Navegando por Palavras-chave "epidemiology"

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    Acceptance for chronic dialysis treatment: Insufficient and unequal
    (Oxford Univ Press United Kingdom, 1996-06-01) Sesso, Ricardo de Castro Cintra [UNIFESP]; Fernandes, Paula Frassinetti Castelo Branco Camurca; Anção, Meide Silva [UNIFESP]; Drummond, Michael; Draibe, Sergio Antonio [UNIFESP]; Sigulem, Daniel [UNIFESP]; Ajzen, Horacio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); AIM PREFEITURA SAO PAULO
    Background. Evidence suggests that a number of end-stage renal disease (ESRD) patients die without receiving dialysis. We investigated and compared ESRD patients who died without receiving treatment and those who were accepted for dialysis.Methods. All patients starting chronic dialysis in 1991 in the city of Sao Paulo and prospectively registered in the Health Secretariat files were studied. From death certificates we obtained data from all patients dying with an underlying cause associated with chronic renal failure. Medical records from a sample of patients who died without receiving dialysis were reviewed.Results. Of 2127 patients, 1582 (74.4%) received dialysis and 545 (25.6%) did not. The best chance of being dialysed occurred in the 20-29 age group. The age groups with the least chance of receiving dialysis were 0-9 years and over 79 years old. The odds ratio (95% Cl) of not receiving dialysis was 12.42 (6.63-23.82) times greater for patients over 60 years old compared to those aged 20-29 years. Patients with renal failure due to congenital diseases, chronic pyelonephritis, unknown cause, and hypertension were less likely to receive dialysis than those with glomerulonephritis or diabetes.Conclusions. Our results suggest that many ESRD patients die without receiving dialysis. Age and cause of renal disease influence the chance of being accepted for treatment. Restrictions of treatment need to be corrected to guarantee that maintenance dialysis will be accessible to ESRD patients.
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    Active Surveillance of Candidemia in Children from Latin America A Key Requirement for Improving Disease Outcome
    (Lippincott Williams & Wilkins, 2014-02-01) Santolaya, Maria E.; Alvarado, Tito; Queiroz-Telles, Flavio; Colombo, Arnaldo L. [UNIFESP]; Zurita, Jeanette; Tiraboschi, Iris N.; Alberto Cortes, Jorge; Thompson, Luis; Guzman, Manuel; Sifuentes, Jose; Echevarria, Juan I.; Nucci, Marcio; Latin Amer Invasive Mycosis Networ; Univ Chile; Hosp Escuela Tegucigalpa; Univ Fed Parana; Universidade Federal de São Paulo (UNIFESP); Pontificia Univ Catolica Ecuador; Hosp Clin Jose San Martin; Univ Nacl Colombia; Univ Desarrollo; Hosp Vargas Caracas; Inst Nacl Ciencias Med & Nutr Salvador Zubiran; Univ Cayetano Heredia; Universidade Federal do Rio de Janeiro (UFRJ)
    Background: Active surveillance is necessary for improving the management and outcomes of patients with candidemia. the aim of this study was to describe the epidemiologic and clinical features of candidemia in pediatric patients in Latin America.Method: Prospective, multicenter, surveillance study of candidemia in a pediatric population from 23 hospitals in 8 Latin America countries between November 2008 and October 2010.Results: Three hundred and two cases of candidemia were reported with a median incidence of 0.81/1000 admissions. Eighty nine (29%) were neonates. the main risk factors were prematurity, intensive care unit (ICU) admission, parenteral nutrition, respiratory disease and mechanical ventilation in neonates and malignancy, neutropenia, neurological disease and previous use of corticosteroids in children. the main species isolated in neonates and children were Candida albicans (43.8% and 35.7%), Candida parapsilosis (27.0% and 26.3%) and Candida tropicalis (14.6% and 14.6%), respectively. the most frequent antifungal therapy used in neonates and children was deoxycholate-amphotericin-B (43.8% and 29.1%) and fluconazole (28.1% and 53.1%). Seventeen neonates (19.1%) and 20 children (9.4%) did not receive antifungal therapy. the 30-day survival rate was 60% in neonates and 72% in children (P = 0.02). Survival was significantly higher in treated than in nontreated neonates (72% vs. 24%; P < 0.001). A multivariate analysis showed that independent predictors for 30-day mortality in children were renal disease (odds ratio: 4.38, 95% confidence interval: 1.92-10.1, P < 0.001) and receipt of corticosteroids (odds ratio: 2.08, 95% confidence interval: 1.04-4.17, P = 0.04).Conclusions: To our knowledge, this is the first prospective, multicenter surveillance study of candidemia in children in Latin America. This epidemiologic information may provide us with methods to improve preventive, diagnostic and therapeutic strategies in our continent.
