PPG - Medicina (Pneumologia)

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    Tradução e adaptação cultural do questionário de satisfação e atendimento pela telemedicina (Telemedicne Satisfaction Questionnaire-TSQ)
    (Universidade Federal de São Paulo, 2023) Leão, Maria Efigênia do Nascimento [UNIFESP]; Jardim, José Roberto de Brito [UNIFESP]; http://lattes.cnpq.br/4320654878656075; http://lattes.cnpq.br/7442330878680402
    Introdução: A satisfação é um parâmetro aceito para avaliar o desempenho do serviço de saúde, refletindo os valores entre as expectativas e realidades dos pacientes em relação a diversos aspectos dos serviços de saúde. Quando há correspondência entre o cuidado esperado e o recebido, os pacientes ficam satisfeitos. Assim, o nível de satisfação é diretamente influenciado pelas experiências reais dos pacientes. Objetivo: Traduzir, adaptar culturalmente e avaliar a reprodutibilidade do questionário de satisfação e atendimento pela telemedicina (Telemedicine Satisfaction Questionnaire-TSQ). Métodos: Estudo transversal, amostra constituída pelos pacientes que procuraram o Núcleo de Cessação e Prevenção do Tabagismo (PrevFumo) da Unidade de Reabilitação Pulmonar vinculado à Disciplina de Pneumologia da Escola Paulista de Medicina, a partir 2020, 2021 e 2022 que participaram de, pelo menos, 50% das oito sessões programadas de atendimento virtual com a psicóloga do PrevFumo. Os pacientes foram contatados por telefone e solicitados a responder às 14 perguntas do TSQ por três vezes com intervalo de 7 e 10 dias após a entrevista inicial. Resultados: Foram analisados 53 pacientes, a média de idade era de 49,7 ±10,2 anos, a maioria era do sexo feminino (73,3%). Em relação à escolaridade, 30,2% tinham curso médio completo ou superior incompleto. Quanto ao nível socioeconômico, a maior proporção era do nível B2 (32,1%), sendo A o nível mais alto e E o mais baixo. Referente à presença nas reuniões, 92,5% dos pacientes frequentaram as oito reuniões. O escore médio da pontuação total do questionário de qualidade de vida Whoqol-Bref, foi 12,3 ± 2,49, com porcentagem média de 51,89 ± 15, 54, sendo quanto maior a pontuação, melhor a qualidade de vida. A média do teste de Fagerstrom foi 5,81 ± 2,28, tendo 39,6% dependência elevada. A carga tabagística média foi 35,32 ± 24,8 anos/maços. O escore médio de ansiedade na Escala Hospitalar de Ansiedade e Depressão foi 10,8 ± 4,4, tendo 45,3% dos pacientes provável ansiedade e a média de depressão foi de 8,2 ± 3,7% com 49,1% dos pacientes com provável depressão. Conclusão: O TSQ é fácil e rápido de responder e os pacientes demonstram satisfação com o atendimento da telessaúde.
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    Avaliação da adesão dos pacientes com doença pulmonar obstrutiva crônica (DPOC) às recomendações de prevenção contra covid-19
    (Universidade Federal de São Paulo, 2023-08-07) Almeida, Raquel Emanuela Lima de; Nascimento, Oliver Augusto [UNIFESP]; http://lattes.cnpq.br/2225674564595145; http://lattes.cnpq.br/1688476159498705
    Objetivo: Verificar se os pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) seguiram as recomendações de prevenção à Covid-19. Associar a adesão dos participantes às medidas de prevenção diante da pandemia do novo coronavírus com: gravidade da DPOC, escolaridade, nível socioeconômico e as comorbidades dos pacientes. Métodos: Estudo observacional e transversal, com amostragem de conveniência. Foi realizada aplicação de um questionário por meio de entrevista telefônica contendo perguntas sobre classificação socioeconômica tratamento medicamentoso da DPOC, adesão ao tratamento, presença de sintomas da Covid-19 e se cumpriram as medidas de prevenção contra o novo coronavírus. Resultados: 434 participantes participaram do estudo, a média de idade foi 69,7 + 9,9 anos, 53,2% eram do sexo feminino. Em geral, os participantes seguiram as recomendações. Houve uma associação significativa (p < 0,01) quando observado a frequência com que os participantes saiam de casa e a gravidade da doença, além disso, também houve resultado significativo (p = 0,03) ao associar a quantidade de visitas que eles recebiam em suas casas com as classes socioeconômicas. Ademais, identificou-se que indivíduos com idade mais avançada tinham 2,9% maior chance de seguir o protocolo, além disso, sexo feminino e aqueles que usavam oxigênio tendiam a seguir mais as recomendações de prevenção à nova doença em 2,7 e 3,1 mais chance, respectivamente. Conclusão: Os pacientes apresentaram uma boa aderência às medidas preventivas contra Covid-19. Indivíduos com idade mais avançada, do sexo feminino e que faziam usam de oxigênio suplementar domiciliar seguiram mais as recomendações.
