Navegando por Palavras-chave "primary prevention"
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- ItemAcesso aberto (Open Access)Avaliação do perfil epidemiológico e das dificuldades encontradas pelos pacientes para o atendimento de primeira consulta no ambulatório de triagem da nefrologia da UNIFESP(Sociedade Brasileira de Nefrologia, 2012-12-01) Padovani, Cícera Sebastiana Da Silva [UNIFESP]; Schor, Nestor [UNIFESP]; Laranja, Sandra Maria Rodrigues; Universidade Federal de São Paulo (UNIFESP); Hospital do Servidor Público Estadual de São Paulo - FMOINTRODUCTION: The aim of this study was to evaluate the epidemiologic profile of patients and difficulties of patients referred by basic health units (UBS) or other hospitals, outpatient screening of the Division of Nephrology, Hospital São Paulo (UNIFESP) for evaluation and treatment kidney disease. METHODS: From February to September 2009, has been evaluated 341 patients referred from UBS in São Paulo and other parts of the Country. RESULTS: Of these patients, 26% (86/341) required for new tests to confirm the diagnosis doubtful for referrals, incomplete, or because of the waiting period for the care and exams, which ranged from one week to three years, and part of them did not bring any kind of examination for the evaluation, 12% (45/341) returned for follow-up at the unit location, 13% (46/341) were referred for treatment site closest to their residence, 47% (164/341) for our sub-specialty Clinics of Nephrology (HSP): 24% (82/341) uremia, 8% (27/341) with polycystic kidney disease, 7% (23/341) for hypertension, 4% (16/341) renal Lithiasis and 4% (16/341) nephritis. CONCLUSION: Our results suggest investments investment in infrastructure in the training of officials of UBS and HSP, reorganization of central references for better management and referral of patients, humanization of care and training of health professionals for outpatient care at UBS in preventive work and basic monitoring of patients, particularly those with diabetes mellitus and hypertension, which can lead to the development of chronic kidney disease (CKD).
- ItemSomente MetadadadosDETERMINANTS of COMMON MENTAL DISORDERS DETECTION BY GENERAL PRACTITIONERS in the PRIMARY HEALTH CARE in BRAZIL(Baywood Publ Co Inc, 2011-01-01) Goncalves, Daniel A. [UNIFESP]; Fortes, Sandra; Tofoli, Luis Fernando; Campos, Monica Rodrigues; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Kings Coll London; Med Univ Estado Rio de Janeiro; Univ Fed CearaCommon Mental Disorders (CIVIC) are highly prevalent among patients attending primary care. Many of these disorders remain unrecognized by general practitioners (GPs), with the detection rates varying from 30 to 60%. This study aims to evaluate the CMD detection rates by Primary Heath Care (PHC) practitioners in Brazil-and factors that affect CMD detection. Methods: A cross sectional study was conducted with users of five PHC units in the city of Petropolis. the CMD prevalence of psychiatric morbidity was estimated by the General Health Questionnaire-12, and the physician's CMD detection was evaluated by a questionnaire completed by GPs after each consultation. Results: Seven hundred and fourteen subjects participated of the study, and 400 (56%) were screened positive using GHQ-12 cut-off point of 2/3. GPs diagnosed 379 people with CMD (53.1%), and 256(36%) subjects were detected by both GHQ and the GPs with an OR of 3.04 (95%CI 2.23-4.13). CMD detection accuracy by GPs was 65%. There was a strong association between the detection of CMD and the report of medically unexplained physical symptoms by GPs. Being female, married, and a frequent service user was also related to higher detection rates. Conclusion: CMD detection rate was similar to those reported worldwide, but contrary to other studies, the presence of MUS increased detection rates. the high frequency of CMD in Primary Health Care highlights the need for improving GP and health worker's training in order to enable them to accurately recognize and treat psychological distress with evidence-based interventions. (Int'l. J. Psychiatry in Medicine 2011;41:3-13)
- ItemAcesso aberto (Open Access)Eficácia de uma intervenção psicológica no estilo de vida para redução do risco coronariano(Sociedade Brasileira de Cardiologia - SBC, 2007-10-01) Pugliese, Rita [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Blay, Sergio Luis [UNIFESP]; Plavinik, Frida [UNIFESP]; Andrade, Marco Antonio [UNIFESP]; Galvão, Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the efficacy of a program of lifestyle change through psychological intervention, combined with pharmacological therapy, for coronary risk reduction in uncontrolled hypertensive patients with overweight and dyslipidemia over 11 months of follow-up. METHODS: A randomized controlled trial with 74 patients assigned to three different treatment programs. One group (CT) only received conventional pharmacological treatment. Another group (OG) received pharmacological treatment and participated in a guidance program to control cardiovascular risk factors. A third group (LSPI) received pharmacological treatment and participated in a brief psychological intervention program for reduction of estresse levels and changing of eating behavior. The main measure was the Framingham risk index. RESULTS: CT patients presented an average reduction of 18% (p = 0.001) in coronary risk; OG patients elevated the risk by 0.8% (NS) and the LSPI group showed an average reduction of 27% on the Framingham risk index (p = 0.001). CONCLUSION: Pharmacological treatment combined with psychological intervention for reduction of estresse level and changing of eating behavior resulted in additional benefits in coronary risk reduction.
