Profile of dermatological consultations in Brazil (2018)

Background: Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. Objectives: To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. Methods: The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. Results: Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. Study limitations: Nonrandomized survey, with a sample period of one week. Conclusion: This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health

Cartografia e diplomacia: usos geopolíticos da informação toponímica (1750-1850)

O artigo explora dimensões geopolíticas da toponímia, registradas em documentos cartográficos, desde as reformas empreendidas pelo consulado pombalino em meados do século XVIII, até às primeiras décadas do século XIX, em meio ao processo de afirmação do Estado imperial pós-colonial.This paper explores the geopolitical dimensions of toponymy as registered in cartographic documents dating from the reforms pushed through by the consulate of Marquis of Pombal in the mid 18th century to the early decades of the 19th century, as the post-colonial imperial State established itself

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Characteristics and variability of the atmospheric water balance in the Amazon Basin

The water balance of the Amazon basin is of great importance, due to the presence of the world’s largest hydrographic system. Hence, there is a concern that large-scale land use changes may change significantly the flow regimes of rivers within the region and the land-atmosphere exchange of moisture, as well as the moisture fluxes from the basin to other regions of South America. This paper describes a research effort to estimate the atmospheric water balance of the Amazon basin, as a whole and by regions, using the NCEP reanalysis, and the network of river and rainfall data in the region. Quantifications are made for the near-surface moisture input from the North Atlantic into the Northern Amazon, from the Northern Amazon into the southern part of the basin, and from the basin to adjacent regions outside the basin, such as central and Southern Brazil-Northern Argentina-Southern Brazil. Preliminary results indicate the presence of decadal variability in rainfall and moisture transport especially in the northern parts of the basin, the effects of ENSO, and a long-term trend that seems to be due to both natural and human induced climate variabilityPages: 597-60

Ser agente comunitário de saúde: motivação e significado

This study aims at characterizing the profile of the Community Health Agent (in Portuguese ACS) working in Health Centers at the municipality of Marilia-SP. It intends also to analyze the motivations and meanings of being an ACS. The quantitative data were studied descriptively whereas the qualitative results were summarized by content analysis. ACSs were predominantly of the female sex and were in average 32. 5 years old. Most of them had finished high school and had been working as Community Health Agents for an average 27 month. Unemployment, the search for a different work area and the desire to help others were pointed out as reasons for becoming an ACS. For them being an ACS means to develop links with the community, to be able to talk, to help, to guide and to encourage their autonomy as well as to offer assistance to the community. In conclusion, it is necessary to better define and improve the ACS’s responsibilities.El presente estudio propone caracterizar el perfil de los Agentes Comunitarios de Salud (ACS) de las unidades de atención básica a la salud del municipio de Marília-SP y analizar los motivos y el significado de ser ACS. Los datos cuantitativos se enfocaron de forma descriptiva, por medio del análisis univariado. En el análisis de datos cualitativos se empleó el referente de análisis del contenido. Predominaban las mujeres con edad promedio de 32,5 años, la mayoría con enseñanza secundaria que trabajaba en esa tarea durante un promedio de 27 meses. El desempleo, la búsqueda de otro campo de trabajo y el anhelo de ayudar el prójimo constituían los motivos que las impulsaban a ser ACS. En cuanto al significado se constato la interlocución y el vínculo, la posibilidad de ayuda, la orientación y el estímulo a la autonomía, además de acciones asistencialistas. Se concluye que habría que definir y perfeccionar las atribuciones de los ACS.Neste estudo, propõe-se caracterizar o perfil dos agentes comunitários de saúde (ACSs) das unidades de atenção básica à saúde do município de Marília-SP e analisar os motivos e o significado de ser ACS. Os dados quantitativos foram abordados de forma descritiva e para a análise dos dados qualitativos foi utilizado o referencial de análise de conteúdo. Houve predomínio de mulheres; a média de idade foi de 32,5 anos; a maioria tem ensino médio completo e atua na função, em média, por 27 meses. O desemprego, a busca de outra área para atuação e o desejo de ajudar o outro foram os motivos de se tornarem ACSs. Quanto ao significado, constatou-se a interlocução e o vínculo, a possibilidade de ajuda, a orientação e o estímulo à autonomia, além de ações assistencialistas. Conclui-se que há necessidade de que as atribuições do ACS sejam definidas e aprimoradas

The meaning of home visits conducted by medicine and nursing students: a qualitative study with users of family health units

