Moacyr Roberto Cuce Nobre

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo | fmusp · Centro de Apoio à Pesquisa

Background: Rheumatoid arthritis primarily affects the working-age population and may cause key functional and work limitations. As the disease progresses, individuals become increasingly unable to conduct daily activities, which has a substantial personal and socioeconomic impact. Fairly recent prior studies showed that patients with RA stop work...

Background: Ice-pack is widely used for alleviating postpartum perineal pain sustained after birth related perineal trauma. However, it lacks robust evidence on timing and frequency of applications, to ensure the effective and safe use of this therapy. Aims: To evaluate if a 10min ice-pack application relieved postpartum perineal pain and if the...

Background: Implantable cardioverter-defibrillator (ICD) therapy significantly improves the survival of patients who are at high risk for sudden cardiac death. However, it is unclear whether this survival is accompanied by impairment on quality of life (QoL). Objectives: This systematic review sought to describe whether ICD therapy, as compared...

Objective: To estimate the prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis. Methods: A cross-sectional study using the American College of Rheumatology diagnostic criteria in order to select patients seen at primary or secondary health care units in Blumenau, Santa Catarina, Southern Brazil, in 201...

Introduction An electronic healthcare record (EHR) system, when used by healthcare providers, improves the quality of care for patients and helps to lower costs. Information collected from manual or electronic health records can also be used for purposes not directly related to patient care delivery, in which case it is termed secondary use. EHR sy...

Introduction:: The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine. Objective:: To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources...

Background Changes in lifestyle include a healthy diet. However, due to different educational approaches, the effects of nutritional counselling are still not very encouraging and require further study. The objective of this study was to analyse the effectiveness of a nutrition education intervention program on mortality and recurrence of cardiovas...

Objective: To estimate the prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis. Methods: A cross-sectional study using the American College of Rheumatology diagnostic criteria in order to select patients seen at primary or secondary health care units in Blumenau, Santa Catarina, Southern Brazil, in 2...

The aim of this study was to identify and reflect on the methods employed by studies focusing on intervention programs for the primordial and primary prevention of cardiovascular diseases. The PubMed, EMBASE, SciVerse Hub-Scopus, and Cochrane Library electronic databases were searched using the terms ‘effectiveness AND primary prevention AND risk f...

Background Smoking restriction laws have spread worldwide during the last decade. Previous studies have shown a decline in the community rates of myocardial infarction after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in...

Introduction: There are few studies that carried out a descriptive and trend analysis based on available data from the Unified Health System (SUS) between pre- and post-free dispensing of pharmacological treatment of rheumatoid arthritis (RA) from the perspective of the public health system, in terms of the direct cost of the disease among adults a...

Poucos estudos fizeram uma análise descritiva e de tendência dos dados disponíveis do Sistema Único de Saúde (SUS) entre os períodos pré e pós‐dispensação gratuita do tratamento medicamentoso da artrite reumatoide (AR) sob a perspectiva do sistema público de saúde em termos de custo direto da doença entre adultos e idosos moradores do Estado de San...

Background and objective: Episiotomy is associated with perineal pain and healing complications. The low-level laser therapy (LLLT) reduces pain and inflammation and stimulates the healing process. This study aimed to assess the effect of LLLT on pain and perineal healing after an episiotomy. Design/materials and methods: A randomized, triple-bl...

Hospital information systems generate data in large quantities and of high importance, which are often underused for clinical research purposes. This article shows the preparation of a database from the electronic patient records of the Heart Institute HCFMUSP for research into diseases. We conducted the selection and cleaning of data from patients...

To evaluate the effect of school-based physical activity (PA) and nutrition education (NE) interventions on children´s and adolescents body mass index. We conducted a systematic search in fourteen databases until September 2012 for randomized controlled trials on PA and NE, conducted in the school setting, and delivered to children and adolescents....

Object: The most appropriate method to determine the quality of life of patients with intradural primary spinal tumors (IPSTs) is not still well established. Methods: Clinical data in 234 patients who underwent surgery for intradural spinal disease were collected prospectively. The 36-Item Short Form Health Survey (SF-36), a generic score scale,...

This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical ac...

