Sao Paulo Medical Journal最新文献

Background: Studies have indicated a substantial increase in alcohol consumption among university students. Specifically, abusive consumption among health students can adversely affect their academic training and future professional practice.

Objective: This study aimed to analyze alcohol consumption habits among healthcare students and investigate the associations between alcohol consumption patterns and sociodemographic and academic variables.

Design and setting: We performed this cross-sectional study at a private university located in the city of Salvador, Bahia.

Methods: We conducted this study with 770 students using a printed, self-administered, anonymous questionnaire containing sociodemographic and academic performance data, as well as the Alcohol Use Disorders Identification Test (AUDIT) and Rutgers Alcohol Problems Inventory (RAPI).

Results: We observed that the prevalence of alcohol consumption (65.1%) and binge drinking (57.5%) among Brazilian healthcare students was high, with more frequent consumption among men (73.1%), in medicine (83.0%) and veterinary medicine (79.1%) programs and in semesters beyond the fourth (71.7%). We found associations between drinking habits and sex (P = 0.016), religion (P < 0.000), course (P < 0.000) and semester (P = 0.047). Binge drinking was associated with attending academic activities without getting any sleep (P < 0.000), missing classes due to hangovers (P < 0.000), encountering issues with the institution's administration (P = 0.028), and failing to complete activities due to alcohol consumption (P < 0.000).

Conclusion: The prevalence of alcohol consumption and binge drinking among Brazilian healthcare students was high and associated with sex, religion, course, academic semester, risky behaviors, and negative academic impacts.

Background: Vaccination hesitation spans from historical diseases such as smallpox to the current challenges with the coronavirus disease (COVID-19). In Brazil, vaccination faces obstacles related to trust and convenience. Despite the National Immunization Program, fear of adverse effects as well as misinformation challenge confidence in vaccines, and anti-vaccine movements have gained momentum.

Objectives: This study investigated childhood vaccine refusal, including COVID-19 vaccines, by comparing the reasons for and sociodemographic differences between vaccinated individuals and those who hesitated or refused immunization.

Design and setting: A cross-sectional study was conducted in São Paulo, Brazil, using questionnaires administered during pediatric consultations between January and April 2023.

Methods: This study investigated vaccine hesitancy and the attitudes of parents and caregivers of children (0-12 years) towards vaccines. The questionnaire was administered during routine pediatric consultations at three different locations, each with 50 participants for a total of 150 participants, to avoid selection bias.

Results: Marked differences were evident among caregivers in terms of sex, race, income, education, and religion, which influenced their attitudes toward vaccination. There was an increase in the refusal of seasonal vaccinations and a significant distrust of the efficacy of the COVID-19 vaccine (52%), with concerns about its side effects. Although most patients did not stop vaccination, significant delays occurred, especially in the clinical setting (58%).

Conclusions: This study emphasizes the importance of childhood health decisions, indicating the need to build trust in vaccines, tailor health policies, and investigate the causes of distrust to promote childhood immunizations.

Background: Accelerated development of atherosclerosis has been observed in renal transplant recipients (RTRs). Angiopoietin-2 (Ang-2) and vascular endothelial growth factor (VEGF) are vascular enzymes that play important roles in vascular development and angiogenesis.

Objective: This study aimed to investigate the relationship between Ang-2 and VEGF and atherosclerosis in RTRs.

Design and setting: This study was conducted at Ankara City Hospital, Turkey.

Methods: This cross-sectional study included 36 (37.5%) female and 60 (62.5%) male RTRs. All findings were compared with those of 70 healthy controls. Ultrasonographic measurements of the carotid artery intima-media thickness (CA-IMT) and renal resistive index (RRI) were used as indicators of atherosclerosis.

Results: Log10 Ang-2, log10 VEGF, CA-IMT, and RRI levels were significantly higher in patients than in healthy controls. No significant differences were detected in CA-IMT and RRI between those with log10 Ang-2 ≥ 3.53 pg/mL and those with < 3.53 pg/mL. No significant differences were detected in CA-IMT and RRI between those with log10 VEGF ≥ 1.98 pg/mL and those with < 1.98 pg/mL. No correlation was detected between log10 Ang-2 and log10 VEGF, CA-IMT, or RRI.

Conclusions: Increased serum angiogenic growth factor levels and increased atherosclerosis development were detected in RTRs compared to healthy individuals. No relationship was observed between angiogenic growth factors and atherosclerosis. This may be due to the decreased synthesis and effect of angiogenic growth factor receptors synthesized from atherosclerotic plaques due to atherosclerosis, which improves after renal transplantation.

Background: The risk of death due to tuberculosis (TB) in Brazil is high and strongly related to living conditions (LC). However, epidemiological studies investigating changes in LC and their impact on TB are lacking.

Objectives: To evaluate the impact of LC on TB mortality in Brazil.

Design and setting: This ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015.

Methods: Data were collected from the Mortality Information System and the Brazilian Institute of Geography and Statistics. The proxy variable used for LC was the Urban Health Index (UHI). Negative binomial regression models were used to estimate the effect of the UHI on TB mortality rate. Attributable risk (AR) was used as an impact measure.

