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- ItemSomente MetadadadosEvolution of reports of randomised clinical trials in plastic surgery(Elsevier B.V., 2011-06-01) Veiga, Daniela Francescato [UNIFESP]; Veiga Filho, Joel [UNIFESP]; Pellizzon, Rosely de Fátima [UNIFESP]; Juliano, Yara [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Vale SapucaiWell-designed, well-conducted and well-reported randomised clinical trials (RCTs) can significantly impact medical care, by contributing to a strong evidence base from which clinical guidelines can be derived. in a previous study, we assessed the quality of reports of RCTs in plastic surgery published from 1966 to 2003. the aim of the present study was to verify what have changed over the last years. RCTs in plastic surgery published from 2004 to 2008 were identified through electronic searches, and classified according to their allocation concealment. Trials with allocation concealment appropriately described were evaluated as to their quality. Two independent reviewers performed the evaluations, using two tools: the Delphi List and the Jadad's quality scale. From 3840 identified studies, 96 were selected for classification according to allocation concealment; 28 (29%) of them appropriately described allocation concealment. From 1966 to 2003, 34 (17%) RCTs appropriately described allocation concealment (chi(2) = 22.98, p < 0.000). in the evaluation of the 28 RCTs by the Delphi List, the agreement coefficient between raters (kw) was 0.46 (z = 7.24, p < 0.000). Groups were similar at baseline in 96.4% of these trials, and this was the only item of the Delphi List, which significantly improved when compared with the period from 1966 to 2003 (chi(2) = 18.53, p < 0.000). When evaluated by Jadad's criteria, 14% of the RCTs were scored two points or less and thus considered of low quality (kw = 0.72, z = 8.57, p < 0.001). From 1966 to 2003, 59% of RCTs were scored two points or less (chi(2) = 17.07, p < 0.004). We concluded that the quality of reports of RCTs in plastic surgery (as measured by the Jadad's criteria and only one component of the nine components of the Delphi List) significantly increased over the last years. (C) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Ineficácia da autorregulamentação das propagandas de bebidas alcoólicas: uma revisão sistemática da literatura internacional(Associação Brasileira de Psiquiatria - ABP, 2011-06-01) Vendrame, Alan [UNIFESP]; Pinsky, Ilana [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The most recent scientific literature indicates that alcohol advertising influences behavior, particularly early and higher alcohol consumption by children and adolescents. From a public health perspective, alcohol advertising should be restricted. In many countries, as well as in Brazil, limits to alcohol advertising are established by industry self-regulation (e.g. controlled by the advertising community itself). We examined in this review all papers on the subject of industry self-regulation of alcohol advertising published in the international literature. METHOD: A systematic literature review was realized on papers investigating the effectiveness of self-regulation of alcohol advertisings. The search was conducted in Medline, SciELO, Camy and Google Scholar, between the years of 1991 and 2010. In addition, the snowball technique for the indication of the main authors on the subject was employed. From the papers found, 11 focused on the subject discussed here. DISCUSSION: The set of papers obtained indicates that industry self-regulation of alcohol advertising does not show evidence of efficacy. In other words, such a regulation does not prevent, for instance, alcohol advertising directed at children and adolescents. CONCLUSION: Further measures should be considered for the control and the broadcast of alcohol advertising, such as independent monitoring, legal control.
- ItemAcesso aberto (Open Access)Programas de exercícios estruturados para pacientes adultos obesos pós-cirurgia bariátrica : revisão sistemática(Universidade Federal de São Paulo (UNIFESP), 2017-06-30) Parra, Maira Tristao [UNIFESP]; Atallah, Alvaro Nagib [UNIFESP]; http://lattes.cnpq.br/8461078281290598; http://lattes.cnpq.br/8133270338402637; Universidade Federal de São Paulo (UNIFESP)Introdução: a obesidade é uma epidemia global crescente e uma forma de tratamento eficaz tem sido a cirurgia bariátrica para o tratamento da obesidade mórbida. Considerando que a obesidade é uma condição multifatorial, os cuidados com o paciente devem ser idealmente multidisciplinares, especialmente após a realização do procedimento cirúrgico. O exercício físico pode ser um aliado nessa terapia: no entanto, ainda faltam informações acerca da efetividade e segurança dessa intervenção. Objetivos: avaliar a efetividade e segurança do exercício físico para pacientes obesos após a cirurgia bariátrica. Métodos: foi realizada uma revisão sistemática da literatura. As fontes consultadas foram: CENTRAL, MEDLINE, Embase, LILACS, CINAHL, ClinicalTrials.gov e ICTRP, sem restrição de idioma e data de publicação. Foram incluídos ensaios clínicos randomizados que avaliaram intervenções de exercício físico em adultos após o procedimento de cirurgia bariátrica. Os desfechos primários foram manutenção da redução do peso corporal, qualidade de vida relacionada à saúde e eventos adversos relacionados à intervenção. A seleção e extração dos dados, bem como a avaliação da qualidade da evidência, foram realizadas por dois revisores independentes, e as discordâncias foram resolvidas por um terceiro revisor. O risco de viés dos estudos incluídos foi avaliado por meio da Risk of Bias Tool e a avaliação da qualidade da evidência seguiu as recomendações do GRADE Working Group. As medidas de efeito utilizadas foram RR para desfechos dicotômicos e DM para desfechos contínuos, ambos com IC de 95%. A heterogeneidade clínica e metodológica foram avaliadas, e caso os dados dos estudos fossem passíveis de serem agrupados, este agrupamento foi feito por meio de metanálise. A heterogeneidade estatística foi avaliada utilizando o teste Chi2 e a estatística I2. Resultados: três ECRs foram incluídos, totalizando 193 participantes submetidos ao bypass gástrico ou a banda gástrica ajustável. Na comparação “exercício versus não exercício”, não houve diferença significativa entre os grupos para a redução do peso corporal (DM 0,59 kg; IC 95% -7,94 a 9,11; P = 0,002; qualidade da evidência muito baixa). Não houve diferença significativa para os eventos adversos (RR 4,58; IC 95% 0,25 a 85,33; qualidade da evidência muito baixa), enquanto a qualidade de vida relacionada à saúde não foi avaliada. Para a comparação “exercício associado à terapia comportamental versus terapia comportamental isolada”, não houve diferença significativa para a redução do peso corporal (DM -0,50 kg; IC 95% -11,71 a 10,71) e para qualidade de vida mensurada com as ferramentas SF-36: domínio físico (DM -1,00 ponto; IC 95% -6,74 a 4,74), domínio mental (DM 6,00 pontos; IC 95% -2,22 a 14,22); e ferramenta IWQOL-L (DM 8,00 pontos; IC 95% -6,92 a 22,92). Os eventos adversos não foram mensurados. Conclusão: Não se pode concluir que o exercício é eficaz ou seguro para os pacientes obesos após a cirurgia bariátrica, considerando a evidência de qualidade muito baixa e o pequeno tamanho amostral que, provavelmente, foi insuficiente para detectar efetividade da intervenção de exercício físico.