- ItemSomente MetadadadosNumber Needed to Treat With Rosuvastatin to Prevent First Cardiovascular Events and Death Among Men and Women With Low Low-Density Lipoprotein Cholesterol and Elevated High-Sensitivity C-Reactive Protein Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)(Lippincott Williams & Wilkins, 2009-11-01) Ridker, Paul M.; MacFadyen, Jean G.; Fonseca, Francisco Antonio Helfenstein [UNIFESP]; Genest, Jacques; Gotto, Antonio M.; Kastelein, John J. P.; Koenig, Wolfgang; Libby, Peter; Lorenzatti, Alberto J.; Nordestgaard, Borge G.; Shepherd, James; Willerson, James T.; Glynn, Robert J.; JUPITER Study Grp; Harvard Univ; Universidade Federal de São Paulo (UNIFESP); McGill Univ; Cornell Univ; Univ Amsterdam; Univ Ulm; Hosp Cordoba; Univ Copenhagen; Univ Glasgow; St Lukes Episcopal HospBackground-As recently demonstrated, random allocation to rosuvastatin results in large relative risk reductions for first cardiovascular events among apparently healthy men and women with low levels of low-density lipoprotein cholesterol but elevated levels of high-sensitivity C-reactive protein. However, whether the absolute risk reduction among such individuals justifies wide application of statin therapy in primary prevention is a controversial issue with broad policy and public health implications.Methods and Results-Absolute risk reductions and consequent number needed to treat (NNT) values were calculated across a range of end points, timeframes, and subgroups using data from Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), a randomized evaluation of rosuvastatin 20 mg versus placebo conducted among 17 802 apparently healthy men and women with low-density lipoprotein cholesterol <130 mg/dL and high-sensitivity C-reactive protein >= 2 mg/L. Sensitivity analyses were also performed to address the potential impact that alternative statin regimens might have on a similar primary prevention population. for the end point of myocardial infarction, stroke, revascularization, or death, the 5-year NNT within JUPITER was 20 (95% CI, 14 to 34). All subgroups had 5-year NNT values for this end point below 50; as examples, 5-year NNT values were 17 for men and 31 for women, 21 for whites and 19 for nonwhites, 18 for those with body mass index <= 5 kg/m(2) and 21 for those with body mass index greater than 25 kg/m2, 9 and 26 for those with and without a family history of coronary disease, 19 and 22 for those with and without metabolic syndrome, and 14 and 37 for those with estimated Framingham risks greater or less than 10%. for the net vascular benefit end point that additionally included venous thromboembolism, the 5-year NNT was 18 (95% CI, 13 to 29). for the restricted hard end point of myocardial infarction, stroke, or death, the 5-year NNT was 29 (95% CI, 19 to 56). in sensitivity analyses addressing the theoretical utility of alternative agents, 5-year NNT values of 38 and 57 were estimated for statin regimens that deliver 75% and 50% of the relative benefit observed in JUPITER, respectively. All of these calculations compare favorably to 5-year NNT values previously reported in primary prevention for the use of statins among hyperlipidemic men (5-year NNT, 40 to 70), for antihypertensive therapy (5-year NNT, 80 to 160), or for aspirin (5-year NNT, >300).Conclusions-Absolute risk reductions and consequent NNT values associated with statin therapy among those with elevated high-sensitivity C-reactive protein and low low-density lipoprotein cholesterol are comparable if not superior to published NNT values for several widely accepted interventions for primary cardiovascular prevention, including the use of statin therapy among those with overt hyperlipidemia.