Sao Paulo Medical Journal最新文献

Background: Previous studies have shown that isometric exercise training reduces systolic blood pressure by approximately 8 mmHg and diastolic blood pressure by approximately 4 mmHg in both normotensive and hypertensive individuals. However, the prescription of isometric exercises can be based on the rating of perceived exertion (RPE) or heart rate (HR) obtained during the maximal incremental isometry test. The reliability and agreement of this test have not been assessed.

Objectives: To analyze the reliability and agreement indicators of HR and RPE during isometric wall squat incremental tests.

Design and setting: A reliability and agreement study was conducted at Universidade Federal de Pernambuco.

Methods: Twenty-eight healthy subjects (54% men, 26 ± 5 years) performed two isometric wall squat incremental tests. The test began with a knee joint angle of 135° (knee and leg) progressively reduced by 10° at each stage. Each stage lasts 2 minutes or until voluntary exhaustion. The HR and RPE were obtained during the tests. Reliability and agreement were established using test-retest (paired t-test or Wilcoxon test), intraclass correlation coefficient (ICC), standard error of measurement (SEM), coefficient of variation (CV), and Bland-Altman plots.

Results: The HR and RPE increased significantly during both tests. The HR and RPE at each stage were similar between the two test sessions (P > 0.05). Both HRmax (ICC: 0.695, P = 0.002, SEM = 8.1 bpm and CV = 5.8%) and RPEmax (ICC: 0.525, P = 0.036, SEM = 0.4 and CV = 3.6%) presented similar reliability indicators, and no statistically significant differences were obtained between the two test sessions (P > 0.05). The Bland-Altman plots indicated good agreement between HRmax and RPEmax.

Conclusion: HR and RPE showed similar reliability and agreement during the isometric wall squat incremental test.

Background: Chronic low back pain (CLBP) is a substantial health problem that causes considerable economic losses. Several studies have demonstrated the protective effect of habitual physical activity; however, little data are available regarding its impact on the costs associated with CLBP.

Objectives: The primary aim of this study was to analyze the costs of CLBP in the Brazilian Health System and associated factors among adults.

Design and setting: An 18-month cohort study was conducted in two basic health units in Presidente Prudente (SP), Brazil.

Methods: A total of 198 patients were interviewed and evaluated four times: at baseline, with retrospective data covering the previous 12 months, and at six, 12, and 18 months. The Nordic and Baecke questionnaires were used to classify CLBP, and the Baecke questionnaire was used for physical activity assessment. The costs were calculated by reviewing the demand for services from medical records. Body mass index (kg/m2) was determined using body mass and height values collected during the interviews. The questionnaire included confounding variables, such as sex, age, ethnicity, and socioeconomic status.

Results: A high prevalence of CLBP was observed, which was associated with female sex and younger age. CLBP resulted in high costs for medical consultations (without: US$ 34.25 ± 23.21; with: US$ 39.62 ± 27.25; P = 0.049), while cycling was negatively associated with costs (rho = -0.289; P = 0.049).

Conclusion: Lower back pain was associated with higher costs of medical consultations, while cycling was associated with reduced costs.

Background: The Problem Areas in Diabetes scale (PAID) is used to measure emotional distress levels related to diabetes mellitus (DM). However, consensus on its internal structure is lacking.

Objectives: To compare the different internal structures of the PAID and propose a shortened version for Brazilian patients with diabetes.

Design and setting: Structural and criterion validity study.

Methods: We included Brazilian patients with type 1 DM (DM1) and type 2 DM (DM2) in this study. In accordance with the international consensus recommendations, we assessed the structural validity using confirmatory factor analysis (CFA) and used the following indices to evaluate model fit: root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), standardized root mean square residual (SRMR), chi-square/degrees of freedom (DF), Akaike information criterion (AIC) and sample-size adjusted Bayesian information criterion (SABIC). Modification indices and factor loadings were used to reduce the number of items.

Results: One hundred eighty-five patients, most of whom included women with DM2, participated in the study. The reduction in the PAID generated a unidimensional structure with 13 items (PAID-13). The PAID-13 presented the best-fit indices (chi-square/DF = 2.15, CFI = 0.989, TLI = 0.986, RMSEA = 0.079, and SRMR = 0.049). When the PAID versions with 13 and 20 items (original version) were correlated, a strong correlation was observed (rho = 0.941, P < 0.001).

