ResumoObjetivando traçar a evolução histórica da distribuição de médicos no Brasil segundo sexo, foi realizado estudo epidemiológico do tipo ecológico, por meio do cruzamento de bancos de dados secundários (linkage). Para a caracterização geral dos médicos foram consideradas as bases de dados dos 27 conselhos regionais de medicina, complementadas pelas bases de dados da Comissão Nacional de Residência Médica e da Associação Médica Brasileira. Os resultados mostram que, desde 2009, entre os novos médicos registrados há mais mulheres que homens. Na população de médicos em atividade os homens ainda predominam (60,1%), mas no grupo com 29 anos ou menos as mulheres já são maioria. A tendência consistente de maior participação das mulheres na profissão médica no Brasil, observada ao longo das últimas décadas e acentuada nos últimos anos, indica a necessidade de reavaliar e readequar as propostas para implementação de políticas públicas na área. Palavras-chave: Feminização. Medicina. Distribuição de médicos. Brasil. Resumen La feminización de la Medicina en BrasilCon el fin de trazar la evolución histórica de la distribución de los médicos en Brasil por sexo, se llevó a cabo un estudio epidemiológico del tipo ecológico, a través de la intersección de las bases de datos secundarias (linkage). Para la caracterización general de los médicos, se han considerado las bases de datos de los 27 Consejos Regionales de Medicina, complementados con las bases de datos de la Comisión Nacional de Residencia Médica y de la Asociación Médica Brasileña. Los resultados muestran que entre los nuevos médicos colegiados hay más mujeres que hombres desde 2009. En la población de los médicos en actividad todavía predominan los hombres (60,1%), pero en el grupo con 29 años o menos, las mujeres son la mayoría. La tendencia constante de aumento de la participación de las mujeres en la profesión médica en Brasil, observada durante las últimas décadas y notablemente en los últimos años, indica la necesidad de reevaluar y reajustar las propuestas para la implementación de políticas públicas en el área. Palabras-clave: Feminización. Medicina. Distribución de médicos. Brasil. Abstract The feminization of Medicine in BrazilAiming to settle the historical evolution of physicians' distribution in Brazil by gender, an ecological study was conducted by secondary database cross-checking (linkage). For a general characterization of the physicians were considered the 27 Regional Medicine Council, complemented by the National Medical Residency and the Brazilian Medical Association databases. The results show that since 2009, among new registered doctors there are more women than men. Although men still prevail (60.1%) in the active physicians population, in the group aged less than 29 years old, women have become majority. The consistent trend of increased participation of women in the medical profession in Brazil, observed over the past decades and intensified over the past few years, indicates the need to reassess and readjust the proposals for implementati...

INTRODUÇÃO: A concentração de cães e gatos em áreas urbanas, associada a um número cada vez mais crescente da população errante desses animais, tem um papel epidemiológico importante na contaminação de solos de praças e parques públicos e na disseminação de infecções por variados gêneros de parasitas. O objetivo do presente estudo foi determinar a frequência de geo-helmintos com potencial zoonótico em solo de praças públicas e escolas municipais infantis da Cidade de Fernandópolis, Estado de São Paulo, Brasil, no período compreendido entre março de 2007 e fevereiro de 2008. MÉTODOS: Foram avaliadas todas as praças (32) e escolas (13) da cidade. As amostras foram testadas pelos métodos de Rugai adaptado, Willis e Caldwell e Caldwell. RESULTADOS: Foram avaliadas 225 amostras de solo com 30,2% (68) de positividade. Nas amostras provenientes de praças públicas, a positividade foi de 40% (64), ao passo que, nas escolas, foi de apenas 6,1% (6). Os ovos de parasitas encontrados foram Toxocara spp. 79,3% (47), Trichuris spp. 13,8% (8) e ancilostomídeos 6,9% (4). Variáveis relacionadas ao local, como o número de cães (OR 21,18 - IC95%: 10,81-41,51), de espécimes de fezes (OR 6,87 - IC95%: 3,51-13,47) e a utilização de cerca (OR 0,1 - IC95%: 0,05-0,20) tiveram impacto na contaminação do solo. CONCLUSÕES: Foram observados, nas amostras contaminadas, parasitas com potencial zoonótico, entre os quais estão os agentes etiológicos de doenças como a larva migrans visceral e cutânea, fato que representa risco a saúde da população que frequenta tais ambientes.