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    Acute Hepatitis C in Brazil: Results of a National Survey
    (Wiley-Blackwell, 2011-10-01) Paiva Ferreira, Adalgisa de Souza; Perez, Renata de Mello; Gomes Ferraz, Maria Lucia [UNIFESP]; Lewis-Ximenez, Lia Laura; Pereira, Joao Luis; Lerias de Almeida, Paulo Roberto; Mattos, Angelo Alves de; Acute Hepatitis C Study Grp Brazil; Univ Fed Maranhao; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP); Osvaldo Cruz Fdn; Gen Hosp Bonsucesso; Nossa Senhora Conceicao Hosp; Fed Fdn Sch Med Sci
    The incidence of acute hepatitis C has decreased in the world. However, new cases are still reported. the objective of this study was to obtain data of acute hepatitis C in Brazil and to identify risk factors of transmission, diagnostic criteria, clinical presentation, evolution, and treatment. A questionnaire was sent to all members of the Brazilian Society of Hepatology. Sixteen centers participated with a total of 170 cases between 2000 and 2008. Among them, 37 had chronic renal failure on hemodialysis and were evaluated separately. the main diagnostic criterion in non-uremic patients was ALT (alanine aminotransferase) elevation associated with risk factors. in patients with chronic renal failure, anti-hepatitis C virus (HCV) sero-conversion was the most frequent criterion. Among the 133 non-uremic patients the main risk factors were hospital procedures, whereas in hemodialysis patients, dialysis was the single risk factor in 95% of the cases. Jaundice was more frequent in non-uremic patients (82% vs. 13%; P < 0.001) and ALT levels were higher in these individuals (P < 0.001). Spontaneous clearance was more frequent in non-uremic patients (51% vs. 3%; P < 0.001). Sixty-five patients were treated: 39 non-urennic patients and 26 on dialysis. Sustained virological response rates were 60% for non-uremic and 58% for uremic patients (P = 0.98). There was no association of these rates with the study variables. These findings show that cases of acute hepatitis C are still occurring and have been related predominantly to hospital procedures. Measures to prevent nosocomial transmission should be adopted rigorously and followed to minimize this important source of infection observed in this survey. J. Med. Virol. 83:1738-1743, 2011. (C) 2011 Wiley-Liss, Inc. J. Med.
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    Addiction Research Centres and the Nurturing of Creativity. National Institute on Alcohol and Drugs Policies, Brazil
    (Wiley-Blackwell, 2012-04-01) Laranjeira, Ronaldo [UNIFESP]; Mitsuhiro, Sandro Sendin [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The National Institute of Public Policy for Alcohol and Other Drugs (INPAD) is based at the Federal University of São Paulo, Brazil, and was created to collect scientific evidence regarding epidemiology, develop new therapeutic approaches, study health economics and provide education to subsidize the proper measures to change the Brazilian scenario of alcohol and drug consumption. Policies directed towards the control of alcohol and drugs in Brazil are fragmented, poorly enforced and therefore ineffective. the unregulated market of alcohol in Brazil has contributed to the worsening health of the Brazilian population. Since 1994, INPAD has participated actively in academic debates and discussions about alcohol and drug policies and their effects on the political welfare of the country. Many scientific papers and books have been published on this subject, and the internet and other media have provided excellent opportunities for the dissemination of specialized information to the general population.