Submitted by Santos Bárbara ([email protected]) on 2015-01-09T11:49:24Z No. of bitstreams: 1 O sentido da visita domiciliária realizada por estudantes de medicina e enfermagem um estudo qualitativo com usuários.pdf: 183173 bytes, checksum: 188804bf68189e2569d7c8815cfa2834 (MD5)Approved for entry into archive by Santos Bárbara ([email protected]) on 2015-01-09T12:07:26Z (GMT) No. of bitstreams: 1 O sentido da visita domiciliária realizada por estudantes de medicina e enfermagem um estudo qualitativo com usuários.pdf: 183173 bytes, checksum: 188804bf68189e2569d7c8815cfa2834 (MD5)Approved for entry into archive by Santos Bárbara ([email protected]) on 2015-01-09T12:30:51Z (GMT) No. of bitstreams: 1 O sentido da visita domiciliária realizada por estudantes de medicina e enfermagem um estudo qualitativo com usuários.pdf: 183173 bytes, checksum: 188804bf68189e2569d7c8815cfa2834 (MD5)Made available in DSpace on 2015-01-09T12:30:51Z (GMT). No. of bitstreams: 1 O sentido da visita domiciliária realizada por estudantes de medicina e enfermagem um estudo qualitativo com usuários.pdf: 183173 bytes, checksum: 188804bf68189e2569d7c8815cfa2834 (MD5) Previous issue date: 2011Faculdade de Medicina de Marília. Disciplina de Enfermagem em Saúde Coletiva. Marília, SP, Brasil.Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Faculdade de Medicina de Marília. Disciplina de Saúde Mental. Marília, SP, Brasil.Faculdade de Medicina de Marília. Disciplina de Bioética. Marília, SP, Brasil.Faculdade de Medicina de Marília. Disciplina de Enfermagem Pediátrica. Marília, SP, Brasil.Faculdade de Medicina de Marília. Disciplina de Saúde Mental. Marília, SP, Brasil.Faculdade de Medicina de Marília. Disciplina de Clínica Médica. Marília, SP, Brasil.A visita domiciliária (VD) é considera-da uma importante tecnologia para a compreen-são e para o cuidado às necessidades de saúde da população. Decorre daí a demanda de sua prática nos processos de formação de profissionais da saú-de. Este estudo se propõe a analisar a ótica dos usuários de unidades de saúde da família sobre as VDs realizadas por estudantes das séries iniciais de medicina e de enfermagem. Trata-se de um es-tudo de abordagem qualitativa, que utiliza, para coleta de dados, a entrevista semiestruturada rea-lizada com usuários que receberam visitas dos es-tudantes de Enfermagem e de Medicina da Facul-dade de Medicina de Marília. Para análise dos dados utiliza-se o método de interpretação de sen-tidos baseado na perspectiva hermenêutico-dia-lética. Os usuários apontam como positivo o fato de que a atuação dos estudantes vai além do cui-dado com um corpo biológico, evidenciando a im-portância das relações interpessoais no contexto da atenção à saúde. Como limitação da VD, os usuários indicam a necessidade de sua maior or-ganização e planejamento. Depreende-se que a VD amplia a interatividade entre o serviço de saúde e o usuário e se desenvolve conforme os princípios da humanização. No entanto, deve-se atentar à importância de um contínuo aperfeiçoamento no planejamento e na implementação das visitas domiciliárias.Home visits (HVs) are considered an important technology to comprehend and care for the population’s health requirements. There-fore, they must be a part of the health profession-als’ education. This study seeks to analyze HVs performed by first-year medical and nursing stu-dents from the viewpoint of family health unit users. It is a qualitative study in which data are collected by means of semi-structured interviews with users who are visited by Marilia Medical School medical and nursing students. The inter-pretation of meaning method is used and is based on a hermeneutic-dialectic perspective. The us-ers find it positive that the students go beyond the biological care of the body and focus on interper-sonal interrelationships. Nevertheless, the users believe it is necessary to organize and plan HVs accordingly. It may thus be inferred that HVs elicit the interaction between humanized healthcare and its users. Planning and reinforcement of health actions must be continuously improved when planning and conducting home visits

Caracteristicas climatologicas sobre a America do Sul nos resultados de uma simulacao de 10 anos com o MCGA CPTEC/COLA na versao T62L28

Seasonal climatological features over South America are analyzed in a long-range ensemble simulation using the CPTEC/COLA AGCM with resolution T62L28. Nine initial conditions are used and observed monthly Sea Surface Temperature are applied as boundary conditions. Although the model is able to simulate the seasonal variability of precipitation there are some errors in areas with strong convection. Tropical and subtropical convergence zones are identified in the precipitation analyses. The main features of wind field and geopotential are well represented, such as the Bolivian High and the Atlantic Trough in the summer and high geopotencial close to South America in the winter, related to blocking situation.Pages: 3552-355