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    Avaliação dos motivos e fatores relacionados à recaída no tabagismo em função do tempo em um serviço universitário especializado em cessação de tabagismo
    (Universidade Federal de São Paulo (UNIFESP), 2021) Albuquerque Neto, Aldo Agra de [UNIFESP]; Jardim, Jose Roberto De Brito [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Relapse is part of the natural history of smokers. The frequency of relapses is different over time and the relapse process appears to be different in relation to the time since cessation. The reasons and characteristics of individuals regarding relapse seem to be different in those who relapse early from those who relapse later, and may relate to these factors associated with chemical and behavioral dependence, in addition to social, economic and personal factors of smokers. Objective: To investigate self-reported factors and reasons related to relapse over time. Methods: Retrospective cross-sectional study evaluating smokers during the first assessment at a smoking cessation clinic, where they were divided into two groups regarding the longer time to relapse in a previous attempt, early and late relapse, using 6 months as the period to differentiate the groups. Univariate analysis was performed using the group with early relapse as a reference, evaluating factors related to these, such as sociodemographic characteristics, smoking history, chemical dependence on tobacco and other drugs, comorbidities, living with smokers, previous. Factors with p<0.1 were evaluated using logistic regression to assess factors associated with early relapse. Differences between reasons for relapse were evaluated according to time of relapse and sociodemographic characteristics, chemical dependency and anxiety and depression. Results: Initially 1900 smokers were evaluated, after the exclusion of patients for various reasons, 1305 individuals remained for analysis, 623 from the early relapse group and 451 from the late relapse group. After multivariate adjustment, chemical dependence (OR 1.170 95%CI 1.111-1.232) was the only factor associated with a higher risk for early relapse and having undergone smoking treatment with cognitive behavioral therapy (OR 0.528 95%CI 0.388-0.718) was the only factor protector. Self-reported reasons for relapse differed over time, with individuals with earlier relapse relating to relapse due to chemical dependency (45% vs 20.5%), anxiety (39.2% vs 27.3%) and irritation (20.5% vs 13.4%) and individuals with late relapse relating to stress from everyday problems (35.5% vs 23.1%), exposure to risky situations (19.6% vs 9, 2%) and living with smokers outside the home (10.7% vs 5.6%). Conclusion: The factor associated with early relapse was chemical dependency and the protector having performed previous behavioral therapy. The self-reported reasons for early relapse were, again, chemical dependency, in addition to anxiety and irritation, while for late relapse were stress, exposure to risky situations and living with smokers outside the home.
