Sao Paulo Medical Journal最新文献

Background: Chronic kidney disease (CKD) presents challenges to human health and quality of life, with care primarily focusing on renal function and comorbidity management. Several studies confirm the relationship between oral and systemic conditions of patients. Therefore, CKD and periodontal disease can be related because they are both inflammatory conditions that further increase the risk of other pathologies. The impact of CKD on oral health and overall quality of life is an area of interest.

Objectives: To evaluate patients with CKD undergoing renal replacement therapy regarding the levels of self-perception of oral health and quality of life.

Design setting: This case-control study was conducted jointly at the Universidade de Passo Fundo and Hospital São Vicente de Paulo, Brazil.

Methods: This study included two patient groups: 1) Case group with CKD (CGA) comprising 116 patients; 2) Control group without CKD (CGO) composed of 124 patients. We used a structured questionnaire and the Oral Health Impact Profile (OHIP-14). We used the Chi-square and Wilcoxon-Mann-Whitney tests as well as an analysis of variance measure (P < 0.05).

Results: The systemic diseases most prevalent among our patient cohort included hypertension (16.9% CGO and 75.9% CGA) and diabetes mellitus (8.9% CGO and 38.8% CGA). The systemic health perception was good in 66.9% of the CGO group and average in 42.2% of CGA group members. Oral health perception was good in 46% of CGO and 50% of CGA group members. Results of the self-assessment for quality of life showed a statistically significant difference between the groups for physical domain, physical disability, and social disadvantage. A comparison between the control and case (CKD) groups, based on the OHIP-14 score, showed statistically significant differences in the functionality (P < 0.006), physical disability (P < 0.042), and social disadvantage (P < 0.031) domains for the CKD group.

Conclusion: Patients with CKD have lower rates of self-perception of oral health and quality of life than individuals without CKD.

Background: The prevalence of obesity has increased considerably worldwide, and it has become an important risk factor for chronic non-communicable diseases.

Bjective: To translate, cross-culturally adapt, and validate the Weight Management Questionnaire (WMQ) to evaluate weight control practices for health monitoring and intervention in Brazil.

Design and setting: This was a quantitative cross-sectional study.

Methods: Obese and physically active lean individuals aged 18-59 years were included in this study. The tool used as an adaptation was the WMQ. The cross-cultural adaptation was conducted in five phases. For structural validity, confirmatory factor analysis (CFA) was used to verify the internal structure considering two domains: diet and physical activity. To determine construct validity, a comparison was performed between different groups (lean versus obese). Reliability was assessed using the intraclass correlation coefficient (ICC).

Results: The short version of the WMQ after CFA presented eight items. Thus, the structure with two domains presented adequate fit indices: chi-square/degree of freedom = 1.66, comparative fit index = 0.996, Tucker-Lewis index = 0.994, root mean square error of approximation = 0.057, and standardized root mean square residual = 0.047. For construct validity, a significant difference was observed between the groups (P < 0.05) in both domains. We observed adequate reliability for both domains (ICC ≥ 0.854).

Conclusions: The WMQ can be used for the Brazilian population, as it is reliable and has adequate internal structure, supporting its use in future research.

Background: People with Autism Spectrum Disorder (ASD) experience phases of life beyond childhood, which increase the difficulties inherent in each cycle. In contrast, the scientific literature lacks broad reviews of developmental strategies regarding quality of life, even though ASD encompasses changes in social, communicative, and behavioral skills.

Objective: This study aimed to identify strategies for promoting and maintaining quality of life among adults diagnosed with autism.

Design and setting: This integrative review was conducted in Brazil.

Methods: This review searched the Scopus and Web of Science databases, from strategies that combined the descriptors ("Autism Spectrum Disorder"), ("Autism"), ("Aging"), and ("Quality of life"). Original studies with the full text available in English published between 2018 and 2023 were included, if they responded to the eligibility criteria.

