Sao Paulo Medical Journal最新文献

Background: Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use.

Objectives: Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption.

Design and setting: A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020.

Methods: Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9.

Results: Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns.

Conclusion: The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

Background: Dynapenia is a risk factor of mortality. Therefore, the development of low-cost and easy-to-apply tools is essential to optimize the health surveillance actions of older people.

Objectives: To compare the time spent on habitual physical activity (HPA) and sedentary behavior (SB) among dynapenic and non-dynapenic older adults and ascertain the predictive ability of these behaviors on outcome.

Design and setting: A cross-sectional population epidemiological survey was conducted involving 208 older adults.

Methods: HPA and SB were quantified using the International Physical Activity Questionnaire, and dynapenia was identified by handgrip strength (women: 18.37 kgf; men: 26.75 kgf).

Results: The prevalence was 24.50%. In both sexes, dynapenic individuals reported a HPA median time of 70.00 minutes/week (min/wk), while non-dynapenic women and men reported HPA median times of 240.00 and 280.00 min/wk, respectively (P < 0.05). For SB among dynapenic individuals, a median of 388.75 min/day was observed in women and 428.57 min/d in men. In contrast, non-dynapenic women and men had 291.42 and 274.28 min/day in SB (P < 0.05), respectively. The best cutoff HPA to discriminate the outcome was 150.00 min/wk in women (sensitivity: 73.30%; specificity: 60.67%) and 140.00 min/wk in men (sensitivity, 71.43%; specificity, 61.54%). The best cutoff SB was 381.43 min/day in women (sensitivity, 53.30%; specificity, 84.80%) and 351.43 min/day in men (sensitivity, 71.43%; specificity, 73.85%).

Conclusion: Older individuals with dynapenia spent less time on HPA and more time in SB. Furthermore, HPA was found to be a better discriminator of dynapenic individuals, and SB better discriminated non-dynapenic individuals.

Background: Managing cervical intraepithelial neoplasia grade 2 (CIN2) is challenging, considering the CIN2 regression rate, perinatal risks associated with excisional procedures, and insufficient well-established risk factors to predict progression.

Objectives: To determine the ability of p16INK4a and Ki-67 staining in biopsies diagnosed with CIN2 to identify patients with higher-grade lesions (CIN3 or carcinoma).

Design and setting: Cross-sectional study conducted at a referral center for treating uterine cervical lesions.

Methods: In 79 women, we analyzed the correlation of p16INK4a and Ki-67 expression in CIN2 biopsies with the presence of a higher-grade lesions, as determined via histopathology in surgical specimens from treated women or via two colposcopies and two cytological tests during follow-up for untreated women with at least a 6-month interval. The expression of these two biomarkers was verified by at least two independent pathologists and quantified using digital algorithms.

Results: Thirteen (16.8%) women with CIN2 biopsy exhibited higher-grade lesions on the surgical excision specimen or during follow-up. p16INK4a expression positively and negatively predicted the presence of higher-grade lesions in 17.19% and 86.67% patients, respectively. Ki-67 expression positively and negatively predicted the presence of higher-grade lesions in 40% and 88.24% patients, respectively.

Conclusions: Negative p16INK4a and Ki67 immunohistochemical staining can assure absence of a higher-grade lesion in more than 85% of patients with CIN2 biopsies and can be used to prevent overtreatment of these patients. Positive IHC staining for p16INK4a and Ki-67 did not predict CIN3 in patients with CIN2 biopsies.

Background: The identification and understanding of dietary factors and other characteristics that influence gestational weight gain can contribute to the formulation of strategies to promote healthy eating habits before and during pregnancy.

Objective: To investigate the association between dietary patterns, sociodemographic and obstetric characteristics, and health-related behaviors in pregnant women.

Design and setting: A cross-sectional study was conducted on women undergoing prenatal care in the Unified Health System of Colombo, Paraná, Brazil, from February 2018 to September 2019.

Method: A weekly food frequency questionnaire was administered, and dietary patterns were identified through factor analysis. Median regression models were constructed to identify the associations between dietary pattern scores and variables.

Results: Complete data were obtained from 495 pregnant women. Three dietary patterns were identified: 1) "healthy," with higher factor loadings for the weekly consumption of raw vegetables, cooked vegetables, and fresh fruits; 2) "Western," including soft drinks or artificial juice, candies, milk, and dairy products, and processed cold meat; and 3) "traditional," beans and meat. Pregnant women aged 30 years or older (coefficient [Coef.] 0.86, 95% confidence interval [CI] 0.38-1.33) with moderate/intense physical activity (Coef. 0.32, 95% CI 0.02-0.62) had higher adherence to the "healthy" pattern. Adolescents and smokers adhered more to the "traditional" pattern (Coef. 0.17, 95% CI 0.01-0.33).

Conclusion: Age, smoking status, and physical activity were associated with dietary patterns in pregnant women.

Background: Down syndrome (DS) is a non-rare genetic condition that affects approximately 1 in every 800 live births worldwide. Further, it is associated with comorbidities, anatomical alterations of the respiratory tract, and immunological dysfunctions that make individuals more susceptible to respiratory infections.

Objective: To systematize the current scientific knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among individuals with DS.

Design and setting: This integrative review was conducted at the Universidade Federal de São Carlos, São Paulo, Brazil.

Methods: This review was conducted in the following databases: the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), PubMed, and Web of Science, using MeSH descriptors. The search included English or Portuguese studies published between January 1, 2020, and October 14, 2022.