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    A distribuição de gordura corporal e suas repercussões clínicas, funcionais, metabólicas e inflamatórias em pacientes obesos, com e sem apneia obstrutiva do sono
    (Universidade Federal de São Paulo (UNIFESP), 2021) Villaca, Debora Strose [UNIFESP]; Moura, Sonia Maria Guimaraes Pereira Togeiro De [UNIFESP]; Universidade Federal de São Paulo
    INTRODUCTION: Morbid obesity (BMI ≥ 40 kg/m2) is related to several health-impairing comorbidities, such as Obstructive Sleep Apnea, which can have an additional negative impact on quality of life as it is associated with excessive sleepiness, accidents, cardiovascular morbidity, cognitive impairment, anxiety, depression and metabolic dysfunction. However, they deserve to be evaluated as the phenotypes of fat distribution in this population affect the Obstructive Sleep Apnea and the inflammatory metabolic profile, as well as the impact of bariatric surgery on such abnormalities. OBJECTIVES: Evaluate (i) the metabolic, inflammatory profile and the functional respiratory and polysomnographic changes of obese patients, referred for bariatric surgery and who have different fat distribution phenotypes (android and gynoid); and (ii) the impact of this therapeutic procedure on the possible abnormalities observed. METHODS: Consecutive patients from a private service with a BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with comorbidities associated with obesity were evaluated: (i) at baseline, through clinical examination, nutritional assessment (anthropometry), quality of life and sleepiness questionnaires, polysomnography, spirometry, dual energy X-ray absorptiometry, blood laboratory tests, such as blood count, lipid profile (total cholesterol, LDL, HDL, triglycerides), insulin profile (insulin, fasting blood glucose, homa-IR), uric acid, adipokines (ghrelin, adiponectin, TNF-α, IL-06 and IL-10), and ultrasound data of the total abdomen; and at least three months after bariatric surgery, they were reevaluated, analyzing the variables listed above. RESULTS: Baseline: the prevalence of Obstructive Sleep Apnea in this population was 76%; even in men, there was a correlation between AHI and waist-to-hip-ratio and android fat mass/ BMI. Post-surgical: there was a decrease in weight and body fat; improved quality of life and decreased sleepiness. Men had a loss of fat, both android and gynoid, greater than women, whereas women had higher adiponectin and cholesterol, and less uric acid than men. Women had lower values of IL-10 in the pre-surgical period and a tendency to lower values of TNF-α in the post compared to men. CONCLUSIONS: Bariatric and metabolic surgery led to a more marked reduction in android and gynoid fat mass in men. There was a significant reduction in Metabolic Syndrome and an increase in adiponectin in the group as a whole. However, reduction in AHI occurred more in patients with moderate and severe AHI, who were predominantly men. We can conclude that bariatric surgery brought a series of benefits to these patients regardless of the presence of sleep-disordered breathing.
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    Características clínicas, resposta ao tratamento e sobrevida em uma coorte de doenças pulmonares intersticiais com achados de miosites
    (Universidade Federal de São Paulo (UNIFESP), 2021) Miranda, Gustavo Frazatto Medeiros De [UNIFESP]; Pereira, Carlos Alberto De Castro [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Interstitial lung diseases (ILD) include a large number of conditions, which can sometimes be associated with myositis findings. Objectives: The aims of present study were to compare the clinical, functional, and tomographic characteristics, treatment response and survival in a Brazilian cohort of patients with ILD and myositis, classified into two groups: (1) With myositis-specific antibodies (MSA); and (2) myositis-associated antibodies (MAA) or clinical features of myositis. Methods: The diagnosis of myositis was characterized by: (1) presence of a mechanic's hands; or (2) elevation of muscle enzymes (creatine phosphokinase or aldolase) 2.5 times above the upper limit of normal associated with subjective muscle weakness or myalgia. All patients included in the study had pulmonary involvement on high-resolution chest tomography (HRCT). Data between the two groups were compared by t-test, median test, chi-square test, Fisher's exact test and survival curves were compared by Kaplan-Meier test. Significant functional decline was characterized by decrease in forced vital capacity (FVC) ≥ 5% of predicted value. Results: Mean age was 51 years and median follow-up was 50 months [IQ=25 - 98]. The mean FVC was 61.9 ± 16.6%. Among 77 patients analyzed, 43 (55.9%) were included in group 1, and 34 (44.1%) in group 2. The groups were similar, except that group 2 had more male subjects (61% versus 39%), more commonly audible pulmonary crackles (91% versus 72) and no SD pattern in capillaroscopy. There was no difference in types and duration of treatment between groups, neither in survival. Overall survival was greater than 80% at five years. Predictive factors for shorter survival were the presence honeycombing on HRCT (log-rank=34.65; p<0.001), and a decrease in FVC from 5% of predicted in longitudinal assessment (log-rank=16.50; p<0.001). Conclusion: Clinical, functional, and tomographic characteristics are similar between patients with ILD and presence of specific antisynthetase antibodies, and those with clinical findings of myositis, with or without associated antibodies. Presence of honeycombing on HRCT and a decrease in predicted FVC ≥ 5% are predictors of lower survival.