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  1. Article ; Online: Desigualdade racial na assistência à saúde do adulto internado por COVID-19

    Fernanda Sandes Cardoso / Danilo Cosme Klein Gomes / Alexandre Sousa da Silva

    Cadernos de Saúde Pública, Vol 39, Iss

    2023  Volume 10

    Abstract: Resumo: O objetivo deste artigo foi analisar a associação entre raça/cor e assistência à saúde, em adultos hospitalizados pela síndrome respiratória aguda grave (SRAG)/COVID-19 no Brasil, entre março de 2020 e setembro de 2022. Trata-se de estudo ... ...

    Abstract Resumo: O objetivo deste artigo foi analisar a associação entre raça/cor e assistência à saúde, em adultos hospitalizados pela síndrome respiratória aguda grave (SRAG)/COVID-19 no Brasil, entre março de 2020 e setembro de 2022. Trata-se de estudo transversal, que utilizou o banco de dados do Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) e contou com uma população composta por adultos (≥ 18 anos). A classificação final foi SRAG por COVID-19 ou SRAG não especificada. O efeito direto do aspecto cor na mortalidade intra-hospitalar foi estimado por meio de regressão logística ajustada por idade, sexo, escolaridade, sistema de saúde e período, estratificado por situação vacinal. Esse mesmo modelo foi utilizado também para avaliar o efeito do quesito cor nas variáveis de acesso aos serviços de saúde: unidade de terapia intensiva (UTI), tomografia, radiografia de tórax e suporte ventilatório. Os resultados evidenciam que pretos, pardos e indígenas morreram mais, independentemente do grau de escolaridade e da quantidade de comorbidades, com maiores chances de óbito em 23%, 32% e 80%, respectivamente, ao serem submetidos ao suporte ventilatório. Foram observadas diferenças raciais no uso de serviços de saúde e nos desfechos de morte por COVID-19 ou SRAG não especificada, em que minorias étnicas tiveram maiores taxas de mortalidade intra-hospitalar e os recursos hospitalares foram utilizados com menos frequência. Tais resultados sugerem que as populações negra e indígena têm severas desvantagens em relação à branca, enfrentando barreiras de acesso aos serviços de saúde no contexto da pandemia de COVID-19.
    Keywords COVID-19 ; Mortalidade Hospitalar ; Fatores Raciais ; Acesso aos Serviços de Saúde ; Medicine ; R ; Public aspects of medicine ; RA1-1270
    Language English
    Publishing date 2023-11-01T00:00:00Z
    Publisher Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: High discrepancies in the mortality of hospitalized patients with COVID-19 in the two most economically important states in Brazil

    Vitor Barreto Paravidino / Rosely Sichieri / Danilo Cosme Klein Gomes / Gulnar Azevedo e Silva

    Revista Brasileira de Epidemiologia, Vol

    2021  Volume 24

    Abstract: ABSTRACT: Objective: The aim of this study was to compare the proportion of deaths among hospitalized cases of COVID-19 in São Paulo and Rio de Janeiro, stratified by private and public services. Methods: Hospitalization data for severe acute respiratory ...

    Abstract ABSTRACT: Objective: The aim of this study was to compare the proportion of deaths among hospitalized cases of COVID-19 in São Paulo and Rio de Janeiro, stratified by private and public services. Methods: Hospitalization data for severe acute respiratory syndrome (SARS) were obtained using the SIVEP-Gripe Database. All hospitalized adults who were diagnosed as COVID-19 or unspecified SARS, between January and December 2020, were included in the analysis. Logistic regression models were fitted to evaluate the risk of death between Rio de Janeiro and São Paulo, adjusted for age, sex, and comorbidities. Results: A total of 388,657 hospital registers for Rio de Janeiro and São Paulo (91,532 and 297,125, respectively) were analyzed. Missing data are frequent in the database and it was greater in Rio de Janeiro, at the state and capital levels. Adjusting for confounders, the odds ratio of dying by COVID-19, comparing the state of Rio de Janeiro with São Paulo, was 2.51 in the private hospitals and 2.29 in the public ones. For the capitals, the scenario is worse. The lethality among hospitalized patients with COVID-19 is at least twice in Rio de Janeiro than São Paulo, both at the states and capitals. The public or private services showed important differences, with odds ratios of 2.74 and 3.46, respectively. Conclusion: It appears that the worst governance in the health sector in Rio de Janeiro, more than lack of resources, explains the excess mortality of hospitalized COVID-19 patients in Rio de Janeiro.
    Keywords COVID-19 ; Hospital mortality ; Delivery of health care ; Brazil ; Public aspects of medicine ; RA1-1270
    Subject code 310
    Language English
    Publishing date 2021-12-01T00:00:00Z
    Publisher Associação Brasileira de Pós-Graduação em Saúde Coletiva
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Metabolic Evaluation in Patients With Hepatitis C Treated With Direct Antiviral Agents