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    ADHD in a representative sample of the Brazilian population: estimated prevalence and comparative adequacy of criteria between adolescents and adults according to the item response theory
    (Wiley-Blackwell, 2010-09-01) Polanczyk, Guilherme; Laranjeira, Ronaldo [UNIFESP]; Zaleski, Marcos [UNIFESP]; Pinsky, Ilana [UNIFESP]; Caetano, Raul; Rohde, Luis Augusto; Univ Fed Rio Grande do Sul; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Santa Catarina (UFSC); Univ Texas Houston
    Background: Attention deficit hyperactivity disorder (ADHD) is a clinically significant disorder in adulthood, but current diagnostic criteria and instruments do not seem to adequately capture the complexity of the disorder in this developmental phase. Accordingly, there are limited data on the proportion of adults affected by the disorder, specially in developing countries.Method: We assessed a representative household sample of the Brazilian population for ADHD with the Adult ADHD Self-report Scale (ASRS) Screener, and evaluated the instrument according to the Rasch model of item response theory.Results: the sample was comprised by 3007 individuals, and the overal prevalence of positive screeners for ADHD was 5.8% [95% confidence interval (CI), 4.8-7.0]. Rasch analyses revealed the misfitt of the overall sample to expectations of the model. the evaluation of the sample stratified by age revealed that data for adolescents showed a signficant fittnes to the model expectations, while items completed by adults were not adequated.Conclusions: the lack of fitness to the model for adult respondents challenges the possibility of a linear transformation of the ordinal data into interval measures and the utilization of parametric analyses of data. This result suggests that diagnostic criteria and instruments for adult ADHD must take into account a developmental perspective. Moreover, it calls for further evaluation of currently employed research methods in light of modern theories of psychometrics. Copyright (C) 2010 John Wiley & Sons, Ltd.
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    Alcohol and violence in the emergency department: a regional report from the WHO collaborative study on alcohol and injuries
    (Inst Nacional Salud Publica, 2008-01-01) Borges, Guilherme; Orozco, Ricardo; Cremonte, Mariana; Buzi-Figlie, Neliana [UNIFESP]; Cherpitel, Cheryl; Poznyak, Vladimir; Inst Nacl Psiquiatria; Univ Autonoma Metropolitana; Univ Nacl Mar del Plata; Universidade Federal de São Paulo (UNIFESP); Inst Publ Hlth; WHO
    Objective. To determine the relative risk (RR) of non-fatal unintentional and violence-related injury associated with alcohol consumption in three emergency departments in Latin America (2001-2002). Material and Methods. Pair-matched case-crossover was used to obtain RR estimates for alcohol in non-fatal injuries among 447 patients in Argentina (A), 489 in Brazil (B) and 455 in Mexico (M). Intentional (violence) or unintentional (non-violence) injury status were the main outcomes Results. About 46% of violence-related cases involved alcohol (versus 11.5% for non-violence related cases). The risk of violence-related injury increased with drinking and had an OR = 15.0 (95% confidence interval (CI), 5.8-39.1), with an OR = 4.2 (CI = 2.7-6.5) for unintentional injuries. Conclusions. Increasing amounts of drinking may have pronounced consequences on the risk of triggering an injury, especially for a violence-related injury. The RR estimates provided here can be useful for new estimates on alcohol and the burden of disease.
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    Amphetamine-type stimulant use and conditional paths of consumption: data from the Second Brazilian National Alcohol and Drugs Survey
    (Assoc Brasileira Psiquiatria, 2017) Massaro, Luciana T. S. [UNIFESP]; Abdalla, Renata R. [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Caetano, Raul; Pinsky, Ilana; Madruga, Clarice S. [UNIFESP]
    Objective: The aim of this study was to estimate nationally representative prevalence rates of amphetamine-type stimulant (ATS) use and to identify consumption-associated factors, proposing a conditional model of direct and indirect consumption paths. Method: Using data from the Second Brazilian National Alcohol and Drugs Survey, this cross-sectional study analyzed a subsample of 3,828 participants between 15 and 64 years old, gathering information on the use of psychoactive substances in a probabilistic sample of the Brazilian household population. Results: Rates of lifetime and last-year ATS use were, respectively, 4.1 and 1.6%. Economically privileged individuals and users of other substances were more at risk for using ATS. The results suggest that higher education decreases the chances of ATS consumption. The conditional model showed that higher income increased ATS use, higher education lowered the odds of such an increase, and cocaine use cancelled that associative effect. Conclusion: Brazil presents high rates of ATS use. Prevention and treatment strategies should focus on the protective effect of higher education levels and should target polydrug use. Knowledge of ATS-associated factors and user profiles is the starting point for developing effective treatments and tailored prevention strategies.