Conclusion: The short version of the PAID scale with 13 items presented a more appropriate internal structure for Brazilian patients with diabetes.

Background: The mortality rates of prostate and testicular cancer are higher mortality in the northeast region.

Objective: We aimed to compare the efficacy of machine learning libraries in predicting testicular and prostate cancer mortality.

Design and setting: A comparative analysis of the pyMannKendall and Prophet machine-learning algorithms was conducted to develop predictive models using data from DATASUS (TabNet) to Caicó (Brazil) and Rio Grande do Norte (Brazil).

Methods: Data on prostate and testicular cancer mortality in men from 2000 to 2019 were collected. The prediction accuracy of the Prophet algorithm was evaluated using the mean squared error (MSE), the root mean squared error and analyzed using the pyMannKendall, and Prophet libraries.

Results: The research data were made publicly available on GitHub. The machine test confirmed the accuracy of the predictions, with the root MSE (RMSE) values closely matching the observed data for Caicó (RMSE = 2.46) and Rio Grande do Norte (RMSE = 22.85). The Prophet algorithm predicted an increase in prostate cancer mortality by 2030 in Caicó and Rio Grande do Norte. This prediction was corroborated by the pyMannKendall analysis, which indicated a 99% probability of a rising mortality trend in Caicó (P < 0.01; tau = 0.586; intercept = 2.59) and Rio Grande do Norte (P = 2.06; tau = 0.84, and intercept = 119.63). For testicular cancer, no significant mortality trend was identified by Prophet or pyMann-Kendall.

Conclusions: Libraries are reliable tools for predicting mortality, providing support for strategic health planning, and implementing preventive measures to ensure men's health. Addressing the gender gap in DATASUS is essential.

Background: Electroconvulsive therapy (ECT) remains a target of prejudice, and finding places to administer it remains a challenge. The main reason for the recommendation of ECT is its effectiveness, especially when compared with other treatments for severe and refractory patients.

Objectives: This study aimed to assess the response rates across a broader patient sample undergoing ECT in three distinct Brazilian states.

Design and setting: This observational cohort study was conducted at the following three sites: Universidade Federal do Tocantins (by partnership with Hospital Geral de Palmas, Palmas-TO), Pax Instituto de Psiquiatria (Goiânia - GO), and Clínica Animus (Joao Pessoa - PB).

Methods: A total of 212 patients who received ECT at three different Brazilian services were assessed for improvement in symptoms in the first week after treatment and 30 and 60 days after treatment completion.

Results: Safety and efficacy of ECT was well established, as evidenced by the zero mortality rate among the study participants, with side effects observed in only 10.5% of cases. The immediate response rate was impressive at 95.8%, and the response rate after 30 and 60 days was 90.6% and 87.7%, respectively. The regression analysis highlighted session frequency as a key determinant of positive responses.

Conclusion: The effectiveness of short term ECT (two months) is one of the greatest among psychiatric treatments. Future research should focus on predictive models for treatment responses to enable personalized approaches.

Background: Home care is increasingly adopted worldwide to improve patients' quality of life and reduce the burden on hospitals. However, the risk of healthcare-related infections in home settings is a growing concern that necessitates further investigation and preventive measures.

Objectives: We aimed to describe the sociodemographic and clinical profiles of home care patients, determine the incidence and management of healthcare-associated infections at home, and evaluate the risk factors.

Design and setting: This quantitative, observational, analytical, cross-sectional study was conducted in Teresina, PI, Brazil.

Methods: Data were collected from 130 patients receiving home care between April 2016 and September 2020 in the state capital of Northeast Brazil. The data were retrospectively collected from hospital records using a previously validated form and analyzed.

Results: The cohort predominantly comprised men (53.1%), older adults (53.1%), and patients with neurological disorders (61.9%). Healthcare-associated infections were prevalent in 46.2% of home care patients, with respiratory infections being the most common (47.2%). Clinical diagnoses were made in 66.7% of these patients. Patients with female caregivers, with a tracheostomy, using invasive feeding devices for >6 months, and with a greater degree of dependence were more predisposed to infections. Adult patients, those with young adult caregivers, those who received long-term home care, and those who required prolonged tracheostomy were also at increased risk.

