RESUMO
Objective: Breast cancer is the most prevalent malignant neoplasm in women. Optimal treatment frequently includes a hormonal-blockage phase maintained for 5-10 years. Pharmacologic agents used for this blockage induce many climacteric-like symptoms, which often exact a heavy toll on patients' quality of life. Acupuncture has had promising results for treating climacteric-like symptoms induced by hormonal blockage, but there is no evidence of efficacy for controlling hot flashes. Materials and Methods: This trial used acupuncture to treat the climacteric-like symptoms of patients with breast cancer, focusing on the mental, physical, and genitourinary symptoms and sleep disturbances, to determine the influence of acupuncture treatment. The randomized placebo-controlled trial, at a university-based cancer center, with blinded data collectors, compared an Acupuncture group (A), a Sham-Acupuncture group (S), and a Wait-List Control group (C). The patients were receiving tamoxifen. Group A had 10 weekly sessions of manual Acupuncture; Group S had 10 weekly sessions of Sham Acupuncture; and Group C spent 10 weeks on a Wait-List. The main outcome measures were the Beck Depression Inventory-II (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), and the Menopause Rating Scale (MRS). Results: Primary analysis revealed differences among the groups' improvements in scores for the 3 questionnaires (P < 0.001), The A group had significant improvements on the BDI-II (P < 0.001), PSQI (P < 0.002), and MRS (P < 0.004) compared to the S group in a post hoc analysis. Conclusions: Acupuncture improved sleep, and mental and emotional distress symptoms induced by hormonal blockage in patients with breast cancer. Clinical Trial: This trial was registered at CAAE as trial #: 37758414.8.0000.0065.
Assuntos
COVID-19 , Pandemias , Brasil/epidemiologia , Estado Terminal , Humanos , Saúde Pública , Alocação de Recursos , SARS-CoV-2RESUMO
AIM: To investigate the external validity of recent antihyperglycaemic trials evaluating cardiovascular outcomes in a multimorbid population. MATERIALS AND METHODS: Selection criteria of 15 randomized controlled trials from the 2020 American Diabetes Association Standard of Care statement were applied in a stepwise manner to tertiary care patients with type 2 diabetes. Primary outcomes were the number of patients eligible per individual trial and for the aggregate of trials. Secondary outcomes included patient predictors of trial eligibility. RESULTS: Of 1059 patients, the mean (SD) age was 66 (10.74) years, the median (IQR) Charlson index was 2 (2, 3) and 458 (43%) had documented cardiovascular disease. The median (IQR) number of patients included in individual trials was 263 (174.25-308.75) and 795 (75.1%) of them were eligible for at least one trial. Among those 264 ineligible, 127 (48.1%) had an HbA1c level of 7% or less and no cardiovascular disease; 53.5% and 34.4% of the patients were eligible for two and three different classes of drugs, respectively. The strongest predictor of trial eligibility was cardiovascular disease (risk ratio 2.17, 95% CI 2.01-2.35). CONCLUSIONS: A considerable proportion of multimorbid patients would be eligible for recent antihyperglycaemic trials. This positive finding can be attributed to development guidance in diabetes trials and the different approach we took, in which we evaluated inclusion by trials as an aggregate.
Assuntos
Doenças Cardiovasculares , Sistema Cardiovascular , Diabetes Mellitus Tipo 2 , Idoso , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Hipoglicemiantes/uso terapêutico , Pessoa de Meia-IdadeAssuntos
Betacoronavirus , Infecções por Coronavirus , Atenção à Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Mão de Obra em Saúde , Hospitais Públicos/organização & administração , Internato e Residência , Pandemias , Pneumonia Viral , Brasil , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2Assuntos
Humanos , Conhecimentos, Atitudes e Prática em Saúde , Infecções por Coronavirus/epidemiologia , Atenção à Saúde/organização & administração , Betacoronavirus , Mão de Obra em Saúde , Hospitais Públicos/organização & administração , Pneumonia Viral/epidemiologia , Brasil , Pandemias , SARS-CoV-2 , COVID-19 , Internato e ResidênciaRESUMO
BACKGROUND: The effects of outdoor air pollution on lung function in adults are still controversial. OBJECTIVE: Evaluate the effects of exposure to different levels of traffic-generated PM2.5 on workers' lung functions in São Paulo, Brazil. METHODS: To cover a wide range of exposures, 101 non-smoking workers from three occupations (taxi drivers, traffic controllers, and forest rangers) were selected for the study. After clinical evaluation, the participants were scheduled to attend four consecutive weekly visits in which they received a 24-hour personal PM2.5 sampler and had lung function tests measured on the following day. The association between the spirometric variables and the averaged PM2.5 levels was assessed using robust regression models adjusted for age, waist circumference, time at the job, daily work hours, diabetes or hypertension and former smoking habits. RESULTS: Relative to workers in the lowest exposed group (all measures < 25 µg/m3), those with the highest level of exposure (all measures > 39.6 µg/m3) showed a reduction of predicted FVC (-12.2%; CI 95%: [-20.0% to -4.4%]), a marginal reduction of predicted FEV1 (-9.1%; CI 95%: [-19.1% to 0.9%]) and an increase of predicted FEF25-75%/FVC (14.9%; CI 95%: [2.9% to 26.8%]) without changes of FEV1/FVC. CONCLUSIONS: Exposure to vehicular traffic air pollution is associated with a small but significant reduction of FVC without a reduction of FEV1/FVC.