- ItemAcesso aberto (Open Access)The transtheoretical model and substance dependence: theoretical and practical aspects(Associação Brasileira de Psiquiatria - ABP, 2009-12-01) Vilela, Fabiana Andrioni de Biaze [UNIFESP]; Jungerman, Flavia Serebrenic [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Callaghan, Russel; Universidade Federal de São Paulo (UNIFESP); University of Toronto Centre for Addiction and Mental Health Department of Public Health SciencesOBJECTIVE: This paper aims to present and discuss the Transtheoretical Model and its importance for the treatment of substance abuse disorders. METHOD: A literature review was made based on articles from the last 10 years in substance use with human subjects found in PubMed (Medline) and the Scientific Electronic Library Online, as well as on the main books written by the creators of the model. From the initial collection of articles related to the Transtheoretical Model, the University of Rhode Island Assessment and substance abuse, those related to other health conditions were excluded. Although articles related to hospitalization were also excluded, as were those related to the Minnesota Model, treatment proposals were included. RESULTS: Although the TTM has been studied for over 20 years, new concerns regarding the initial idea continue to arise. Such concerns include the cross-sectional design of studies employing the model, as well as the prescriptive versus descriptive point of view. DISCUSSION: The review of the Transtheoretical Model brought intentional behavior change to light, which could broaden the understanding of addictive behaviors. Together with its concepts of processes and stages of change, the Transtheoretical Model provides professionals with the idea that the effectiveness of therapy is dependent upon the capability of the therapist to match the technique to the current motivational stage of the patient in the process of change. This demonstrates the importance of identifying the stage of change of the patient when they present for treatment. Here, we describe the principal elements of the Transtheoretical Model, as well as the instruments currently used to identify the stage of change. Finally, criticisms and limitations of the model are discussed.
- ItemAcesso aberto (Open Access)Voz do professor: uma revisão de 15 anos de contribuição fonoaudiológica(Sociedade Brasileira de Fonoaudiologia, 2010-01-01) Dragone, Maria Lúcia Suzigan; Ferreira, Léslie Piccolotto; Giannini, Susana Pimentel Pinto; Simões-zenari, Marcia; Vieira, Vanessa Pedrosa [UNIFESP]; Behlau, Mara [UNIFESP]; UNIARA Centro Universitário de Araraquara; Pontifícia Universidade Católica de São Paulo Faculdade de Fonoaudiologia; Pontifícia Universidade Católica de São Paulo; Hospital do Servidor Público Municipal de São Paulo; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Centro de Estudos da VozThe purpose of this study was to review Brazilian publication regarding teachers' voice produced by Speech-Language Pathologists (SLPs) within the period from 1994 to 2008. This transversal study of bibliographic nature was carried out in three stages. The first consisted of data compilation from different sources; the second comprehended the search for the abstracts of the selected references; in the third stage, the publications were classified into four categories: individuals' assessment, treatment outcome evaluation, intervention description, and bibliographical/theoretical/documental researches. The final sample consisted of 500 publications, from which 415 (83%) were related to the assessment categories. Among these, 357 (86%) evaluated individuals and/or their working conditions, and 58 (14%) had the aim to evaluate treatment outcome. Regarding analyses dimensions of the assessments, 202 studies (48.7%) had more than one. Teachers' perspective (self-assessment) was the predominant dimension (52.5% of the analyses), followed by auditory-perceptual analyses performed by SLPs (15.2%), and evaluation of working environment and organization (14.9%). The category intervention description had 31 (6.2%) studies, and there were 54 (10.8%) bibliographical/theoretical/documental researches. This literature review confirms that vocal assessment has been privileged in Brazilian researches regarding teachers' voice. Publications about treatment outcome evaluations are more recent and less representative, indicating a tendency of change of focus that might help the comprehension of the complex use of voice in teaching, and guide future studies on speech-language pathology intervention with these individuals.