FREDERICO LEON ARRABAL FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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- Comparação entre medidas objetivas do tabagismo e tabagismo autodeclarado em pacientes com asma ou DPOC: será que nossos pacientes dizem a verdade?(2015) STELMACH, Rafael; FERNANDES, Frederico Leon Arrabal; CARVALHO-PINTO, Regina Maria; ATHANAZIO, Rodrigo Abensur; RACHED, Samia Zahi; PRADO, Gustavo Faibischew; CUKIER, AlbertoObjective: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. Methods: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. Results: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. Conclusions: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management and counseling.
conferenceObject Heart rate and ventilation in a group of burned sugar cane cutters (Brazil): Estimative of particulate matter (PM2,5) exposure load(2012) COZZA, Izabela; NAMBU, Danilo; FERNANDES, Frederico; BUSSACOS, Marcos; PACELI, Renato; PRADO, Gustavo; TERRA-FILHO, Mario; SANTOS, Ubiratan- A real-life study of the effectiveness of different pharmacological approaches to the treatment of smoking cessation: re-discussing the predictors of success(2011) PRADO, Gustavo Faibischew; LOMBARDI, Elisa Maria Siqueira; BUSSACOS, Marco Antonio; ARRABAL-FERNANDES, Frederico Leon; TERRA-FILHO, Mario; SANTOS, Ubiratan de PaulaOBJECTIVE: To evaluate the effectiveness of nicotine replacement therapy (NRT), bupropion, nortriptyline and combination therapy and describe factors associated with treatment success. INTRODUCTION: Clinical trials clearly demonstrate the efficacy of pharmacotherapy in smoking cessation. However, it is only after its use in real-life settings that clinical effectiveness and limitations of a treatment are fully known. METHODS: Patients attended a four-session cognitive-behavioral program and received medicines free of charge. Abstinence from smoking was assessed at each visit. RESULTS: A total of 868 smokers (68.8% women) were included. Their mean age was 49.6 years; the amount smoked was 25 cigarettes/day and the Fagerstrom Score was 6.6. Abstinence rates after 6 months and 1 year were 36.5% and 33.6%. In univariate analysis, male gender, age (> 50), higher number of cigarettes smoked, cardiovascular comorbidities, longer interval from the last cigarette and combined treatment of nortriptyline plus NRT were predictive of abstinence, while neuropsychiatric comorbidities and the answer ""yes'' to the question ""Do you smoke more often during the first hours after waking'' were correlated with failure. In a multivariate model, predictors of abstinence were neuropsychiatric comorbidities, the answer ""yes'' to the question ""Do you smoke more often during the first hours after waking'' and combined treatment of nortriptyline plus NRT. Male gender and a longer period from the last cigarette were correlated with lower abstinence rate. CONCLUSION: Satisfactory success rates were obtained in a teaching hospital. Factors such as age, daily cigarette consumption, number of pack-years and dependency score were not reliable markers of abstinence. The combination nortriptyline+NRT was independently associated with higher abstinence rates.
- Knowledge of and attitudes toward the WHO MPOWER policies to reduce tobacco use at the population level: a comparison between third-year and sixth-year medical students(2021) MARTINS, Stella Regina; SZKLO, Andre Salem; BUSSACOS, Marco Antonio; PRADO, Gustavo Faibischew; PACELI, Renato Batista; FERNANDES, Frederico Leon Arrabal; LOMBARDI, Elisa Maria Siqueira; BASSO, Rafaela Giunti; TERRA-FILHO, Mario; SANTOS, Ubiratan PaulaObjective: To evaluate third- and sixth-year medical students in Brazil in terms of their knowledge of and attitudes toward the WHO MPOWER policies to reduce tobacco use. Methods: The WHO Global Health Professions Student Survey was applied in five cohorts of medical students evaluated in their third and sixth years of medical school, between 2008 and 2015. Comparisons were drawn between the two years of medical school in terms of the proportions of students who experimented with or used tobacco products in the last 30 days prior to the survey; knowledge of and compliance with smoke-free policies on the university campus; formal training on smoking cessation strategies; and self-recognition as role models for patients/society. Results: Of the 943 students who completed the survey, approximately 6% had smoked cigarettes in the last 30 days prior to the survey. Comparing the third and sixth years of medical school, we observed a significant increase in the proportion of students who were knowledgeable about smoking cessation strategies (22.74% vs. 95.84%; p < 0.001) and in that of those who recognized their role as models for patients/society (84.5% vs. 89.7%; p = 0.023). Student knowledge of the smoking policies on the university campus was associated with an increase in self-recognition as role models (adjusted absolute difference = 6.7%; adjusted p = 0.050). Conclusions: Knowledge of smoking cessation strategies and self-recognition as role models for patients/society increase over the course of medical school and are associated with the implementation of smoke-free policies.