    Sergio Estefan / Carlos Eduardo Brandão-Melo / Cintia Marques dos Santos Silva / Danilo Cosme Klein Gomes / Paula Cardoso / Marcia Helena S. Costa

    Frontiers in Medicine, Vol

    2021  Volume 8

    Abstract: Epidemiological data clearly indicate a link between hepatitis C virus (HCV) and altered glucose homeostasis.Objective: To evaluate the response of treatment with direct antiviral agents (DAAs) on metabolic variables of patients with hepatitis C.Methods: ...

    Abstract Epidemiological data clearly indicate a link between hepatitis C virus (HCV) and altered glucose homeostasis.Objective: To evaluate the response of treatment with direct antiviral agents (DAAs) on metabolic variables of patients with hepatitis C.Methods: Observational, cross-sectional study in a sample of patients with hepatitis C starting therapy with DAAs followed on the hepatology division of Federal University of Rio de Janeiro State. Data were collected in two stages: before the start of therapy and between 12 and 52 weeks after obtaining the sustained virological response.Results: In the baseline assessment of the 97 patients selected, 19.3% were obese, 38.6% were overweight, 50% were hypertensive, 43.8% were pre-diabetic, 12.5% were diabetic, 31.2% were dyslipidemic, and 21.8% had metabolic syndrome. There was an increase in total cholesterol and LDL levels (p < 0.001), and a non-significant reduction in blood glucose, glycated hemoglobin, insulin, and HOMA-IR levels after treatment. In the post-treatment, there was a reduction in fibrosis (p = 0.016), with a reduction in the levels of GGT, AST, and ALT (all with p < 0.001), as well as in the FIB4 and APRI scores (both with p < 0.001) and in the degree of fibrosis evaluated by elastography represented in kPa (p = 0.006). The blood glucose level was higher in patients with steatosis (p = 0.039) after treatment. There was a positive pre-treatment correlation between the degree of fibrosis (kPa) and FIB4 (r = 0.319, p = 0.004), APRI (r = 0.287, p = 0.010), and the NAFLD score (r = 0.275, p = 0.016).Conclusion: Patients with hepatitis C had a high prevalence of metabolic disturbance in the pre-treatment phase, but the therapy did not show beneficial effects, especially on glucose metabolism.
    Keywords hepatitis C ; metabolic syndrome ; hepatic steatois ; direct action antiviral agents ; hepatic fibrosis ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2021-05-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Is muscular strength compromised by overnight fasting or food ingestion in hospital settings?

    Renata da Rocha Muniz Rodrigues / Joana Maia Brandão / Danilo Cosme Klein Gomes / Rafael Lavourinha Pinto

    Einstein (São Paulo), Vol 17, Iss

    2019  Volume 4

    Keywords Medicine ; R
    Language English
    Publishing date 2019-12-01T00:00:00Z
    Publisher Instituto Israelita de Ensino e Pesquisa Albert Einstein
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Trends in obesity prevalence among Brazilian adults from 2002 to 2013 by educational level

    Danilo Cosme Klein Gomes / Rosely Sichieri / Eliseu Verly Junior / Cristiano Siqueira Boccolini / Amanda de Moura Souza / Diana Barbosa Cunha

    BMC Public Health, Vol 19, Iss 1, Pp 1-

    2019  Volume 7

    Abstract: Abstract Background Obesity ranks as a major public health problem in many countries in the world. The obesity-socioeconomic status relationship is not well established in middle-income countries. Methods The aim of this study was to estimate the obesity ...