Conclusion: This study underscores the home care patient profiles, prevalence of associated infections, and risk factors. Preventive measures and specific interventions are needed to enhance home care quality and reduce the infection risk.

Background: Insulin resistance often occurs in patients with chronic kidney disease (CKD) owing to mineral and bone metabolism disorders. Fibroblast growth factor (FGF)-23 and soluble klotho (s-KL) play crucial roles in linking CKD with mineral and bone metabolism.

Objective: This study aimed to examine the relationship between insulin resistance and FGF-23 and s-KL in patients with non-diabetic pre-dialysis patients with CKD.

Design and setting: This research was conducted in the Ankara Bilkent City Hospital Nephrology Clinic. Ankara,Turkey.

Methods: This study included 133 male and 150 female patients with pre-dialysis CKD. The patients were compared with 80 healthy individuals. FGF-23 and s-KL levels were determined using enzyme-linked immunosorbent assay kits. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to determine insulin resistance.

Results: Creatinine, urine protein/creatinine ratio (UPCR), log10 FGF-23, log 10 s-KL, and HOMA-IR were notably higher, while glomerular filtration rate was notably lower, in patients than in healthy individuals. Stage 5 CKD, log10 FGF-23, creatinine, and UPCR were significantly higher in patients with HOMA-IR > 3.06 compared to those with HOMA-IR ≤ 3.06. No difference was observed in s-KL levels between the two groups. Univariate and multivariate logistic regression analyses revealed an increase in HOMA-IR and log10 FGF-23 values.

Conclusions: Insulin resistance, serum FGF-23, and s-KL levels increased in patients compared with healthy individuals. Higher creatinine, proteinuria, and FGF-23 levels were associated with greater insulin resistance. The study highlighted a significant relationship between insulin resistance and FGF-23.

Background: Although multiple strategies have been suggested for evidence-based practice educational interventions, few studies have focused on the development of abilities for evidence-based practice implementation.

Objective: To explore the effectiveness of evidence-based practice in higher education and understand its teaching methods.

Design and setting: Narrative review was conducted at the Universidade Municipal de São Caetano do Sul, Brazil.

Methods: Narrative review included research studies that measured any type of evidence-based practice teaching method and its effectiveness. Searches included publications from inception to June 2022, conducted on MEDLINE, EMBASE, CINAHL, CENTRAL, ERIC, and the Cochrane Library. Two independent authors descriptively extracted and analyzed the data. The methodological quality of the studies was also analyzed.

Results: The results determined that 79.2% of the studies proved their effectiveness. Teaching methods varied according to the time period, format, and types of questionnaire.

Conclusions: Most studies demonstrated the effectiveness of the chosen teaching methods. This study shows the importance of health professionals using evidence-based practice to ensure effective patient treatment.

Background: Studies have shown an association between the clinical severity of coronavirus disease (COVID-19) and sociodemographic and clinical variables in older adults. However, few studies have described the explanatory factors of the relationship between these variables and the clinical severity of COVID-19 using structural equation modeling.

Objective: To analyze the factors directly and indirectly associated with the clinical severity of coronavirus disease (COVID-19) among older adults in Minas Gerais, Brazil.

Design and setting: Retrospective epidemiological study.

Methods: This study included 51,141 elderly adults with COVID-19 living in Minas Gerais, Brazil. Data were collected through the Individual Registration Form - Hospitalized Cases of Severe Acute Respiratory Syndrome from January 28, 2020, to January 27, 2022.

Results: Older age (P < 0.001), male sex (P < 0.001), dyspnea (P < 0.001), change in chest X-ray examination findings (P < 0.001), greater number of risk factors/comorbidities (P < 0.001), and longer hospitalization time (P < 0.001) were directly associated with the clinical severity of COVID-19. Female sex, mediated by the greater number of risk/comorbidity factors (β = -0.02, P < 0.001), and younger age, mediated by longer hospitalization time (β = -0.01; P < 0.001), were indirectly associated with the clinical severity of COVID-19.

Conclusion: Demographic and clinical variables were directly associated with increased disease severity. In addition to the direct effect, a greater number of risk/comorbidity factors and longer hospitalization time mediated the association between demographic variables and outcomes.