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    Amyotrophic lateral sclerosis in Brazil: 1998 national survey
    (Academia Brasileira de Neurologia - ABNEURO, 2000-09-01) Dietrich-neto, Flávia; Callegaro, Dagoberto; Dias-Tosta, Elza; Silva, Helga Cristina Almeida da [UNIFESP]; Ferraz, Maria Elizabeth [UNIFESP]; Lima, José Mauro Braz de; Oliveira, Acary Souza Bulle [UNIFESP]; Aventis Pharma; Universidade de São Paulo (USP); Hospital de Base do Distrito Federal Head of Neurology Unit; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro Neurological Institute
    OBJECTIVES: To assess the epidemiologic characteristics of amyotrophic lateral sclerosis (ALS) in Brazil in 1998. METHOD: Structured Clinical Report Forms (CRFs) sent to 2,505 Brazilian neurologists from January to September 1998 to be filled with demographic and clinical data regarding any ALS patient seen at any time during that year. RESULTS: Five hundred and forty CRFs were returned by 168 neurologists. Data on 443 patients meeting the criteria of probable or definite ALS according to El Escorial definition were analysed: 63 probable (14.2%) and 380 definite (85.8%). Two hundred and fifty-nine (58.5%) of the patients were male, mean age of onset was 52. Spinal onset occurred in 306 patients (69%); bulbar onset in 82 (18.5%), and both in 52 (11.7%). Twenty-six (5.9%) had a family history of ALS. Two hundred and fifty-nine (58.6%) were seen by private practitioners, and 178 (40.2%) at a hospital clinic. Age-ajusted incidence shows a peak incidence at the 65-74 years old range. CONCLUSIONS: The disease's characteristics are similar to those described in international studies, except for age of onset (Brazilian patients are younger). This difference is not confirmed when figures are age-adjusted.
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    Anemia falciforme: perfil epidemiológico das crianças atendidas no hemocentro regional de montes claros - mg
    (Universidade Federal de São Paulo (UNIFESP), 2013-08-28) Dourado Sobrinha, Ernestina [UNIFESP]; Peterlini, Maria Angelica Sorgini Peterlini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Descriptive reminiscent, census and documentary study using secondary data which focused the demographic features and the main clinical signs of the Sickle Cell Disease (SCD) in pediatric patients at the Regional Hemocenter in Montes Claros – Minas Gerais. All the medical notes of the SCD carried children, who were submitted to the treatment at the outpatient care of coagulopathies and hemoglobinopathies in the Hemocenter, and who were 11 year - 11 month - 29 day old, between February 1998 and December 2010. In order to list the collected data a spreadsheet based on the statistic program SPSS® 17.0 was used. The results were shown according to the absolute and relative frequency and the analysis of the association among the variables was done by the chi-square test. The study sample were 168 children, most of them (89.9%) were not from Montes Claros, mainly male (51.8%), 32.1% of them in the age group from 0 to 3 years old and 57.7% were part of the afro descendant group. In 75.5%, diagnosis was made until the age of one month, 78.6% did not develop symptoms at diagnosis and in 73.8% there was no family history of the disease. 66.7% of the patients were submitted to blood transfusion and 75.9% of these received from one to 10 transfusions; half of the sample has had from one to five pain episodes; 61.3% have already been admitted to hospital and more than a half of these have already been admitted to hospital once or twice; and 85.7% have shown some kind of infection, mainly URTI (upper respiratory tract infection). 5.4% of the children were submitted to splenectomy and 5.4% have had cerebrovascular accident. Every three months, 35.1% of the children returned to the practice and death occurred in 2.4% of the children. Afro descendant children were submitted to blood transfusion in a higher frequency (p=0.012), as well as those who showed splenic sequestration (p=0.000). The inpatients have had one or more pain episodes (p=0,000), splenic sequestration (p=0,000) and some infection (p=0,000).
