Olavo Franco Ferreira Filho

Epidemiological profile of cocaine users on treatment in psychiatrics hospitals, Brazil

OBJECTIVE To describe the epidemiological profile and patterns of cocaine use among hospitalized drug users. METHODS A cross-sectional study was carried out among drug users, aged 18 years or more, hospitalized in one out six selected psychiatric hospitals in the metropolitan area of Greater S o Paulo, whose clinical conditions allowed them to reliably answer to a standardized questionnaire and who agreed to participate. Six psychiatric hospitals who attended spontaneously referred public and private patients from all Greater S o Paulo were selected. Data collection was conducted using structured interviews, individually applied by a trained psychologist. Statistical analysis was performed using Student t-test and Chi-square test at p<0.05. RESULTS There was a predominance of crack use (38.4%) over intravenous drug use (1.6%). Addicts who smoked cocaine had lower education, most were unemployed and had previously lived on the streets, and used higher amounts of drugs. These addicts also had been previously incarcerated more often than addicts who used other routes for drug administration. CONCLUSIONS Drug use is a serious public health problem in Greater S o Paulo, and this is shown by the great amount of hospital admissions due to drug addiction. Crack users have lower socioeconomic status and more often engage in violence and crimes.

Genetic diversity and HIV-1 incidence estimation among cocaine users in Sao Paulo Brazil.

Summary: We describe HIV‐1 incidence and the prevalence of genetic subtypes among cocaine users in São Paulo, Brazil. A cross‐sectional HIV‐1 survey was carried out among 839 current cocaine users attending seven drug treatment units in the São Paulo metropolitan area from 1997 to 1998. HIV‐1 subtyping was performed among 41 positive individuals using the heteroduplex mobility assay and DNA sequencing. Participants were mainly male (95.7%) with a history of previous imprisonment (54%), and the mean age was 26.9 years (SD = 7.2). The majority (64.4%) were current crack cocaine users, and 82.1% of the total participants were noninjectors. HIV‐1 seroprevalence was 4.9% (95% confidence interval [CI], 3.6%‐6.6%), and the incidence (estimated by the sensitive/less‐sensitive immunoassay testing strategy) was 0.71% per year (95% CI, 0.07‐3.03). HIV‐1 subtype B was predominant (90.3%), followed by subtype F. There was no statistically significant association between HIV‐1 subtype and specific route of drug administration. Our incidence data show evidence of recent HIV‐1 transmission among cocaine users, mainly among noninjectors. Detection of recently infected HIV‐1 cases linked to genetic diversity analysis may provide baseline information for public health interventions in this sentinel group.

Redução do número de internações hospitalares por asma após a implantação de programa multiprofissional de controle da asma na cidade de Londrina

OBJECTIVE To evaluate the relationship between the reduction in the number of asthma-related hospital admissions and the changes occurring after the intervention performed in the health care system of the city of Londrina, Brazil. METHODS In 2003, an intervention was performed in the local health care system (Family Health Clinics). The steps adopted were as follows: development of a protocol based on the III Brazilian Consensus on Asthma Management; access to free inhaled corticosteroids for patients; training of health professionals; and implementation of educational measures, especially for the community. The authorizations for hospital admissions of patients diagnosed with asthma alone between 2002 and 2005 in the city of Londrina were analyzed. RESULTS The mean age was 14.3 +/- 0.5 years, without gender predominance. The number of hospital admissions fell more markedly in 2005 than in the previous years studied. This decline was more pronounced at the Family Health Clinics where professional training occurred earlier. The post-intervention (2004-2005) rate of asthma-related hospital admissions (120/100,000 inhabitants) was significantly lower than the pre-intervention (2002-2003) rate (178/100,000 inhabitants; p < 0.01). CONCLUSIONS The admission curve showed a tendency toward a reduction after 2003, and, aside from the intervention performed, no other factors that would explain the results obtained were identified. The rate at which the number of hospital admissions decreased was in direct proportion to the length of time elapsed since the intervention (greater decreases over time). We conclude that the intervention performed in the local health care system was responsible for the data presented.