Durante as últimas duas décadas, a sociedade testemunhou dois fenômenos sociais que a afetaram substancialmente: a epidemia de HIV/AIDS com suas características pouco usuais e alta letalidade; e a intrusão de leis de propriedade intelectual na vida cotidiana, como o Acordo TRIPS com amplas repercussões sobre a saúde pública. O objetivo deste trabal...

Aims and objectives: To compare the effect of an ice pack applied for 10, 15 and 20 minutes to relieve perineal pain after birth. Background: Perineal pain after vaginal birth, with or without vaginal trauma, is one of the most common morbidities reported for postnatal women. Cryotherapy has been used in postpartum period to relieve perineal pai...

Aims and objectives: To evaluate the effectiveness of a low-level laser therapy for pain relief in the perineum following episiotomy during childbirth. Background: Laser irradiation is a painless and non-invasive therapy for perineal pain treatment and its effects have been investigated in several studies, with no clear conclusion on its effecti...

Though elderly persons with chronic atrial fibrillation have more comorbidities that could limit indications for the chronic use of anticoagulants, few studies have focused on the risk of falls within this particular group. To evaluate the predictors of the risk of falls among elderly with chronic atrial fibrillation, a cross-sectional, observation...

The identification of stages of dietary change and the factors affecting food choices can direct more effective nutritional intervention against coronary heart disease progression. Identify the stages of change of eating behavior and its relation with nutritional status, food consumption and previous cardiovascular events in patients who underwent...

Introduction: The identification of stages of dietary change and the factors affecting food choices can direct more effective nutritional intervention against coronary heart disease progression. Objective: Identify the stages of change of eating behavior and its relation with nutritional status, food consumption and previous cardiovascular events i...

Surrogate endpoints may be used as substitutes for, but often do not predict clinically relevant events. Objective To assess the methodological quality of articles that present their conclusions based on clinically relevant or surrogate outcomes in a systematic review of randomised trials and cohort studies of patients with rheumatoid arthritis tre...

OBJETIVO: Avaliar a efetividade da educação nutricional em escolas na redução ou prevenção de sobrepeso e obesidade em crianças e adolescentes. FONTES DOS DADOS: Busca sistemática em 14 bases de dados e cinco revisões sistemáticas por ensaios controlados randomizados realizados em escolas com o objetivo de reduzir ou prevenir o sobrepeso em criança...

To evaluate the effectiveness of school-based nutrition education in reducing or preventing overweight and obesity in children and adolescents. Systematic search in 14 databases and five systematic reviews for randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. Body mass index and fruit and...

This study evaluated the effectiveness of an ice pack applied for 20 minutes to alleviate perineal pain after spontaneous vaginal birth. We conducted a randomized controlled trial at the Amparo Maternal Birth Center in São Paulo, Brazil. Study participants included 114 nulliparous women divided into 3 groups (n = 38 per group): experimental (ice pa...

New health technologies have made an impact in clinical and economic outcomes. Therefore, research methodologies that allow to evaluate the efficiency of these new technologies such as cost-effectiveness analysis are necessary. Cost-effectiveness analysis assess the value of health care interventions or drugs, the technology. Cost-effectiveness ana...

Studies have shown that there is no safe level of secondhand smoke (SHS) exposure and there is a close link between SHS and the risk of coronary heart disease and stroke. Carbon monoxide (CO) is one of the most important components present in SHS. To evaluate the impact of the smoking ban law in the city of Sao Paulo, Brazil, on the CO concentratio...

BACKGROUND: Cardiovascular disease is the leading cause of mortality worldwide. There is evidence demonstrating the association of this disease with cardiovascular risk factors related to lifestyle, incorporated in adolescence. OBJECTIVE: To identify, in adolescents, the prevalence of overweight and lifestyle factors associated with risk for develo...

Cardiovascular disease is the leading cause of mortality worldwide. There is evidence demonstrating the association of this disease with cardiovascular risk factors related to lifestyle, incorporated in adolescence. To identify, in adolescents, the prevalence of overweight and lifestyle factors associated with risk for developing cardiovascular dis...

To document the relationship between physical activity, absenteeism, presenteeism, health care utilization, and morbidity among Brazilian automotive workers. Eligible employees (N = 620) completed a questionnaire. Univariate correlations, multivariate logistic regression, and Pearson's product-moment correlation coefficient were used. Work absentee...