Results: From 2002 to 2015, TB mortality rate decreased by 23.5%, and LC improved. The continuous model analysis resulted in an RR = 0.89 (95%CI = 0.82-0.96), so the AR was -12.3%. The categorized model showed an effect of 0.92 (95%CI = 0.83-0.95) in municipalities with intermediate LC and of 0.83 (95%CI = 0.82-0.91) in those with low LC, representing an AR for TB mortality of -8.7% and -20.5%, respectively.

Conclusions: Improved LC impacted TB mortality, even when adjusted for other determinants. This impact was greater in the strata of low-LC municipalities.

Background: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature.

Objectives: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon.

Design and setting: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016.

Methods: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records.

Results: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity.

Conclusion: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.

Background: Acute kidney failure is a serious consequence of coronavirus disease 2019 (COVID-19).

Objectives: To identify the prevalence of COVID-19, kidney failure, frequency of death, and associated factors in patients receiving intensive care.

Design and setting: Analytical cross-sectional study conducted in the intensive care unit (ICU) of a medium-sized philanthropic general hospital in center-west Minas Gerais.

Methods: Adults and older individuals who underwent real-time polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were evaluated by the nephrology team.

Results: Among the 176 patients, the prevalence of COVID-19 and acute kidney injury (AKI) were 103 (58.5%) and 132 (75%), respectively, and 44 (25%) had chronic kidney disease (CKD) and 16 (15,5%) were positive for SARS-CoV-2. In the Charlson index classification, which estimates the risk of death, a statistically significant difference was identified in the percentages of groups with and without COVID-19 for indices 0, 1, and 2. There was a significant association between kidney disease and ICU mortality (P < 0.05). Patients with CKD had fewer fatal outcomes (13/97, 13.4%) than those with AKI (85/97, 87.6%).

Conclusions: COVID-19 rates remained high long after diagnosis and prevention of SARS-CoV-2 infection. In addition, a higher death rate among patients who developed AKI, whose prevalence was also greater than that in the national literature, regardless of the presence of COVID-19, revealed a worrying scenario and corroborated the need for early and judicious approaches to preserve the lives of patients with AKI admitted to intensive care units.

Background: Smoking and unhealthy diet are important risk factors for cardiovascular and metabolic diseases, contributing to public health crises.

Objective: To evaluate the consumption of natural/minimally processed and ultra-processed foods by Brazilian adults (18-59 years old) according to smoking status.

Design and setting: Cross-sectional study of a representative population sample from 26 state capitals and the Federal District (Brazil-2018).

Methods: Data were obtained from Vigitel-Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey. Participants were categorized as smokers, ex-smokers, and never smokers. Multinomial logistic regression was used for analyses.

Results: Of the 30,800 adults evaluated, 9.4% (95%CI: 8.7-10.2) were smokers and 16.5% (95%CI: 15.8-17.3) were ex-smokers. Smokers were less likely to consume fruit and natural juice, and more likely to consume soda or artificial juice (≥ 5 days/week) than ex-smokers and never smokers. Regarding the daily frequency of consumption, smokers were observed to be less likely to eat fruit more than 1 time/day and more likely to drink ≥ 3 cups/cans of soda/day. Compared to never smokers, smokers had a 42% higher chance of consuming ≥ 3 glasses of natural juice/day. On the day before the interview, fruit, milk, tubers, squash, and okra consumption were lower among smokers than non-smokers. Smokers were more likely to report consuming soft drinks, fruit juice, sauces, ready-made dishes, margarine, and sausages.

Conclusion: Smokers had lower fruit consumption, and higher consumption of natural juices and ultra-processed foods. We highlight the need for strategies that encourage healthy eating and smoking cessation.

Background: Embolization is a promising treatment strategy for cerebral arteriovenous malformations (AVMs). However, consensus regarding the main complications or long-term outcomes of embolization in AVMs remains lacking.

Objective: To characterize the most prevalent complications and long-term outcomes in patients with AVM undergoing therapeutic embolization.

Design and setting: This systematic review was conducted at the Federal University of Alagoas, Arapiraca, Brazil.

Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data were obtained from MEDLINE, PubMed, LILACS, and SciELO databases, which included the epidemiological profile of the population, characteristics of the proposed therapy, complications (hemorrhagic events and neurological deficits), and long-term outcomes (modified Rankin scale pre- and post-treatment, AVM recanalization, complete obliteration, and deaths).

Results: Overall, the analysis included 34 articles (2,799 patients). Grade III Spetzler-Martin AVMs were observed in 34.2% of cases. Notably, 39.3% of patients underwent embolization combined with radiosurgery. The most frequently reported long-term complication was hemorrhage, which occurred in 8.7% of patients at a mean follow-up period of 58.6 months. Further, 6.3% of patients exhibited neurological deficits after an average of 34.7 months. Complete obliteration was achieved in 51.4% of the cases after a mean period of 36 months. Recanalization of AVMs was observed in 3.5% of patients. Long-term death occurred in 4.0% of patients.

Conclusion: Embolization of AVMs is an increasingly safe strategy with low long-term complications and satisfactory outcomes, especially in patients who have undergone combination therapies.

Systematic review registration: https://www.crd.york.ac.uk/prospero/ Registration number CRD42020204867.