Introduction Although patients’ clinical conditions have been shown to be associated with coronavirus disease (COVID-19) severity and outcome, their impact on hospital costs are not known. This economic evaluation of COVID-19 admissions aimed to assess direct and fixed hospital costs and describe their particularities in different clinical and demographic conditions and outcomes in the largest public hospital in Latin America, located in São Paulo, Brazil, where a whole institute was exclusively dedicated to COVID-19 patients in response to the pandemic. Methods This is a partial economic evaluation performed from the hospital´s perspective and is a prospective, observational cohort study to assess hospitalization costs of suspected and confirmed COVID-19 patients admitted between March 30 and June 30, 2020, to Hospital das Clínicas of the University of São Paulo Medical School (HCFMUSP) and followed until discharge, death, or external transfer. Micro- and macro-costing methodologies were used to describe and analyze the total cost associated with each patient's underlying medical conditions, itinerary and outcomes as well as the cost components of different hospital sectors. Results The average cost of the 3,254 admissions (51.7% of which involved intensive care unit stays) was US$12,637.42. The overhead cost was its main component. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic (US$15,257.95) diseases were associated with higher costs. Age strata >69 years, reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19, comorbidities, use of mechanical ventilation or dialysis, surgery and outcomes remained associated with higher costs. Conclusion Knowledge of COVID-19 hospital costs can aid in the development of a comprehensive approach for decision-making and planning for future risk management.

A urbanização é um processo irreversível em escala mundial e estima-se que o número de pessoas que vivem em cidades deverá atingir 67% da população do planeta até 2050. Os países de baixa ou média renda, por sua vez, possuem 30% a 40% da população urbana vivendo atualmente em favelas, em situação de risco para diversos agravos de saúde. No Brasil, embora 84,3% da população residissem em áreas urbanas já em 2010, não se verificam no momento ações consistentes voltadas ao enfrentamento das questões de saúde urbana. Neste artigo discute-se a situação epidemiológica de agravos infecciosos de interesse para a saúde pública (dengue, infecção por HIV/aids, leptospirose, hanseníase e tuberculose) a partir do ano 2000 nas 17 metrópoles do país, de modo a esclarecer o papel atual das doenças infecciosas no contexto da saúde urbana brasileira.

BackgroundToxocariasis is a worldwide helminthic zoonosis caused by infection with the larvae of the ascarid worms that comprise the Toxocara spp. Children are particularly prone to infection because they are exposed to the eggs in sandboxes and playgrounds contaminated with dog and cat feces. Certain behaviors, such as a geophagy habit, poor personal hygiene, a lack of parental supervision, close contact with young dogs, and ingestion of raw meat, as well as gender, age, and socioeconomic status, affect the prevalence of the disease. However, previous studies of the risk factors for toxocariasis have generally produced inconsistent results. An epidemiological cross-sectional study was conducted to evaluate the seroprevalence of IgG anti-Toxocara spp. antibodies and associated factors in schoolchildren from a region in the southeast of Brazil.Methodology/Principal FindingsA total of 252 schoolchildren aged 1 to 12 years (120 males and 132 females) were assessed. An enzyme-linked immunosorbent assay based on Toxocara canis larval excretory-secretory antigens was used to determine outcomes. A questionnaire was used to collect information on children, family, and home characteristics. Clinical and laboratory data completed the dataset investigated in this study. Seroprevalence was 15.5% (95%CI 11.5–19.8). Geophagy (aPR 2.38 [95%CI 1.36–4.18], p-value 0.029) and the habit of hand washing before meals (aPR 0.04 [95%CI 0.01–0.11], p-value ≤0.001) were factors associated with increased and decreased seroprevalence, respectively. The income factor and its related variables lost statistical significance after adjustment with a multiple Poisson regression model.Conclusions/SignificanceThe current study confirms that toxocariasis is a public health problem in the evaluated area; modifiable factors such as soil contact and personal hygiene appear to have a greater influence on the acquisition of infection than sociodemographic attributes, thus representing direct targets for disease prevention and control.

BackgroundThe intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country’s medical workforce. Physicians’ simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services.MethodsA nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based  on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians’ sociodemographic characteristics and their engagement with public and private services.ResultsFrom the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68–0.89]; PR 0.47 [0.38–0.56]), less experienced (PR 0.78 [0.73–0.94]; PR 0.44 [0.36–0.53]) and predominantly female (PR 0.79 [0.71–0.88]; PR 0.68 [0.6–0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48–0.69]) and mixed sectors (PR 0.31 [0.25–0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58–2.43]), specialized (PR 1.29 [1.17–1.42]) and male (PR 1.35 [1.21–1.51]), often working less than 20 h per week (PR 2.04 [1.4–2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16–1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1.11–1.37]).ConclusionThe study shows that more than half of Brazilian physicians currently engage with dual practice, while only one fifth dedicate exclusively to public services, highlighting also substantial differences in socio-demographic and work-related characteristics between public, private and dual-practitioners. These results are consistent with the international literature suggesting that physicians’ sociodemographic characteristics can help predict dual practice forms and prevalence in a country.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3076-z) contains supplementary material, which is available to authorized users.