Malignant fungating wounds (MFW) result from cutaneous infiltration by carcinogenic cells. Fetid odor, profuse exudate, pain, and infection are common symptoms that add to the physical and psychological suffering of patients with MFW. The topical treatment of MFW remains controversial. To collect evidence about topical treatments to control the odo...

Resumen Fundamento: En ensayos clínicos, el Formulario de Consentimiento Informado (FCI) es fundamental para que se preserve la ética, sin embargo por su complexidad él puede no comprenderse completamente. En este estudio, evaluamos la comprensión del FCI por parte del paciente. Objetivo: Abordamos la cuestión sobre el nivel de comprensión de los p...

FUNDAMENTO: Em ensaios clínicos, o Termo de Consentimento Livre e Esclarecido (TCLE) é fundamental para preservar a ética, mas pela sua complexidade ele pode não ser entendido completamente. Neste estudo, avaliamos o entendimento do TCLE pelo paciente. OBJETIVO: Abordamos a questão sobre o nível de compreensão dos pacientes em relação aos estudos b...

In clinical tests, the Informed Consent is critical to preserve the ethics, but due to its high complexity level, it cannot be fully understood. This study assesses the Informed Consent as viewed by patients. We addressed the issue of what do patients understand about the studies based on the IC. We invited participants of outpatient clinical drug...

Existe, atualmente, grande demanda para se aumentar a eficiência do ato médico e isto pode ser alcançado através de pesquisas de avaliação de tecnologia em saúde, a ATS. Esta visa, por um lado, determinar a melhor evidência de eficácia ou efetividade de um dado tratamento em saúde, por outro, determinar os custos associados com tal tratamento médic...

Currently it is expected a higher efficiency of health care and this can be achieved by health technology assessment. This aims, for one side, to determine the best evidence of efficacy or effectiveness of a given treatment, and, on the other side, to determine the costs associated with this treatment. Only cost-effective alternatives, in other wor...

The present study was motivated by the need to systematically assess the research productivity of the Heart Institute (InCor), Medical School of the University of São Paulo, Brazil. To explore methodology for the assessment of institutional scientific research productivity. Bibliometric indicators based on searches for author affiliation of origina...

OBJETIVO: A crescente utilização de opióides em doentes com dor crônica de etiologias variadas e os possíveis efeitos desses fármacos em atividades diárias suscitam a importância de se avaliar tais efeitos. Com essa finalidade, desenvolveu-se este estudo de revisão sistemática que avaliou a influência de opióides nas funções cognitivas de doentes c...

OBJECTIVE: To investigate the presence of psychiatric disorders in patients with chest pain not responsive to treatment. METHOD: We evaluated 18 patients judged by their physicians to have a chest pain not responsive to usual treatment, which included anti-pain medicines and investigation and treatment of possible etiological causes such as coronar...

The increasing use of opioids by patients suffering from chronic pain caused by different etiologies, and the possible effects of those substances on everyday activities, require careful evaluation of their effects. For this purpose, a systematic review was developed to assess the influence of opioids on the cognitive function in patients with chro...

Health education practices are central to preventing heart disease. The great challenge remains how to promote the adoption of healthy behaviors that can reduce risk factors for heart disease. In São Paulo, Brazil, the Healthy Lifestyle Multiplier Students program is based on studies that train older students ("multipliers") as peer educators for y...

to evaluate the effect of an immersion bath on pain magnitude during the first stage of labour. a randomised controlled trial comparing the pain scores of bathing and non-bathing nulliparous women during birth was employed. the study was conducted at the Normal Birth Center of Amparo Maternal, São Paulo, Brazil. 108 birthing women, with 54 women ra...

INTRODUCTION: Fungating malignant wounds (FMW) is the result of the cutaneous infiltration by cancerous cells and, when exteriorized, they acquire fungating aspect. Malodour, exudate, bleeding, pain and infection are common symptoms, wich are added to the psychological and physical suffering of these patients. The manage of FMW is inserted in the a...

Evidence based practice is the use of the best scientific evidence to support the clinical decision making. The identification of the best evidence requires the construction of an appropriate research question and review of the literature. This article describes the use of the PICO strategy for the construction of the research question and bibliogr...

