Objective. To determine if supervised cardiovascular training improves exercise tolerance, aerobic capacity, depression, functional capacity, and quality of life in patients with systemic lupus erythematosus (SLE). Methods. Sixty women with SLE (ages 18 -55 years) were evaluated using Short Form 36, visual analog scale for pain, scale for fatigue, Beck Depression Inventory, and Health Assessment Questionnaire (HAQ), and participated in a training protocol of incremental load on a treadmill with computed gas metabolic analysis. Maximum oxygen consumption (VO 2max ) and anaerobic threshold VO 2 were calculated with a SensorMedics Vmax29C analyzer (Sensor Medics, Yorba Linda, CA), and heart rate was measured by electrocardiogram. Patients were divided into 2 groups: a training group (41 patients) that participated in the supervised cardiovascular training program and a control group ( 19 patients) that did not participate in the program. All variables were analyzed at baseline and after 12 weeks for both groups. The training program occurred in the morning for 60 minutes, 3 times a week for 12 weeks. Statistical analysis included Wilcoxon's rank sum test, Mann-Whitney U test, chi-square test, and Fisher's exact test. P values <0.05 were considered to be statistically significant. Results. The 2 groups were homogeneous and comparable at baseline. The training group showed a significant improvement of aerobic capacity measured by anaerobic threshold VO 2 (14.67 ؎ 3.03 versus 17.08 ؎ 3.35 ml/kg/minute, P < 0.001).Comparison of the training group and control group after 12 weeks showed a significant difference relating to VO 2max (24.31 ؎ 4.61 versus 21.21 ؎ 3.88 ml/kg/minute, P ؍ 0.01) and anaerobic threshold VO 2 (17.08 ؎ 3.35 versus 13.66 ؎ 2.82 ml/kg/minute, P < 0.0001). After cardiovascular training, we found a significant improvement of Beck inventory score (8.37 ؎ 12.79 versus 2.90 ؎ 3.00, P < 0.001) and HAQ score (0.14 ؎ 0.21 versus 0.06 ؎ 0.19, P < 0.01) in the training group. Conclusion. This study showed significant improvement in exercise tolerance, aerobic capacity, quality of life, and depression after a supervised cardiovascular training program in patients with SLE.
Resumo O artigo analisa a evolução da cobertura da Estratégia de Saúde da Família (ESF), a partir dos resultados dos inquéritos populacionais das Pesquisas Nacionais de Saúde (PNS) de 2013 e 2019. Foram calculados indicadores de cobertura de moradores e domicílios por Unidade de Saúde da Família (USF), frequência da visita de Agente Comunitário de Saúde (ACS), serviço de procura regular e tipo de serviço buscado; estratificados por área rural e urbana, grandes regiões, unidades da federação, escolaridade do responsável pelo domicílio e quintis de renda. Em 2019, 60,0% dos domicílios estavam cadastrados em USF e a cobertura de moradores era 62,6%. A cobertura é superior na área rural e nas regiões Nordeste e Sul. Entre 2013 e 2019, observa-se aumento de cobertura em 11,6% e redução na visita mensal do ACS. A cobertura é mais elevada entre a população mais vulnerável, considerada escolaridade do responsável pelo domicílio ou renda familiar. A disponibilidade de serviço de procura regular é maior entre cadastrados na USF. Os resultados da PNS 2019 reiteram que a ESF permaneceu como política equitativa e principal modelo de APS no SUS. No entanto, as recentes mudanças na condução da política nacional, que enfraquecem o enfoque comunitário e a prioridade da ESF, podem ameaçar tais avanços.
O presente estudo tem como propósito caracterizar a prevalência de Diabetes Mellitus (DM) em São Paulo, segundo diferenciais sociais e de gênero, constituindo um desdobramento do inquérito domiciliar realizado em nove capitais brasileiras (Estudo Multicêntrico de Prevalência de Diabetes Mellitus no Brasil). Este levantamento envolveu duas etapas de investigação: numa primeira fase, foi rastreada a glicemia capilar de jejum (GCJ) em 2.007 indivíduos, na faixa etária de 30 a 69 anos; numa segunda fase, foi realizada a determinação da glicemia capilar após 2 horas de sobrecarga com 75g de glicose em todos os indivíduos com GCJ maior ou igual a 100mg/dl e em 1/6 dos indivíduos com GCJ menor que 100mg/dl. Realizada a expansão dos resultados obtidos na segunda fase da investigação para a amostra original, foram estudadas as prevalências de DM pré e recém diagnosticados, relacionando-as com idade, sexo, ocupação, escolaridade, naturalidade, bem como com a distribuição por área. Ancorada na oposição e complementaridade das relações de gênero, a presente proposta se organiza norteada pela hipótese de que o DM recém-diagnosticado aumentaria na população masculina e nos segmentos mais pobres da população, diante da busca ativa, como contraponto dos resultados referenciados ao DM pré- diagnosticado ou auto-referido. Os resultados encontrados confirmaram as referidas hipóteses, ressaltando o desaparecimento das diferenças entre os sexos. A elevada proporção da doença decorrente da busca ativa, duplicando a prevalência observada entre os pré-diagnosticados, chamou a atenção para a relevância da consideração socialmente diferenciada na detecção dos novos casos. A identificação de diversificadas injunções sociais junto às populações masculina e feminina, associadas à ocorrência do diabetes, reforçaram a necessidade da realização de estudos específicos sobre a obesidade, com vistas à melhor compreensão das situações de risco e prevenção da doença.
