma diagnosed prevalence was 3.6% (2003), 3.7% (2008) and 4.5% (2013), showing a statistically significant increased trend. Asthma diagnosed prevalence also increased when analysed by gender (annual change for men: 2.47%, p < 0.003; women: 2.16%, p < 0.001), urban area (annual change for urban: 2.15%, p < 0.001; rural: 2.69%, p = 0.072), healthcare insurance status (annual change without healthcare insurance: 2.18%, p < 0.001; with healthcare insurance: 1.84%, p = 0.014), and geographic regions (annual change North: 4.68%, p < 0.001; Northeast: 4.14%, p < 0.001; and Southeast: 1.84%, p = 0.025). Female gender, obesity, living in urban areas and depression were associated with asthma diagnosed prevalence. Discussion: PNAD and PNS surveys allow for a very large, representative community-based sample of the Brazilian adults to investigate the asthma prevalence. From 2003 to 2013, the prevalence of self-reported physician diagnosis of asthma increased, especially in the North and Northeast regions. Gender, region of residence, household location (urban/rural), obesity, and depression diagnosis seem to play significant roles in the epidemiology of asthma in Brazil.

RESUMO Objetivos: Determinar a tendência da prevalência de diagnóstico de asma autorreferida e descrever os fatores associados à asma em adultos brasileiros. Método: Estudo transversal de análise de dados de três pesquisas domiciliares nacionais: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 e Pesquisa Nacional de Saúde (PNS) 2013. Participantes entre 18 e 45 anos foram incluídos. A análise de tendência da prevalência do diagnóstico de asma foi realizada utilizando modelo logístico linear. Aplicou-se o modelo de regressão logística hierárquico para selecionar fatores significativamente associados à prevalência de asma. Resultados: A prevalência do diagnóstico de asma foi de 3,6% (2003), 3,7% (2008) e 4,5% (2013), apresentando tendência de elevação significativa. A prevalência do diagnóstico de asma também se elevou quando analisada por sexo (variação anual entre homens: 2,47%, p < 0,003; mulheres: 2,16%, p < 0,001), área urbana (variação anual: 2,15% p < 0,001), plano de saúde (variação anual sem plano: 2,18%, p < 0,001; com plano: 1,84%, p = 0,014) e regiões geográficas (variação anual Norte: 4,68%, p < 0,001; Nordeste 4,14%, p < 0,001; e Sudeste 1,84%, p = 0,025). Sexo feminino, obesidade, viver em áreas urbanas e depressão foram associados positivamente com a prevalência de diagnóstico de asma. Discussão: PNAD e PNS são bases populacionais representativas de adultos brasileiros que possibilitam a investigação da prevalência de asma. De 2003 a 2013, a prevalência de diagnóstico autorreferido de asma aumentou, especialmente nas regiões Norte e Nordeste. Sexo, região geográfica e área de residência (urbana/rural), obesidade e diagnóstico de depressão parecem desempenhar papéis significativos na epidemiologia da asma no Brasil.

Functional assessment of cancer therapy-brain questionnaire: translation and linguistic adaptation to Brazilian Portuguese.

CONTEXT AND OBJECTIVE: Quality of life assessment among patients with brain tumors is important, given that new treatments have increased patient survival. The aim of this study was to translate the Functional Assessment of Cancer Therapy-Brain (FACT-Br) questionnaire (version 4) into Portuguese, carry out cross-cultural adaptation and assess its reproducibility. DESIGN AND SETTING: Cohort at the Universidade Federal de São Paulo (Unifesp). METHODS: Forty patients with a brain tumor seen at the neuro-oncology outpatient clinic participated in the study. The process of translation and back-translation was carried out, along with adaptation to the Portuguese language and Brazilian culture. The intraclass correlation coefficient (ICC) was used to test the reproducibility of the FACT-Br (version 4). RESULTS: The reproducibility of the questionnaire was excellent (ICC = 0.95; 95% confidence interval, CI: 0.89-0.97). The ICC with a mean interval of 15 days between applications of the questionnaire was very good in all domains (ICC = 0.87 to 0.95). The mean time taken to answer the questionnaire was 6.27 ± 2.26 minutes, ranging from 3 to 11 minutes. CONCLUSION: The translated version of the FACT-Br questionnaire (version 4) adapted to the Portuguese language and Brazilian culture proved to be easily understood and achieved very good reproducibility among patients with diagnoses of brain tumors.

Negative impact of asthma on patients in different age groups / Impacto negativo da asma em diferentes faixas etárias

Objective: To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). Methods: From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. Results: The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p < 0.001); "Have you discontinued your asthma relief or control medication in the last 12 months?" (p = 0.008). In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). Conclusions: In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance. .

Objetivo: Avaliar o impacto da asma em pacientes segundo as faixas etárias de 12-17 anos, 18-40 anos e ≥ 41 anos no Brasil. Métodos: Os dados de 400 pacientes com asma diagnosticada por um médico e residentes de quatro capitais estaduais brasileiras (São Paulo, Rio de Janeiro, Curitiba e Salvador) foram obtidos em um inquérito realizado em países da América Latina em 2011. Os dados foram coletados por meio de um questionário padronizado em entrevista presencial com os pacientes ou com os pais/responsáveis daqueles < 18 anos. As questões abordavam controle da asma, número de hospitalizações, número de consultas de urgência, absenteísmo na escola/trabalho e impactos da asma na qualidade de vida, sono e lazer. Os dados foram estratificados pelas faixas etárias selecionadas. Resultados: Em comparação com os grupos de pacientes adultos, houve uma proporção significativamente maior no grupo 12-17 anos em relação a ter ao menos um episódio de asma grave que impediu o paciente a continuar a jogar ou a se exercitar nos últimos 12 meses (p = 0,012), absenteísmo escolar/trabalho nos últimos 12 meses (p < 0,001), e interrupção de medicação para controle ou prevenção da asma nos últimos 12 meses (p = 0,008). Além disso, 30,2% dos pacientes na faixa etária 12-17 anos relataram que esforços físicos normais eram atividades muito limitantes (p = 0,010 vs. outros grupos), enquanto 14% dos pacientes do grupo ≥ 41 anos descreveram as atividades sociais como muito limitantes (p = 0,011 vs. outros grupos). Conclusões: Nessa amostra, o impacto da asma foi maior nos pacientes com idade entre 12 e 17 anos do que nos adultos, e isso pode ser atribuído à baixa aderência ao tratamento. .