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    Anemia ferropriva e estado nutricional de crianças de creches de Guaxupé
    (Assoc Medica Brasileira, 2008-03-01) Camillo, Carlos Cesar [UNIFESP]; Amancio, Olga Maria Silverio [UNIFESP]; Vitalle, Maria Sylvia de Souza [UNIFESP]; Braga, Josefina Aparecida Pellegrini [UNIFESP]; Juliano, Yara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); UNIFEG
    OBJECTIVE, To evaluate the nutritional status and the prevalence of iron deficiency anemia in children attending public day care centers in the city of Guaxupe (MG), Brazil.METHODS. Children of both genders, from 6 to 72 months, registered in public day-care centers in the city of Guaxupe, were studied Nutritional evaluation was conducted using the Z-score for height-to-age and weight-to-height relationships. Hemoglobin dosage, serum iron, total iron binding capacity and the transferrin saturation index were used for diagnosis of anemia.RESULTS. Z score < - 2 was observed in 3.3% of the children for the height-to-age relationship and of 0.4% for the weight-to-height relationship. Prevalence of total iron deficiency anemia was of 16.1%. in the age span from 6 to 36 months it was of 44.6%. the entire e sample showed 45% with low serum 1 on, 37 9% with high total iron binding capacity and 43. 1 % with a low transferrin saturation Index.CONCLUSION. Malnutrition was not considered to be a problem due to its low prevalence; however, an important prevalence of iron deficiency was observed. Iron deficiency anemia is more prevalent in children between 6 and 36 months confirming that this age span is more vulnerable, No association between iron deficiency anemia and the Z score of the studied anthropometry relationships was found.
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    Aspectos epidemiológicos da depressão pós-parto em amostra brasileira
    (Sociedade de Psiquiatria do Rio Grande do Sul, 2007-12-01) Ruschi, Gustavo Enrico Cabral; Sun, Sue Yazaki [UNIFESP]; Mattar, Rosiane [UNIFESP]; Chambô Filho, Antônio; Zandonade, Eliana; Lima, Valmir José De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia do Espírito Santo Escola de Ciências Superiores Departamento de Ginecologia e Obstetrícia; Universidade Federal do Espírito Santo Departamento de Estatística
    INTRODUCTION: Psychiatric symptoms are frequent in the postpartum period, a moment marked by hormonal alterations and changes in social character, family organization and women's identity. The Edinburgh Postnatal Depression Scale (EPDS) is a self-reporting instrument to track depression after pregnancy, unfortunately not always properly supported by health care professionals. This study aimed at verifying the prevalence of postpartum depression in women receiving care at basic health units. METHODS: Cross-sectional study including 292 women in the postpartum period (from day 31 to 180) who answered the EPDS questionnaire. Cut-off point < 12 for EPDS depression was used. RESULTS: A total of 115 women (39.4%) had scores < 12 in EPDS, classified as depressive; 177 (60.6%) had scores < 12 and were not considered depressive. Women with lower education, higher number of pregnancies, higher parity, higher number of live children and shortest relationship time had more depression. CONCLUSION: High frequency of postpartum depression is associated with social factors, which shows the importance of health care professionals in early detection of depression, with the aid of instruments such as EPDS, due to its efficacy and practicability.
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    Assessment of risk and incidence of falls in neurosurgical inpatients
    (Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2008-08-01) Diccini, Solange [UNIFESP]; Pinho, Priscila Gomes de; Silva, Fabiana Oliveira da; Universidade Federal de São Paulo (UNIFESP); Hospital Sírio Libanês; Hospital Pirajussara
    Neurosurgical patients may present motor, sensitive and balance impairment and increased risk of falling. The aim of this study was to evaluate the fall-related risk factors and the incidence of falls in the pre and post-operative period of neurosurgical patients. A prospective cohort study with a research population of patients undergoing elective neurosurgical procedures. Ninety-seven patients took part in the study. Eight (8.2%) have presented falls with a total of 12 falls (12.4%). In two falls (16.7%), bed side rails were down, whereas in six falls (50%), beds had no rails at all. There was no difference among fall-related risk factors during pre and the post-operative periods. We have concluded that most falls could have been prevented through an improvement in the hospital internal structure and with the introduction of a falls prevention program.
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    Asthma and Rhinitis in South America: How Different They are From Other Parts of the World
    (Korean Acad Asthma Allergy & Clinical Immunology, 2012-03-01) Chong Neto, Herberto Jose; Rosario, Nelson Augusto; Sole, Dirceu [UNIFESP]; Latin Amer ISAAC Grp; Univ Fed Parana; Universidade Federal de São Paulo (UNIFESP)
    Asthma and rhinitis epidemiology has wide variations around the world. the aim of this review was verify the prevalence of asthma and rhinitis in South America and report differences from other regions of the world. We reviewed studies with International Study of Asthma and Allergies in Childhood (ISAAC) methodology in South America, Phases I and III. in South America the ISAAC Phase I ranked four countries among top ten in prevalence of asthma and three countries among top ten in prevalence of rhinoconjunctivitis. ISAAC Phase III showed little changes in asthma and rhinitis prevalence in South American countries. the prevalence increases of asthma and rhinitis in South American centers indicate that the burden of both is continuing to rise, but the differences in prevalence are lessening.