O abandono do tratamento da tuberculose tem implicações sociais e epidemiológicas. Objetivos: Comparar características de pacientes que abandonaram o tratamento com os que não o abandonaram (controle), matriculados no CS-EPM/Unifesp, no período de 1995 a 1997, e verificar se os grupos educativos de sala de espera diminuíram a ocorrência dos abandonos. Método: Foi realizado estudo retrospectivo controlado com 100 pacientes (38 abandonos pareados para 62 controles) matriculados para tratamento de tuberculose, em que se verificaram as variáveis mais relacionadas ao abandono. Destes, 60 pacientes participaram voluntariamente de grupos educativos (16 abandonos e 44 controles). Resultados: As variáveis mais relacionadas ao abandono foram: sexo masculino, tabagismo, alcoolismo, uso de drogas, presença de fatores de risco para HIV e internação prévia. Os que participaram voluntariamente dos grupos educativos de sala de espera tinham características semelhantes ao total de pacientes estudados, mas houve menor ocorrência de abandono durante o tratamento (p < 0,05). Conclusão: Os autores concluem que, tendo-se amplamente disponíveis os meios para diagnóstico e seguimento dos pacientes com tuberculose, todos os esforços possíveis deverão estar concentrados para evitar o abandono, sobretudo nos pacientes de risco, que deverão ter à sua disposição grupos educativos sobre a doença.
Health-related quality of life predictors during medical residency in a random, stratified sample of residents Preditores de qualidade de vida relacionada à saúde durante a residência médica em uma amostra randomizada e estratificada de médicos residentes
Resumo: Este artigo tem por objetivo construir o perfil dos egressos de Pós-Graduação em Saúde Coletiva, tendo como eixos principais a inserção no mercado de trabalho, a divulgação da produção científica referente à defesa de tese e a relevância da Pós-Graduação. A ABRASCO encaminhou um formulário (a ficha C) para as coordenações dos cursos de Pós-Graduação, que se encarregariam de seu preenchimento junto aos egressos. Obtivemos respostas de 51,5% do universo de egressos que concluíram o mestrado ou doutorado entre 1990-94 (N = 257). Os egressos, em sua maioria, estavam inseridos no mercado de trabalho na qualidade de docentes e pesquisadores em universidades, instituições e fundações públicas, chamando a atenção a presença significativa de egressos inseridos nos serviços público-assistenciais de saúde, bem como exercendo funções administrativas. Quando indagados sobre a relevância da Pós-Graduação em suas vidas profissionais, a maioria se reportou a alterações de atividades e aumento de salário. A elevada proporção de divulgação das dissertações/teses, e seu crescente aumento nos anos estudados, apontaram para a aproximação do desempenho da área de Saúde Coletiva em relação às demais áreas de Pós-Graduação. Palavras-chave:Avaliação; Egressos; Pós-Graduação; Saúde Coletiva. Summary:The aim of this paper is to draw a profile of Public Health postgraduates, through the evaluation of their jobs, scientific production and the relevance of the degree to their career. An instrument (called "C form") was sent by ABRASCO to all institutions in Brazil that offer Public Health postgraduate courses. 51,5% of the universe of postgraduate students with a Master or Doctor degree, obtained throughout the years of 1990-94, answered the questionnaire. Most of the postgraduates were involved in teaching or research; however, a significant proportion was also working in health services or administrative assignments.When inquired about the relevance of the degree to their career, most postgraduates described changes in their activities or better wages. The efficient diffusion of the findings of their dissertations, as well as the increasing strength of this process of diffusion in recent years corroborate the evidence that the profile of the Public Health postgraduation courses is becoming similar to other postgraduation courses in Brazil, most of them with good standards of quality.
CONTEXT: It has been demonstrated that children exposed to parents who smoke have more respiratory infections and asthma. OBJECTIVE: To study the association of both respiratory infections and asthma attacks with atopy, passive smoking and time spent daily at school, among children aged 4 to 9 years old from a kindergarten and elementary school in the city of São Paulo between May and July of 1996. TYPE OF STUDY: Descriptive study. SETTING: A kindergarten and elementary school with linkages to Universidade Federal de São Paulo/Escola Paulista de Medicina. PARTICIPANTS: 183 children between 4 and 9 years old. MAIN MEASUREMENTS: A questionnaire consisting of 31 questions was answered by the parents of 183 children, and skin tests for inhaled antigens were performed on 88 children whose parents had given prior agreement for the procedure. RESULTS: Among the children, 51% had had respiratory infections during the preceding 3 months and 25.7% were asthmatic, of whom 52.1% had had one or more asthma attacks during the preceding 3 months. Children exposed to passive smoking did not have more respiratory infections or asthma attacks in comparison with those not exposed. We observed a significant association between atopic disorders in parents and children who were not exposed to passive smoking. There were also associations between atopic disorders in parents and asthma attacks in their infants, and between such disorders and a higher incidence of respiratory infections in the infants during the preceding 3 months. However, the presence of two or more positive skin tests for allergies did not have a correlation with respiratory infections and asthma attacks in this sample. In addition to this, children who studied full time at school did not have a higher occurrence of respiratory infections and asthma attacks. CONCLUSIONS: The presence of respiratory infections and asthma was associated with atopic parents but not with the presence of two or more positive skin tests for allergies among the children. Also, respiratory infections and asthma attacks were not associated with smoking parents or with the length of time spent by the children at school.
Background Health equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. Method Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. Results Both methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV. Conclusion The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.
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