Pneumonias adquiridas na comunidade em pacientes idosos: aderência ao Consenso Brasileiro sobre Pneumonias

BACKGROUND: Pneumonia is a common disease with a high mortality rate, being the sixth leading cause of death among elderly people in the USA and the fifth among those in Brazil. Initial treatment of pneumonia is usually empirical since the ethiological agent is identified in only approximately 50% of cases. Therefore, several scientific societies have defined some guidelines for initial antimicrobial therapies. OBJECTIVES: This study evaluated adherence to the guidelines set forth by the Consenso Brasileiro sobre Pneumonias (Brazilian Consensus on Pneumonia) for treatment of community-acquired pneumonia in hospitalized elderly patients. METHOD: Fifty-four patients, aged 60 or over, hospitalized at Londrina University Hospital with community-acquired pneumonia between 2 August 1999 and 2 August 2000 were evaluated. Whether their treatment adhered or did not adhere to guidelines, the patients were compared in terms of 30-day mortality, average time for clinical stabilization, average length of hospital stay, cost of treatment and severity score. RESULTS: The average age was 74.1, and 61.1% of the patients were treated in accordance with the Brazilian guidelines for treatment of community-acquired pneumonia. There were no differences in length of hospital stays, cost of treatment, time to clinical stability and severity score between the two groups (adherent and non-adherent). However, there was a difference in mortality. The rate of mortality was higher in patients with pneumonia severity index (PSI) scores of IV or V who were treated according to the guidelines than in those with the same score whose treatment was non-adherent (p = 0.04). In general, PSI score was related to mortality. The mortality rate among patients with scores of II and III was 9.5%, compared with 30.3% in patients with scores of IV and V. CONCLUSION: Adherence to the Brazilian guidelines for treatment of community-acquired pneumonia in elderly patients was satisfactory, and there was no difference in results between both groups, except for the higher mortality rate found for patients with higher PSI scores who were treated according to the guidelines. A positive correlation was found between PSI score and mortality.

Brazilian examples of programs for the control of asthma.

The aim of this study was to determine which Brazilian programs demonstrate experience in asthma management. Data on and characteristics of those programs were obtained by electronic mail. The variables studied were related to the program itself, its patients and staff. Descriptive statistics were used in the study, which evaluated 17 programs. All programs received public funding, produced educational/training materials and had specialized physicians on staff. We concluded that the experience accumulated by all the programs can be used as one of the pillars of a national program for the control of asthma in Brazil.The aim of this study was to determine which Brazilian programs demonstrate experience in asthma management. Data on and characteristics of those programs were obtained by electronic mail. The variables studied were related to the program itself, its patients and staff. Descriptive statistics were used in the study, which evaluated 17 programs. All programs received public funding, produced educational/training materials and had specialized physicians on staff. We concluded that the experience accumulated by all the programs can be used as one of the pillars of a national program for the control of asthma in Brazil.

Prevalence of symptoms of asthma, rhinitis and atopic eczema among students between 6 and 7 years of age in the city of Londrina, Brazil

OBJECTIVE To determine the prevalence of symptoms of asthma, rhinitis and atopic eczema among students between 6 and 7 years of age in the city of Londrina, Brazil. METHODS A population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaire (asthma, rhinitis and atopic eczema modules), validated for use in Brazil, in public school students between 6 and 7 years of age. RESULTS Of the 3,963 questionnaires retrieved, 3,600 (90.8%) were appropriately completed and were used in the analysis. The prevalence of symptoms of asthma, rhinitis and atopic eczema in the last 12 months was 22.0%, 27.3% and 9.6%, respectively. The prevalence of physician-diagnosed asthma, rhinitis and atopic eczema was 10.4%, 23.4% and 11.4%, respectively. The prevalence of rhinoconjunctivitis and flexural eczema was 13.6% and 6.6%, respectively. Although symptoms of asthma and rhinitis were more common in males than in females, no gender difference was found regarding atopic eczema symptoms. CONCLUSIONS The prevalence of symptoms of asthma, rhinitis and atopic eczema in our sample was within the range found at the facilities that participated in phases I and III of the ISAAC in Brazil. The low prevalence of physician-diagnosed asthma suggests that asthma continues to be underdiagnosed.