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    Asthma in children and adolescents in Brazil: contribution of the International Study of Asthma and Allergies in Childhood (ISAAC)
    (Sociedade de Pediatria de São Paulo, 2014-03-01) Solé, Dirceu [UNIFESP]; Camelo-Nunes, Ines Cristina; Wandalsen, Gustavo Falbo [UNIFESP]; Mallozi, Marcia Carvalho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective:To assess asthma among Brazilian pediatric population applying the International Study of Asthma and Allergies in Childhood (ISAAC), an internationally standardized and validated protocol.Data sources:ISAAC was conceived to maximize the value of epidemiologic studies on asthma and allergic diseases, establishing a standardized method (self-applicable written questionnaire and/or video questionnaire) capable to facilitate the international collaboration. Designed to be carried out in three successive and dependent phases, the ISAAC gathered a casuistic hitherto unimaginable in the world and in Brazil. This review included data gathered from ISAAC official Brazilian centers and others who used this method.Data synthesis:At the end of the first phase, it has been documented that the prevalence of asthma among Brazilian schoolchildren was the eighth among all centers participating all over the world. Few centers participated in the second phase and investigated possible etiological factors, especially those suggested by the first phase, and brought forth many conjectures. The third phase, repeated seven years later, assessed the evolutionary trend of asthma and allergic diseases prevalence in centers that participated simultaneously in phases I and III and in other centers not involved in phase I.Conclusions:In Brazil, the ISAAC study showed that asthma is a disease of high prevalence and impact in children and adolescents and should be seen as a Public Health problem. Important regional variations, not well understood yet, and several risk factors were found, which makes us wonder: is there only one or many asthmas in Brazil?
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    Avaliação da sobrevida de crianças com neuroblastoma entre 1991-2012: experiência do instituto de oncologia pediátrica - São Paulo
    (Universidade Federal de São Paulo (UNIFESP), 2013-10-30) Lucena, Januaria Nunes [UNIFESP]; Caran, Eliana Maria Monteiro Caran [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Neuroblastoma is the most common extracranial solid tumor of childhood and accounts for 15% of cancer-related deaths. Despite the increased survival in patients with high risk after the intensification of therapy, the prognosis is still poor. The aim of this study is to describe the clinical and epidemiological characteristics of children treated at the Instituto de Oncologia Pediátrica in the period of 1991-2012 and report increased survival observed in recent years. Retrospective information obtained through analysis of medical records of 258 patients studied for age, sex, tumor location, clinical presentation, pathological classification, MYCN and clinical outcome. The median age at diagnosis was 40.5 months. There was a slight male predominance with an incidence ratio of 1.3:1 (M: F). Most was of abdominal tumors (63.5%). Bone marrow was the most common site of metastasis (36.8%) followed by bone (32.9%). Tumor recurrence occurred in 22.1% of patients, and in most cases in bone marrow (47.5%). Histology was unfavorable in 51/217 (23.7%) and MYCN was amplified in 10/44 (25%) of the cases studied.The overall five-year survival rate was 62% and the main cause of death was tumor progression (72.3%). Stage 4 patients who underwent bone marrow transplantation had better survival than those who did not. The overall survival rate of patients with stage 3 and 4 admitted between 2004 to 2012 was higher than that of patients admitted from 1991 to 2003 (5-year overall survival of 59% and 46%, respectively). The epidemiological characteristics were similar, which reinforces the data that the neuroblastoma distribution is uniform throughout the world. There was significant increase in survival of patients with stage 3 and 4 in the study period, which may have been influenced by the greater number of transplants performed and reduced mortality from toxicity.
