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2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis
No full textAbstract\ud
The objective of this document is to provide a comprehensive update of the recommendations of Brazilian Society of Rheumatology on drug treatment of rheumatoid arthritis (RA), based on a systematic literature review and on the opinion of a panel of rheumatologists. Four general principles and eleven recommendations were approved. General principles: RA treatment should (1) preferably consist of a multidisciplinary approach coordinated by a rheumatologist, (2) include counseling on lifestyle habits, strict control of comorbidities, and updates of the vaccination record, (3) be based on decisions shared by the patient and the physician after clarification about the disease and the available therapeutic options; (4) the goal is sustained clinical remission or, when this is not feasible, low disease activity. Recommendations: (1) the first line of treatment should be a csDMARD, started as soon as the diagnosis of RA is established; (2) methotrexate (MTX) is the first-choice csDMARD; (3) the combination of two or more csDMARDs, including MTX, may be used as the first line of treatment; (4) after failure of first-line therapy with MTX, the therapeutic strategies include combining MTX with another csDMARD (leflunomide), with two csDMARDs (hydroxychloroquine and sulfasalazine), or switching MTX for another csDMARD (leflunomide or sulfasalazine) alone; (5) after failure of two schemes with csDMARDs, a bDMARD may be preferably used or, alternatively a tsDMARD, preferably combined, in both cases, with a csDMARD; (6) the different bDMARDs in combination with MTX have similar efficacy, and therefore, the therapeutic choice should take into account the peculiarities of each drug in terms of safety and cost; (7) the combination of a bDMARD and MTX is preferred over the use of a bDMARD alone; (8) in case of failure of an initial treatment scheme with a bDMARD, a scheme with another bDMARD can be used; in cases of failure with a TNFi, a second bDMARD of the same class or with another mechanism of action is effective and safe; (9) tofacitinib can be used to treat RA after failure of bDMARD; (10) corticosteroids, preferably at low doses for the shortest possible time, should be considered during periods of disease activity, and the risk-benefit ratio should also be considered; (11) reducing or spacing out bDMARD doses is possible in patients in sustained remission.Brazilian Society of Rheumatology. The funding body had no role in the\ud
design of the study and collection, analysis, and interpretation of data and in\ud
writing the manuscript
Relationships between parent feeding behaviors and parent and child characteristics in Brazilian preschoolers: a cross-sectional study
No full textAbstract\ud
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Background\ud
Eating habits formed in early childhood are influenced by parental feeding behaviors, warranting investigation of predictors and correlates of parent feeding. We aimed to describe relationships between parental feeding practices and parent and child characteristics in a sample of Brazilian preschoolers.\ud
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Methods\ud
Four hundred and two parents of preschoolers enrolled in private schools of São Paulo and Campinas, Brazil, completed a Brazilian version of the Comprehensive Feeding Practices Questionnaire, as well as questions about parental attitudes, child food intake, other obesity-associated behaviors, and socioeconomic and demographic characteristics. We ran bivariate logistic regression models examining associations between independent variables and each feeding practice. Next, we ran multiple logistic regression models predicting each parental feeding practice.\ud
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Results\ud
Greater ‘Restriction for Weight Control’ and ‘Restriction for Health’ were associated with lower maternal education (OR = 2.42 (CI 95% 1.07–5.48) and 2.79 (CI 95% 1.25–6.22), respectively), and with higher concern about child overweight (OR = 2.46, CI 95% 1.64–3.69 for ‘Restriction for Weight Control’, only), while greater ‘Pressure’ was associated with greater concern about child underweight (OR = 2.30, CI 95% 1.53–3.47) and lower maternal BMI (OR = 0.94, CI 95% 0.88–1.00). Greater use of ‘Emotion Regulation/ Food as Reward’ was associated with lower maternal education (OR = 2.22, CI 95% 1.05–4.71). In analyses of positive feeding practices, lesser use of ‘Healthy Eating Guidance’ and ‘Monitoring’ was associated with greater intake of less healthy foods in children (OR = 1.53 (CI 95% 1.01–2.32) and OR = 1.94 (CI 95% 1.27–2.97), respectively), and greater use of screen devices (OR = 1.59 (CI 95% 1.04–2.44) and OR = 1.57 (CI 95% 1.03–2.39), respectively). Lesser use of ‘Healthy Eating Guidance’ was additionally associated with higher maternal BMI (OR = 1.09, CI 95% 1.03–1.16), and lesser use of ‘Monitoring’ with lesser perceived parent responsibility for child feeding (OR = 1.68, CI 95% 1.12–2.52).\ud
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Conclusions\ud
Our results demonstrate diverse socioeconomic, anthropometric and behavioral correlates of parent feeding in a large Brazilian sample of parents of preschoolers.Funding for SW and LAM was provided by Coordenação de\ud
Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasília (DF),\ud