Results: In total, 3,098 studies were identified, of which 44 were selected to compose the bibliographic sample of this review. The population sample included 184,653 participants diagnosed with ASD, aged on average 43.5 years old. The following were described for adults with autism: 1) cognitive aspects, 2) aspects related to suffering/mental illness, and 3) strategies to promote quality of life.

Conclusion: This research contributes to basic clinical practice and promotes responsible care that attends to the health needs of people with autism throughout life. Early interventions in autistic adults and the availability of support throughout life are essential for maintaining cognitive health and quality of life.

Background: Investigating the frequency and characteristics of iron overload cases with HFE gene mutation is crucial, given the population-level risks associated with excessive iron.

Objective: To determine the frequency of HFE mutations in patients with iron overload in Santa Catarina, Brazil.

Design and setting: A cross-sectional study of patients with iron overload at the Ambulatory Department of the Centro de Hematologia e Hemoterapia de Santa Catarina (Hemorrede-HEMOSC) in Santa Catarina.

Methods: HFE genotype frequencies were determined, and a division were made between carriers of HFE -C282Y/C282Y mutations and carriers of other HFE-non-C282Y/C282Y mutations, according to each region of Santa Catarina. Binary logistic regression was used for association between sex and age with genetic mutation trait.

Results: Among the 1,022 patients, 10.4% had secondary hemochromatosis, and 89.6% were evaluated for iron overload due to hereditary hemochromatosis (HH). Of these, 367 underwent genetic testing, which revealed HFE mutations in 77.3%. Most patients with HFE mutations had non-C282Y/C282Y-hemochromatosis, especially H63D/WT (> 39%), regardless of the Santa Catarina region. The frequency of C282Y/C282Y was higher in the West (20.9%) and North (28.3%) regions. Adjusted association analysis showed that men have an increased chance of hemochromatosis when involving 'non-C282Y/C282Y' mutations (OR: 2.77; 95% CI: 1.60-6.608).

Conclusions: The data show the magnitude and characteristics of iron overload cases with HFE mutations in Santa Catarina. As most patients referred for treatment have H63D mutation, we suggest further studies to assess whether other factors, including dietary habits and mandatory iron fortification policies, contribute to iron overload or HH manifestation.

Background: Severe heart disease has high prevalence, morbidity, and mortality rates.Heart stimulation is important in the final stages of heart disease. The concentration of procedures in a service allows for the epidemiological analysis of our population.

Objective: To analyze the epidemiological profile of severe heart disease in Rio Grande do Norte by registering all patients undergoing artificial cardiac stimulation (ACS) in a Unified Health System reference service in Rio Grande do Norte.

Design and setting: This cross-sectional study included all patients who underwent ACS procedures at the Hospital Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), from 2006 to 2021. Sociodemographic characteristics, procedures, and health conditions were examined. Additionally, a spatial analysis of casuistry was performed according to the municipality of origin.

Methods: This cross-sectional study analyzed data derived from patients treated at Hospital Onofre Lopes, UFRN, from 2006 to 2021, including sociodemographic characteristics, procedures, and health conditions.

Results: A total of 894 patients (male, 59.8%; mean age: 65.5 years) were included. Third-degree atrioven tricular block was indicated in 191 patients, an ischemic etiology was found in 269 patients, whereas dyspnea was reported by 398 patients. Furthermore, 69.5%, 24.4%, and 31.7% of patients had hypertension, diabetes, and dyslipidemia, respectively. Spatial analysis showed no significant differences in the formation of clusters.

Conclusions: The characteristics of the service contributed to possible differences in the literature. The spatial distribution of severe heart disease was random in the state, indicating an adequate distribution of reference services even in the absence of a defined flowchart for such services.

Objective: To assess the Functional Index Questionnaire (FIQ) structure using confirmatory factor analysis (CFA) in Brazilian patients with anterior knee pain.

Methods: Brazilian patients of both sexes (n = 100), aged ≥ 18 years, with anterior knee pain for at least 3 months were included. Eligible participants completed an online form that collected personal and clinical data as well as responses to the assessment tools. We used CFA and the following fit indices: chi-square/degrees of freedom (DF), comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residuals (SRMR).