    Abstract Abstract Background Obesity ranks as a major public health problem in many countries in the world. The obesity-socioeconomic status relationship is not well established in middle-income countries. Methods The aim of this study was to estimate the obesity and overweight trends from 2002 to 2013 by sex, age, and educational levels among Brazilian adults. The panel prevalence trend study was conducted, considering the sample weights and study design. Three nationwide surveys were analyzed: the Household Budget Survey 2002/2003 and 2008/2009, and the National Health Survey 2013. The total sample was 234,791 adults aged 20–59 years. Results The prevalence of obesity increased from 7.5 to 17.0% from 2002 to 2013 among adults aged 20–39 years and from 14.7 to 25.7% among those aged 40–59 years, slightly higher among young women. In each survey, education was positively associated with the prevalence of obesity among men, whereas this association was negative among women. The greatest increase in the prevalence of obesity was 90% (11.9 to 22.5%) and occurred from 2008 to 2013 among women with secondary educational level, whereas at the pre-primary level there was a 42% (20.4 to 29.0%) increase. Conclusions Obesity prevalence in Brazil continued to increase, mostly among women with secondary education. Policies aimed at reducing the prevalence of obesity should consider sociodemographic characteristics in the population.
    Keywords Obesity ; Overweight ; Body mass index ; Prevalence ; Educational status ; Public aspects of medicine ; RA1-1270
    Subject code 796
    Language English
    Publishing date 2019-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Association between obesity and COVID-19 mortality and length of stay in intensive care unit patients in Brazil

    Vitor Barreto Paravidino / Tatiana Henriques Leite / Mauro Felippe Felix Mediano / Rosely Sichieri / Gulnar Azevedo e Silva / Victor Cravo / Alex Balduino / Emmanuel Salgueiro / Bruno Adler Maccagnan Pinheiro Besen / Rodrigo de Carvalho Moreira / Carlos Eduardo Brandão / Danilo Cosme Klein Gomes / Cinthia Almeida Guimarães Assemany / Pedro Cougo

    Scientific Reports, Vol 12, Iss 1, Pp 1-

    a retrospective cohort study

    2022  Volume 9

    Abstract: Abstract The present study aimed to evaluate the association between obesity and COVID-19 mortality and length of stay in ICU patients, and how these associations were modified by age groups. We performed a retrospective multicenter cohort study with ... ...

    Abstract Abstract The present study aimed to evaluate the association between obesity and COVID-19 mortality and length of stay in ICU patients, and how these associations were modified by age groups. We performed a retrospective multicenter cohort study with data obtained from a hospital-based registry. The sample consisted of 8183 ICU hospitalized patients who tested positive for SARS-CoV-2. Cox proportional models were used to evaluate the association between BMI categories and COVID-19 mortality and generalized linear models for the length of stay in the ICU. After adjusting for confounders, those in the younger group with severe obesity had an increased risk of COVID-19 mortality compared to those with normal/overweight (HR 1.27; 95% CI 1.01–1.61). An increased risk of death was also observed for patients with underweight (HR 3.74; 95% CI 1.39–10.07). For patients aged ≥ 60 year, mild/moderate obesity was associated with reduced mortality risk (HR 0.87; 95% CI 0.78–0.97). For the age group < 60 year, the length of stay in ICU for those patients with severe obesity was 35% higher compared to the normal/overweight category (eβ 1.35; 95% CI 1.21–1.51). Conversely, for the survivors in the underweight category, the length of stay in ICU was 51% lower compared to the normal/overweight group (eβ 0.49; 95% CI 0.31–0.78). In the age group ≥ 60 year, mild/moderate obesity was associated with an increased length of stay in the ICU (e β 1.10; 95% CI 1.01–1.21), adjusting for confounders. These findings could be helpful for health professionals to identify subgroups at higher risk for worse outcomes.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2022-08-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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