Health education is important to increase adherence to treatment and the control of patients with hypertension or diabetes, associated to the self-control of blood pressure or glycemia levels, physical activity and diet. The better understanding of the diseases is related to an improvement in quality of life, decrease in the number of decompensatio...

BACKGROUND: To study the prevalence of cardiovascular risk associated to the lifestyle of school children from the 5th to 8th grade, in public and private schools. METHODS: Eighty seven randomly selected school rooms were visited adding up to 2,125 students who completed the questionnaire and whose body mass index was calculated. This sample repres...

To study the prevalence of cardiovascular risk associated to the lifestyle of school children from the 5th to 8th grade, in public and private schools. Eighty seven randomly selected school rooms were visited adding up to 2,125 students who completed the questionnaire and whose body mass index was calculated. This sample represents around 2% of stu...

Clinical decisions in daily practice, to resolve patient's problem, are usually based at the conscious use of the available information, through explicit determined rules. Evidence based clinical practice recognize the explicit and tacit knowledge, understanding that it is impossible all the aspects of professional competence become explicit. The d...

The inadequacy of most of traditional sources for medical information, like textbook and review article, do not sustained the clinical decision based on the best evidence current available, exposing the patient to a unnecessary risk. Although not integrated around clinical problem areas in the convenient way of textbooks, current best evidence from...

We present a pedagogical proposal, which is not common in traditional medical schools. This proposal introduces the graduate student early on to a medical practice observation stage. Second semester students of the medical course were trained to observe patient consultations and interviews with health professionals in a participative way. They deve...

Apresenta-se uma proposta pedagógica, não habitual nas escolas médicas tradicionais, que introduz precocemente o aluno de graduação em um estágio de observação da prática médica. Alunos do segundo semestre do curso médico preparados para fazer uma observação participativa do atendimento aos pacientes e entrevistas com profissionais de saúde, desenv...

Evidence based health care begins with a clinical question and the search on data bases to retrieve the relevant information, that was the issue of two preceding articles of this series. At present it will be discussed how to critically appraise the medical literature using the clinical epidemiological methodology. Clinical research aims to develop...

Evidence based health care begins with a clinical question and the search on data bases to retrieve the relevant information, that was the issue of two preceding articles of this series. At present it will be discussed how to critically appraise the medical literature using the clinical epidemiological methodology. Clinical research aims to develop...

The inadequacy of most of traditional sources for medical information, like textbook and review article, do not sustained the clinical decision based on the best evidence current available, exposing the patient to a unnecessary risk. Although not integrated around clinical problem areas in the convenient way of textbooks, current best evidence from...

Na prática diária as decisões tomadas para resolver o problema do paciente são usualmente baseadas na aplicação consciente da informação avaliável por regras explicitamente definidas. A prática clínica baseada em evidências leva em consideração o reconhecimento dos conhecimentos explícitos e tácitos, entendendo que é impossível tornar explícito tod...

Clinical decisions in daily practice, to resolve patient's problem, are usually based at the conscious use of the available information, through explicit determined rules. Evidence based clinical practice recognize the explicit and tacit knowledge, understanding that it is impossible all the aspects of professional competence become explicit. The d...

O Projeto Diretrizes, iniciativa conjunta da Associação Médica Brasileira e Conselho Federal de Medicina, tem por objetivo conciliar informações da área médica a fim de padronizar condutas que auxiliem o raciocínio e a tomada de decisão do médico. As informações contidas neste projeto devem ser submetidas à avaliação e à crítica do médico, responsá...

O Projeto Diretrizes, iniciativa conjunta da Associação Médica Brasileira e Conselho Federal de Medicina, tem por objetivo conciliar informações da área médica a fim de padronizar condutas que auxiliem o raciocínio e a tomada de decisão do médico. As informações contidas neste projeto devem ser submetidas à avaliação e à crítica do médico, responsá...

To verify whether the guidelines for the treatment of heart failure have been adopted at a university hospital. The guidelines recommend the following: use of angiotensin-converting enzyme inhibitors for all patients with systolic ventricular dysfunction, use of digitalis and diuretics for symptomatic patients, use of beta-blockers for patients in...