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    Avaliação epidemiológica da mortalidade em um hospital universitário
    (Universidade Federal de São Paulo (UNIFESP), 2013-08-28) Mota, Ecila Campos [UNIFESP]; Barbosa, Dulce Aparecida Barbosa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The analysis of mortality allows you to track changes in the epidemiological profile of the population through the aspects of their structure, levels and its trend. Data on the mortality of patients during or after hospitalization may determine the performance of a hospital over time. Objective: Thus, this work aims to analyze the main causes of mortality according to gender of adult patients admitted to a university hospital in Northern Brazil-General, Mines and also describe the sociodemographic characteristics of hospitalized patients who died, as well as identifying major comorbidities related to patient death. Method: This was a cross-sectional study with conducting field research, using quantitative and descriptive methodology. Data were collected through the death certificates of patients and Mortality Information System of the Regional Health Montes Claros. Results: The hospital mortality rate was 3.73%. The average age of patients who died was 64.9 years and standard deviation of 19 was found that the majority (54.6%) were male; marital status was more present married (37.6%). Regarding education was a higher proportion of illiterate (34%) and the brown color was predominant (73.5%). The main chapters of the identified causes of mortality in both sexes were diseases of the respiratory system (27.8%), infectious and parasitic diseases (20.9%) and symptoms, signs and abnormal (20.7%) findings. Conclusion: The mortality rate was higher in males, the main causes were respiratory diseases, infectious and parasitic diseases and symptoms, signs and abnormal in over 60 years. Studies on secondary data sources are inexpensive and offer possibilities for monitoring the indicators over time ..
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    Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies
    (Oxford Univ Press, 2011-04-01) Cardwell, Chris R.; Stene, Lars C.; Joner, Geir; Bulsara, Max K.; Cinek, Ondrej; Rosenbauer, Joachim; Ludvigsson, Johnny; Svensson, Jannet; Goldacre, Michael J.; Waldhoer, Thomas; Jarosz-Chobot, Przemyslawa; Gimeno, Suely Godoy Agostinho [UNIFESP]; Chuang, Lee-Ming; Roberts, Christine L.; Parslow, Roger C.; Wadsworth, Emma J. K.; Chetwynd, Amanda; Brigis, Girts; Urbonaite, Brone; Sipetic, Sandra; Schober, Edith; Devoti, Gabriele; Ionescu-Tirgoviste, Constantin; Beaufort, Carine E. de; Stoyanov, Denka; Buschard, Karsten; Radon, Katja; Glatthaar, Christopher; Patterson, Chris C.; Queens Univ Belfast; Norwegian Inst Publ Hlth; Oslo Univ Hosp; Univ Oslo; Univ Western Australia; Univ Notre Dame; Charles Univ Prague; Univ Dusseldorf; Linkoping Univ; Glostrup Univ Hosp; Univ Oxford; Med Univ Vienna; Med Univ Silesia; Universidade Federal de São Paulo (UNIFESP); Natl Taiwan Univ Hosp; Univ Sydney; Univ Leeds; Cardiff Univ; Univ Lancaster; Riga Stradins Univ; Kaunas Univ Med; Univ Belgrade; Univ Lecce; N Paulescu Inst Diabet; Pediat Clin; Childrens Diabet Ctr; Rigshosp; Hosp LMU Munich; Sir Charles Gairdner Hosp
    Background the incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.Methods Relevant studies published before January 2010 were identified from MEDLINE, Web of Science and EMBASE. Authors of studies provided individual patient data or conducted pre-specified analyses. Meta-analysis techniques were used to derive combined odds ratios (ORs), before and after adjustment for confounders, and investigate heterogeneity.Results Data were available for 6 cohort and 25 case-control studies, including 11 955 cases of type 1 diabetes. Overall, there was no evidence of an association prior to adjustment for confounders. After adjustment for maternal age at birth and other confounders, a reduction in the risk of diabetes in second- or later born children became apparent [fully adjusted OR = 0.90 95% confidence interval (CI) 0.83-0.98; P = 0.02] but this association varied markedly between studies (I(2) = 67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children < 5 years of age (n = 25 studies, maternal age adjusted OR = 0.84 95% CI 0.75, 0.93; I(2) = 23%).Conclusion Although the association varied between studies, there was some evidence of a lower risk of childhood onset type 1 diabetes with increasing birth order, particularly in children aged < 5 years. This finding could reflect increased exposure to infections in early life in later born children.