Brazil. Funding for SC was provided by the National Institutes of Health\ud
(NIH). Funding for JAACT was provided by the Conselho Nacional de\ud
Pesquisa (CNPq)
Determinants of inequalities in the quality of Brazilian diet: trends in 12-year population-based study (2003–2015)
No full textAbstract\ud
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Background\ud
Recent studies have explored the influence of socioeconomic inequalities on the diet quality. However, there is lack of evidence regarding the level of inequalities in dietary quality and its main contributing factors from population-based follow-up studies. The primary objective of this study was to investigate the level and the determinants of inequalities in diet quality in a representative sample of adolescents, adults and older adults resident in São Paulo, Brazil.\ud
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Methods\ud
Data from the Health Survey of São Paulo (ISA-Capital) were analyzed for 2003 (n = 2398), 2008 (n = 1662) and 2015 (n = 1742) surveys. Information on food consumption was obtained through 24-h dietary recall, and diet quality was assessed based on the Revised Brazilian Healthy Eating Index (BHEI-R). The descriptive variables were compared using 95% confidence interval. The scores of BHEI-R and its components were compared across age groups and year. The association between socioeconomic inequalities and diet quality was based on the estimation of concentration index.\ud
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Results\ud
We observed that the BHEI-R scores gradually improved over 12-years, with older adults showing the greatest improvement. The increase in overall population score was observed for total fruits, whole fruits, whole grains, oils and sodium. The main contributor to socioeconomic inequality in diet quality in 2003 was ethnic group, and in 2008 and 2015, it was per capita household income; age was a persistent factor of inequality in the population over the years. Concentration indices indicated that lower income individuals had higher BHEI-R scores in 2003; however, there was a shift in favor of higher income individuals in 2008 and 2015.\ud
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Conclusions\ud
Changes in the patterns of determination of inequalities according to age, ethnic group or income during the period analyzed show the existence of ongoing process of contribution of demographic and socioeconomic factors in the diet quality of individuals in a large urban center.This work was supported by the São Paulo Municipal Health Department [grant\ud
number 2013–0.235.936–0], Research Support Foundation of the State of São\ud
Paulo [grant number 98/14099–7; 2007/51488–2; 2009/15831–0; 2012/22113–9],\ud
and National Council for Scientific and Technological Development [grant\ud
number 502948/2003–5, 481176/2008–0; 473100/2009–6; 472873/2012–1; 402674/\ud
2016–2; 301597/2017–0]. We are grateful for grant support from the Coordination\ud
for the Improvement of Higher Education Personnel (CAPES), Brazil
Gender differences of aortic wave reflection and influence of menopause on central blood pressure in patients with arterial hypertension
No full textAbstract\ud
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Background\ud
Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic waveform reflection is scarce. We aim to evaluate the impact of gender and menopause on central blood pressure of hypertensive patients.\ud
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Methods\ud
In a cross sectional study 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75 bpm (AIx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct series of questions. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status, and the data were compared considering gender and menopausal status.\ud
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Results\ud
Height and weight were significantly lower in women than in men at the same age. Conversely, AIx (32.7 ± 9.8% vs. 20.1 ± 11.7%, p < 0.01), AIx75 (29.6 ± 6.7% vs. 18.3 ± 9.4%, p < 0.01) and central systolic blood pressure (136 ± 30 vs. 125 ± 23 mmHg, p = 0.03) were higher in women than men. The menopausal women (mean age of menopause = 48 years) had the worst indexes of aortic wave reflection, compared to men at the same age and younger women.\ud
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Conclusion\ud
Hypertensive women had both higher reflected aortic pressure waveform and central blood pressure indexes than hypertensive men, and these findings were worsened by the menopausal status
Antônio Gomide at MAC USP
No full textNo ano do cinquentenário da morte de Antônio Gomide, o Museu de Arte Contemporânea da\ud
Universidade de São Paulo presta-lhe uma singela homenagem ao documentar o conjunto\ud
de sua obra no Acervo e ao exibir algumas de suas peças, jamais exibidas antes – a exemplo\ud
do afresco Santa Ceia (1933/34 ca.), apresentado na mostra A instauração do moderno
Interprofessional team member’s satisfaction: a mixed methods study of a Chilean hospital
No full textAbstract
Introduction
The health organizations of today are highly complex and specialized. Given this scenario, there is a need for health professionals to work collaboratively within interprofessional work teams to ensure quality and safe care. To strengthen interprofessional teamwork, it is imperative that health organizations enhance strategic human resources management by promoting team member satisfaction.