Doença de Castleman ou hiperplasia angiofolicular como nódulo pulmonar solitário: relato de caso

Castleman disease is a rare disorder generally characterized by a mediastinal nodule, with a great variety of alternative presentations regarding age, clinical manifestations and evolution. This case report describes a 40-year-old female patient presenting with uncharacteristic chest pain for a few years. A chest X-ray revealed a hypotransparency on the right side. Computed tomography and pulmonary arteriography did not elucidate the diagnosis, which was made through surgical resection and anatomopathological examination of the nodule, which presented characteristics of angiofollicular hyperplasia, or Castleman disease. This article emphasizes the importance of adding this disease to the list of morbidities in the differential diagnosis of pulmonary solitary nodules.

Educação permanente de docentes: análise crítica de experiências não sistematizadas

Whenever great changes in the curriculum of medical courses are proposed, as is the case in the current implementation of an integrated curriculum, the teachers are expected to change their role from mere knowledge providers to a more cooperative and integrating role, facilitating the teaching-learning process. Such changes can cause insecurity, a sense of powerlessness and consequently resistance to these changes. To qualify the teachers for their new functions is thus pivotal for the success of any curricular changes. Besides the systematic educational actions, alternative activities can also contribute to the improvement of the teaching practice. This article analyzes the experience of teachers from the Londrina State University Medical School (UEL), who participated in the group responsible for developing non-systematic education activities with the teaching body of the medical course during the first year of the implementation of the integrated curriculum. The following activities are commented: the weekly meetings with tutors, the action-research on the development and insertion of the teaching body in the integrated curriculum, the topic-based module content reviews, the action-research with the topic-based module coordinators and the survey carried out with the coordinators of internship areas. The analyzed activities provided answers for local needs and contributed to a dynamic and continuously renewed implementation process.

Teste de progresso e avaliação do curso: dez anos de experiência da medicina da Universidade Estadual de Londrina

Progress testing is a longitudinal assessment method covering the full cognitive content considered pertinent to the curriculum of undergraduate medical education. Several medical schools in the world and in Brazil have been applying this test. The medical school of the State University of Londrina, Brazil, introduced the test in 1998 in order to evaluate the course and the learning performance of the students. The purpose of this paper was to present the implementation process of progress testing as an evaluation method and some of the results observed during this period. Among these results were increasing participation of students in the test; the students showed progress in their overall medical knowledge in each test, however with lower scores than expected in ethics, public health and internal medicine. These results reflect the structure of the curriculum as well as the strong and weak points of the course. It is concluded that progress testing is a good indicator in the self-assessing process but that further studies into techniques for analyzing the results are necessary to be able to determine the cognitive progress of the students during the course.

Freqüência relativa de hipomagnesemia em pacientes com limitação crônica do fluxo aéreo atendidos em ambulatório de referência do norte do Paraná

OBJECTIVE: To determine the relative frequency of hypomagnesemia among patients with chronic airflow limitation treated as outpatients at a referral center in the northern part of the state of Parana between 2000 and 2001, as well as to determine whether hypomagnesemia correlates with hypoxia, with other electrolyte disturbances and with the severity of airflow limitation. METHODS: This was a descriptive study of the relative frequency of hypomagnesemia in 72 patients with chronic airflow limitation. All of the patients were submitted to blood tests to determine serum levels of magnesium and other electrolytes, as well as to staging of the underlying disease. RESULTS: The prevalence of hypomagnesemia was 27.8%. The mean age was 65 ± 9.9 years, and there was a predominance of males. The mean forced expiratory volume in one second was 1.31 ± 0.52 L. Most of the patients (68.1%) were found to be in the advanced stages of the disease. Hypomagnesemia was not found to correlate with other electrolyte disturbances, hypoxemia or disease stage. CONCLUSION: The high frequency of patients in the advanced stages is likely attributable to the fact that the outpatient facility is a referral center for the region. Further studies should be conducted in order to determine the probable causes of this high prevalence of hypomagnesemia.