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    BODY DYSMORPHIC DISORDER in PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER: PREVALENCE and CLINICAL CORRELATES
    (Wiley-Blackwell, 2012-11-01) Conceicao Costa, Daniel Lucas; Assuncao, Melissa Chagas; Ferrao, Ygor Arzeno; Conrado, Luciana Archetti; Gonzalez, Christina Hajaj [UNIFESP]; Fontenelle, Leonardo Franklin; Fossaluza, Victor; Miguel, Euripedes Constantino; Torres, Albina Rodrigues; Shavitt, Roseli Gedanke; Universidade de São Paulo (USP); UFCSPA; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)
    Background the prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessivecompulsive disorder (OCD) have been previously addressed in primarily relatively small samples. Methods We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. Results the lifetime prevalence of BDD was 12.1%. the individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. in addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. Conclusions Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders. Depression and Anxiety 29: 966-975, 2012. (C) 2012 Wiley Periodicals, Inc.
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    Brazilian cross-cultural adaptation and validation of the List of Threatening Events Questionnaire (LTE-Q)
    (Assoc Brasileira Psiquiatria, 2017) de Abreu, Patricia B. [UNIFESP]; Cogo-Moreira, Hugo[UNIFESP]; Pose, Regina A.; Laranjeira, Ronaldo [UNIFESP]; Caetano, Raul [UNIFESP]; Gaya, Carolina M. [UNIFESP]; Madruga, Clarice S. [UNIFESP]
    Objective: To perform a construct validation of the List of Threatening Events Questionnaire (LTE-Q), as well as convergence validation by identifying its association with drug use in a sample of the Brazilian population. Methods: This is a secondary analysis of the Second Brazilian National Alcohol and Drugs Survey (II BNADS), which used a cross-cultural adaptation of the LTE-Q in a probabilistic sample of 4,607 participants aged 14 years and older. Latent class analysis was used to validate the latent trait adversity (which considered the number of events from the list of 12 item in the LTE experienced by the respondent in the previous year) and logistic regression was performed to find its association with binge drinking and cocaine use. Results: The confirmatory factor analysis returned a chi-square of 108.341, weighted root mean square residual (WRMR) of 1.240, confirmatory fit indices (CFI) of 0.970, Tucker-Lewis index (TLI) of 0.962, and root mean square error approximation (RMSEA) score of 1.000. LTE-Q convergence validation showed that the adversity latent trait increased the chances of binge drinking by 1.31 time and doubled the chances of previous year cocaine use (adjusted by sociodemographic variables). Conclusion: The use of the LTE-Q in Brazil should be encouraged in different research fields, including large epidemiological surveys, as it is also appropriate when time and budget are limited. The LTE-Q can be a useful tool in the development of targeted and more efficient prevention strategies.
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    The burden of osteoporosis in Brazil: regional data from fractures in adult men and women - The Brazilian Osteoporosis Study (BRAZOS)
    (Elsevier B.V., 2010-03-01) Pinheiro, Marcelo de Medeiros [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Schuch, Natielen Jacques; Genaro, Patricia de Souza [UNIFESP]; Martini, LÍgia Araújo [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Objectives: The BRAZOS (The Brazilian Osteoporosis Study) study is the first epidemiological and population-based study carried out in a representative sample of Brazilian men and women, 40 years or older, with the objective of identifying the prevalence and main clinical risk factors (CRF) associated with low-impact fractures. This report shows the main results according to each region of the country. Patients and Methods: A total of 2,420 subjects (70% women) from 150 different cities in five geographic regions in Brazil, and from all different socio-economical classes were included in this study. Anthropometrical data, as well life style, previous fractures, nutritional status, physical activity, falls, and quality of life were evaluated by a quantitative individual survey. Low-impact fracture was defined as that resulting from a fall no greater than standing height of an individual. A P < 0.05 was considered significant. Results: Statistically significant differences in the prevalence of fractures among the five Brazilian regions according to gender or social class were not observed. However, in women, a higher incidence of fractures was observed in metropolitan areas than in rural areas, and a tendency for a higher frequency of fractures was observed in men from Northeastern states. Statistically significant differences among men from metropolitan areas or rural areas were not observed. Conclusions: Significant differences in the prevalence of low-impact fractures among the five different regions of Brazil were not observed, as well as its frequency or relevance of risk factors.