Objective
To analyze the satisfaction of members in interprofessional teams and to explore interpersonal relationships, leadership, and team climate in a hospital context.
Methodology
This study is an explanatory sequential mixed methods (quantitative/qualitative) study of 53 teams (409 professionals) at a university hospital in Santiago, Chile. The first phase involved quantitative surveys with team members examining team satisfaction, transformational leadership, and team climate. Social network analysis was used to identify interactions among team members (cohesion and centrality). The second phase involved interviews with 15 professionals belonging to teams with the highest and lowest team satisfaction scores. Findings of both phases were integrated.
Results
Significant associations were found among variables, and the linear regression model showed that team climate (β = 0.26) was a better predictor of team satisfaction than team leadership (β = 0.17). Registered nurse was perceived as the profession with the highest score on the transformational leadership measure (mean = 64), followed by the physician (mean = 33). Team networks with the highest and lowest score of team satisfaction showed differences in cohesion and centrality measures. Analysis of interviews identified five themes: attributes of interprofessional work; collaboration, communication, and social interaction; interprofessional team innovation; shared leadership; and interpersonal relationship interface work/social. Integration of findings revealed that team member satisfaction requires participation and communication, common goals and commitment for patient-centered care, clear roles and objectives to support collaborative work, and the presence of a transformational leader to strengthen well-being, dialog, and innovation.
Conclusions
Results have the potential to contribute to the planning and decision-making in the field of human resources, providing elements to promote the management of health teams and support team member satisfaction. In turn, this could lead to job permanence especially where the local health needs are more urgent
First molecular screening of Plasmodium species in ungulates from Southern Brazil
No full textAbstract
Objective
Despite malaria epidemiology has been extensively studied in primates, few studies were conducted in ungulates. After half a century without descriptions of Plasmodium spp. in deer since its first identification, recent research has rediscovered Plasmodium on ungulates in Africa, Asia, North America and South America, including Central Brazil. Here, a captive herd was evaluated in southern Brazil using light microscopy and PCR. DNA samples were tested for fragment amplification of two Plasmodium spp. genes: mitochondrial cytochrome b and small subunit ribosomal RNA.
Results
All analyses were negative. However, the tests were performed on samples that were collected at a single time point, and parasitemia may fluctuate over the parasite’s life cycle. Thus, the possibility of occult infection cannot be ruled out. Despite the negative results of all of the methods applied, it cannot be categorically stated that these animals are free from Plasmodium sp. infection. Further monitoring and/or multiple sequential sampling may improve the success rate of detecting parasites. Moreover, although this survey of Plasmodium represents the first molecular study on ungulate malaria parasites from Southern Brazil, further analysis of samples from different ungulate species is important for characterizing the epidemiology of Plasmodium of these mammals in this region
Estimating the number of unvaccinated Chinese workers against yellow fever in Angola
No full textAbstract\ud
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Background\ud
A yellow fever epidemic occurred in Angola in 2016 with 884 laboratory confirmed cases and 373 deaths. Eleven unvaccinated Chinese nationals working in Angola were also infected and imported the disease to China, thereby presenting the first importation of yellow fever into Asia. In Angola, there are about 259,000 Chinese foreign workers. The fact that 11 unvaccinated Chinese workers acquired yellow fever suggests that many more Chinese workers in Angola were not vaccinated.\ud
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Methods\ud
We applied a previously developed model to back-calculate the number of unvaccinated Chinese workers in Angola in order to determine the extent of lack of vaccine coverage.\ud
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Results\ud
Our models suggest that none of the 259,000 Chinese had been vaccinated, although yellow fever vaccination is mandated by the International Health Regulations.\ud
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Conclusion\ud
Governments around the world including China need to ensure that their citizens obtain YF vaccination when traveling to countries where such vaccines are required in order to prevent the international spread of yellow fever