Results: The majority of the respondents were women, young adults, overweight, with incomplete higher education, were physically active, and had pain in sitting or squatting positions. The mean duration of pain was 38.24 months, and the mean pain intensity was 4.54 points. The model fit indices were as follows: χ2/DF = 2.08, TLI = 0.978, CFI = 0.969, RMSEA = 0.104, and SRMR = 0.077. Therefore, the one-dimensional structure with eight items yielded an RMSEA value above the 0.08 cutoff point, suggesting a poorer fit and more residual error than is acceptable for a well-fitting model. Using the modification indices within the CFA, we observed a correlation between Items 2 (climbing up two flights of stairs [16 steps]) and 6 (climbing up four flights of stairs [32 steps]) and Items 3 (squatting) and 4 (kneeling), indicating the similarity in the response pattern for these items. After adding these correlations to the model, we obtained improved fit indices (χ2/DF = 1.51, TLI = 0.990, CFI = 0.985, RMSEA = 0.072, and SRMR = 0.061).

Conclusion: This version of the FIQ should be used with caution, as the unidimensional model demonstrates substantial residuals, mainly because of item redundancy.

Background: The mismatch between the supply and demand for organs and tissues for transplantation is one of the reasons for the high rates of donation refusal. A more recent contributing factor has been the COVID-19 pandemic.

Objectives: To analyze, through the Terms of Donation of Organs and Tissues, the rates and trends of specific refusals for each organ and tissue from brain-dead donors between 2001 and 2020 in an Organ Procurement Organization.

Design and setting: This was a cross-sectional, exploratory, and retrospective quantitative study on specific donation refusals conducted in one of the ten Organ Procurement Organizations in São Paulo, Brazil.

Methods: The variables collected included year, age, gender, cause of death, type of hospital, and organs and tissues donated and refused. The data were transferred to Stata software for descriptive and inferential analysis, using generalized linear regression to examine time trends. A significance level of P lt; 0.05 was adopted.

Results: Bones and skin had the highest rates of tissue donation refusal, at 56.40% and 55.37%, respectively. Among solid organs, the pancreas (4.05%) and lungs (5.23%) had the highest refusal rates. In the first decade analyzed, there were increasing time trends in refusals of valves, heart, pancreas, and lungs. In contrast, during the second decade, refusals of valves, kidneys, and pancreas showed decreasing trends. In 2020, the number of refusals for all tissues declined.

Conclusion: To reduce tissue-specific refusals, it is important to address and mitigate family beliefs, myths, and negative attitudes toward organ and tissue donation.

Background: Physical activity (PA) and sedentary behavior (SB) are key determinants of health outcomes in individuals living with type 1 diabetes (T1D). However, the influence of sociodemographic and clinical factors on engagement in these behaviors is not yet well understood.

Objective: This study aimed to analyze the associations of sociodemographic factors, body mass index, and both the duration and age at diagnosis of diabetes with SB, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) in Brazilian adults.

Design and setting: A cross-sectional study was conducted at the Diabetes and Metabolism Service of a public secondary care unit in Rio de Janeiro.

Methods: One hundred adults diagnosed with T1D had their daily awake time spent in SB, LPA, and MVPA measured using triaxial accelerometers. Sociodemographic and clinical factors were assessed using questionnaires. Generalized Linear Models were used to analyze the relationships of these factors with SB, LPA, and MVPA.

Results: Significant associations were found between age, education level, and employment status with SB and LPA, but not with MVPA. On average, each additional year of age was associated with decreased time in SB and increased time in LPA. Higher education levels and unemployment were linked to more SB and less time in LPA.

Conclusions: Age, education level, and employment status emerged as key sociodemographic predictors of SB and LPA in Brazilian adults living with T1D. These findings contribute to a better understanding of the sociodemographic determinants associated with SB and PA in individuals diagnosed with T1D.