BackgroundLiver transplantation has received increased attention in the medical field since the 1980s following the introduction of new immunosuppressants and improved surgical techniques. Currently, transplantation is the treatment of choice for patients with end-stage liver disease, and it has been expanded for other indications. Liver transplantation outcomes depend on donor factors, operating conditions, and the disease stage of the recipient. A retrospective cohort was studied to identify mortality and graft failure rates and their associated factors. All adult liver transplants performed in the state of São Paulo, Brazil, between 2006 and 2012 were studied.Methods and FindingsA hierarchical Poisson multiple regression model was used to analyze factors related to mortality and graft failure in liver transplants. A total of 2,666 patients, 18 years or older, (1,482 males; 1,184 females) were investigated. Outcome variables included mortality and graft failure rates, which were grouped into a single binary variable called negative outcome rate. Additionally, donor clinical, laboratory, intensive care, and organ characteristics and recipient clinical data were analyzed. The mortality rate was 16.2 per 100 person-years (py) (95% CI: 15.1–17.3), and the graft failure rate was 1.8 per 100 py (95% CI: 1.5–2.2). Thus, the negative outcome rate was 18.0 per 100 py (95% CI: 16.9–19.2). The best risk model demonstrated that recipient creatinine ≥ 2.11 mg/dl [RR = 1.80 (95% CI: 1.56–2.08)], total bilirubin ≥ 2.11 mg/dl [RR = 1.48 (95% CI: 1.27–1.72)], Na+ ≥ 141.01 mg/dl [RR = 1.70 (95% CI: 1.47–1.97)], RNI ≥ 2.71 [RR = 1.64 (95% CI: 1.41–1.90)], body surface ≥ 1.98 [RR = 0.81 (95% CI: 0.68–0.97)] and donor age ≥ 54 years [RR = 1.28 (95% CI: 1.11–1.48)], male gender [RR = 1.19(95% CI: 1.03–1.37)], dobutamine use [RR = 0.54 (95% CI: 0.36–0.82)] and intubation ≥ 6 days [RR = 1.16 (95% CI: 1.10–1.34)] affected the negative outcome rate.ConclusionsThe current study confirms that both donor and recipient characteristics must be considered in post-transplant outcomes and prognostic scores. Our data demonstrated that recipient characteristics have a greater impact on post-transplant outcomes than donor characteristics. This new concept makes liver transplant teams to rethink about the limits in a MELD allocation system, with many teams competing with each other. The results suggest that although we have some concerns about the donors features, the recipient factors were heaviest predictors for bad outcomes.

ObjectiveIn many countries an increase in the number of women in medicine is accompanied by gender inequality in various aspects of professional practice. Women in medical workforce usually earn less than their male counterparts. The aim of this study was to describe the gender wage difference and analyse the associated factors in relation to Brazil’s physicians.Participants2400 physicians.SettingNationwide, cross-sectional study conducted in 2014.MethodsData were collected via a telephone enquiry. Sociodemographic and work characteristics were considered factors, and monthly wages (only the monthly earnings based on a medical profession) were considered as the primary outcome. A hierarchical multiple regression model was used to study the factors related to wage differences between male and female physicians. The adjustment of different models was verified by indicators of residual deviance and the Akaike information criterion. Analysis of variance was used to verify the equality hypothesis subsequently among the different models.ResultsThe probability of men receiving the highest monthly wage range is higher than women for all factors. Almost 80% of women are concentrated in the three lowest wage categories, while 51% of men are in the three highest categories. Among physicians working between 20 and 40 hours a week, only 2.7% of women reported receiving >US$10 762 per month, compared with 13% of men. After adjustment for work characteristics in the hierarchical multiple regression model, the gender variable estimations (ß) remained, with no significant modifications. The final effect of this full model suggests that the probability of men receiving the highest salary level (≥US$10 762) is 17.1%, and for women it is 4.1%. Results indicate that a significant gender wage difference exists in Brazil.ConclusionThe inequality between sexes persisted even after adjusting for working factors such as weekly workload, number of weekly on-call shifts, physician office work, length of practice and specialisation.