Performance of the Brazilian version of GloboDiet software for dietary intake assessment
No full textAbstract\ud
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Background\ud
GloboDiet is a software that conducts the interview of the 24-h dietary recall (24HR) guided by a standardized routine. The successful experience of adapting this software in different cultural contexts in Europe led to the extension of the project to Latin American countries. Brazil was one of the selected countries to start the project in collaboration with IARC, and a Brazilian version of the GloboDiet software was developed. Therefore, this study aimed to estimate food intake using the Brazilian version of GloboDiet software and compare whether there is concordance of the estimated intake of energy, carbohydrates, protein, and lipids between the GloboDiet and Nutrition Data System for Research—NDSR software.\ud
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Methods\ud
We considered a sub-sample of 100 adult individuals from ISA-Capital 2008 survey, a population-based study of resident in the urban area of São Paulo, Brazil. We obtained dietary intake data through the 24HR using the NDSR software. In this study, the 24HR of the same 100 individuals were entered in GloboDiet software—Brazilian version. Then, statistical analyses were performed considering Bland and Altman analysis and Kappa statistic to evaluate the agreement between the software. It also used the terciles of energy and macronutrients.\ud
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Results\ud
The mean (SD) obtained for energy, protein, carbohydrate, and lipids in the NDSR was 2386.47 (444.25) kcal, 100.08 (35.33) g, 286.75 (84.02) g, and 87.34 (28.32) g, respectively. In comparison, the SD obtained in the GloboDiet for those same variables was 2279.67 (655.50) kcal, 92.94 (38.35) g, 277.62 (93.86) g, and 83.12 (33.69) g, respectively. The mean (95% CI of agreement limits) of the differences between two measurements for energy, protein, carbohydrate, and lipids is 106.8 (− 961.3; 1174.9) kcal, 7.142 (− 58.6; 72.9) g, 9.1 (− 128.958; 147.208), and 4.2 (− 64.039; 72.489) g, respectively. From the Kappa statistic, we verified a slight and significant agreement (p < 0.05) considering the tertiles of energy and macronutrient between the software.\ud
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Conclusions\ud
The Brazilian version of GloboDiet software seems to have a good performance when compared to NDSR software. However, further researchers are needed to validate the dietary intake from GloboDiet.Financial support for the project is from CNPq (Process #485314/2012-6) and\ud
the scholarship granted through the “Programa Institucional de Bolsas de\ud
Iniciação em Desenvolvimento Tecnológico e Inovação” (PIBITI)
Predictors of major complications after elective abdominal surgery in cancer patients
No full textAbstract\ud
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Background\ud
Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group.\ud
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Methods\ud
We performed a prospective observational study including all patients (age > 18) undergoing abdominal surgery for cancer at a single institution between June 2011 and August 2013. Patients undergoing emergency surgery, palliative procedures, or participating in other studies were excluded. Primary outcome was a composite of 30-day all-cause mortality and infectious, cardiovascular, respiratory, neurologic, renal and surgical complications. Univariate and multiple logistic regression analyses were performed to identify predictive factors for major perioperative adverse events.\ud
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Results\ud
Of a total 308 included patients, 106 (34.4%) developed a major complication during the 30-day follow-up period. Independent predictors of postoperative major complications were: age (odds ratio [OR] 1.03 [95% CI 1.01–1.06], p = 0.012 per year), ASA (American Society of Anesthesiologists) physical status greater than or equal to 3 (OR 2.61 [95% CI 1.33–5.17], p = 0.003), a preoperative haemoglobin level lower than 12 g/dL (OR 2.13 [95% CI 1.21–4.07], p = 0.014), intraoperative use of colloids (OR 1.89, [95% CI 1.03–4.07], p = 0.047), total amount of intravenous fluids (OR 1.22 [95% CI 0.98–1.59], p = 0.106 per litre), intraoperative blood losses greater than 500 mL (2.07 [95% CI 1.00–4.31], p = 0.043), and hypotension needing vasopressor support (OR 4.68 [95% CI 1.55–27.72], p = 0.004). The model had good discrimination with the area under the ROC curve being 0.80 (95% CI 0.75–0.84, p < 0.001).\ud
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Conclusions\ud
Our findings suggest that a perioperative strategy aimed at reducing perioperative complications in cancer surgery should include treatment of preoperative anaemia and an optimal fluid strategy, avoiding fluid overload and intraoperative use of colloids.This study received departmental funds only