Results: A total of 55 articles from 24 countries were selected, comprising 21 case-control or cohort studies, 23 case reports or series, and 11 narrative reviews or opinion studies. The articles were grouped into five categories: previous comorbidities, coronavirus disease 2019 (COVID-19) clinical features and evolution, cytokine storm and interleukins, living in institutions as a risk factor, and behavioral actions as a protective factor against SARS-CoV-2 infection.

Conclusion: Individuals with DS are more susceptible to COVID-19 infection due to variables such as previous comorbidities, immunological factors, and their habitable environments. These aspects confer a higher risk of infection and an unfavorable clinical course. The precise pathways involved in the pathophysiology of COVID-19 in individuals with DS are not clear, thus requiring further studies.

Systematic review registration: The Open Science Framework registered the research protocol (https://osf.io/jyb97/).

Background: A bibliometric analysis covering only the production of original studies or considering world production until 2022 has yet to be conducted. The creation and advancement of vaccines have also influenced research priorities, demonstrating the need for a new approach to this subject.

Objectives: To analyze worldwide scientific production related to coronavirus disease 2019 (COVID-19) and the aged and to describe what has already been produced.

Design and setting: Bibliometric analysis with a quantitative approach.

Method: The search terms "COVID-19," "SARS-CoV-2," "Aged," and "Elderly" were used to retrieve articles from the Web of Science database. A total of 684 articles were included in the analysis. Data were imported into RStudio Desktop Software and linked to R Software. The Bibliometrix R package and VOSviewer software were used for analysis.

Results: Most articles were published in 2020. These were produced by 4,937 authors and published in 379 journals. The keyword most used by the authors was "COVID-19." Publications from 77 countries were obtained. China had the highest article production ranking, and Spain collaborated the most. The articles addressed the implications of the pandemic on the aged, the relationship between vaccination in the aged, and the implications for the disease itself.

Conclusion: Further research should be conducted, mainly concerning vaccines and vaccination of the aged, owing to the need for and importance of immunization in this risk group, including assessing the long-term effects of vaccines.

Background: Nutritional status and growth curves can affect cognitive development, increase the risk of infection, and contribute to the development of chronic diseases. Its etiology is related to food, socioeconomic, and maternal conditions. However, to date, no data on these parameters exist in the state of Goiás, Brazil.

Objective: To compare the nutritional status and growth curves of children and adolescents in the city of Goiânia, Goiás, Brazil.

Design and setting: This was a cross-sectional study. A total of 529 individuals were recruited from a primary health center in the municipality.

Methods: To assess nutritional status, the sample was divided into three categories: 3-4, 5-10, and 11-19 years, with z-score classification considering body mass index for age. The classification of growth curves was performed considering the median height values for age, assuming two references: (a) young Brazilian population and (b) one recommended for international use. The independent sample T-test was used to compare anthropometric variables.

Results: The results showed that the classification of eutrophics represents a predominant percentage between both sexes (men: 03-04 = 55.4%; 05-10 = 57.6%; 11-19 = 53.5 % and women: 03-04 = 53.5%; 05-10 = 63.9%; 11-19 = 56.9%), and growth curves showed differences in specific periods in both sexes.

Conclusions: It can be concluded that children and adolescents from the city of Goiânia present as predominance the eutrophic nutritional status, followed by the risk of overweight, underweight, obesity, and malnutrition of both sexes.

Background: Precisely determining the aspects related to an instrument's validity and reliability measures allows for greater assurance of the quality of the results.

Objectives: To analyze the psychometric properties of The Providers Survey in the Brazilian context of mental health services.

Design and setting: The instrument validation study was conducted in Montes Claros, Minas Gerais, Brazil.

Methods: The validation study was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist to analyze its validity and reliability.

Results: A committee of expert judges performed content validation after which the Content Validity Index was calculated. Construct validation took place through Exploratory Factor Analysis using the Kaiser-Meyer-Olkin Test criterion and Bartlett's Sphericity Test. Reliability was verified using test-retest reliability. The significance level adopted for the statistical tests was 5% (P < 0.05). The final instrument comprised 54 questions. The Content Validity Index was 97%. Exploratory Factor Analysis identified a Kaiser-Meyer-Olkin index of 0.901 and Bartlett's Sphericity Test with P < 0.001. We obtained a Cronbach's alpha coefficient of 0.95 and an intraclass correlation coefficient of 0.849.

Conclusions: The Providers Survey, translated and adapted into Portuguese, was named the Work Assessment Instrument for the Recovery of Mental Health. It presented adequate psychometric properties for evaluating work-related practices for the recovery of psychosocial care network users.

Background: There is a lack of studies evaluating the oral health of traditional indigenous communities in Brazil.

Objectives: Thus, the objective of this study was to describe the oral health characteristics of the indigenous Fulni-ô ethnic group in Northeast Brazil.

Design and setting: A cross-sectional observational investigation was conducted within the Project on Atherosclerosis among Indigenous Populations.

Methods: This study included participants of both sexes from the Fulni-ô ethnic group. The participants included in this investigation underwent a comprehensive oral health evaluation by a registered and experienced dentist to assess oral health and identify potentially malignant oral lesions. Participants with suspicious lesions were referred for biopsy. Shapiro-Wilk, Mann-Whitney, and Student's t-tests were used, and measures of central tendency and dispersion were described. Statistical significance was 5%.

Results: A total of 104 individuals were included in this study. The prevalence of the use of tobacco derivatives was 94.0%, with similarities between sexes. The prevalence of oral changes in this study population was 84.4%. Fifty-one individuals who underwent oral reassessment were referred for oral lesion biopsy.

Conclusions: This study demonstrated a high prevalence of oral alterations in the Fulni-ô population. Histopathological analyses indicated the presence of mild oral epithelial dysplasia in five cases.