conferenceObject CT-guided biopsy of lung lesions: Experience of an oncology center in Brazil(2012) MORAIS, Anna; MAIORANO, MariaCecilia; PUKA, Juliana; FERNANDES, Caio; FERNANDES, Frederico; PRADO, Gustavo; TAKAGAKI, TeresaconferenceObject Prospective analysis among medical school of University of Sao Paulo: GHPSS (2008/2011)(2012) PACELI, Renato; MARTINS, Stella; PRADO, Gustavo; MORAIS, Anna; LOMBARDI, Elisa; FERNANDES, Frederico; TERRA-FILHO, Mario; SANTOS, Ubiratan- An approach to using heart rate monitoring to estimate the ventilation and load of air pollution exposure(2015) COZZA, Izabela Campos; ZANETTA, Dirce Maria Trevisan; FERNANDES, Frederico Leon Arrabal; ROCHA, Francisco Marcelo Monteiro da; ANDRE, Paulo Afonso de; GARCIA, Maria Lucia Bueno; PACELI, Renato Batista; PRADO, Gustavo Faibischew; TERRA-FILHO, Mario; SALDIVA, Paulo Hilario do Nascimento; SANTOS, Ubiratan de PaulaBackground: The effects of air pollution on health are associated with the amount of pollutants inhaled which depends on the environmental concentration and the inhaled air volume. It has not been clear whether statistical models of the relationship between heart rate and ventilation obtained using laboratory cardiopulmonary exercise test (CPET) can be applied to an external group to estimate ventilation. Objectives: To develop and evaluate a model to estimate respiratory ventilation based on heart rate for inhaled load of pollutant assessment in field studies. Methods: Sixty non-smoking men; 43 public street workers (public street group) and 17 employees of the Forest Institute (park group) performed a maximum cardiopulmonary exercise test (CPET). Regression equation models were constructed with the heart rate and natural logarithmic of minute ventilation data obtained on CPET. Ten individuals were chosen randomly (public street group) and were used for external validation of the models (test group). All subjects also underwent heart rate register, and particulate matter (PM2.5) monitoring for a 24-hour period. Results: For the public street group, the median difference between estimated and observed data was 0.5 (CI 95% -0.2 to 1.4) l/min and for the park group was 0.2 (CI 95% -0.2 to 1.2) l/min. In the test group, estimated values were smaller than the ones observed in the CPET, with a median difference of -2.4 (CI 95% -4.2 to -1.8) l/min. The mixed model estimated values suggest that this model is suitable for situations in which heart rate is around 120-140 bpm. Conclusion: The mixed effect model is suitable for ventilation estimate, with good accuracy when applied to homogeneous groups, suggesting that, in this case, the model could be used in field studies to estimate ventilation. A small but significant difference in the median of external validation estimates was observed, suggesting that the applicability of the model to external groups needs further evaluation.
- Effective tobacco control measures: agreement among medical students(2017) MARTINS, Stella Regina; PACELI, Renato Batista; BUSSACOS, Marco Antonio; FERNANDES, Frederico Leon Arrabal; PRADO, Gustavo Faibischew; LOMBARDI, Elisa Maria Siqueira; TERRA-FILHO, Mario; SANTOS, Ubiratan Paula
- Experimentation with and knowledge regarding water-pipe tobacco smoking among medical students at a major university in Brazil(2014) MARTINS, Stella Regina; PACELI, Renato Batista; BUSSACOS, Marco Antonio; FERNANDES, Frederico Leon Arrabal; PRADO, Gustavo Faibischew; LOMBARDI, Elisa Maria Siqueira; TERRA-FILHO, Mario; SANTOS, Ubiratan PaulaObjective: Water-pipe tobacco smoking is becoming increasingly more common among young people. The objective of this study was to estimate the prevalence of the use of water pipes and other forms of tobacco use, including cigarette smoking, among medical students, as well as to examine the attitudes, beliefs, and knowledge of those students regarding this issue. Methods: We administered a questionnaire to students enrolled in the University of Sao Paulo School of Medicine, in Sao Paulo, Brazil. The respondents were evaluated in their third and sixth years of medical school, between 2008 and 2013. Comparisons were drawn between the two years. Results: We evaluated 586 completed questionnaires. Overall, the prevalence of current cigarette smokers was low, with a decline among males (9.78% vs. 5.26%) and an increase among females (1.43% vs. 2.65%) in the 3rd and 6th year, respectively. All respondents believed that health professionals should advise patients to quit smoking. However, few of the medical students who smoked received physician advice to quit. Experimentation with other forms of tobacco use was more common among males (p<0.0001). Despite their knowledge of its harmful effects, students experimented with water-pipe tobacco smoking in high proportions (47.32% and 46.75% of the third- and sixth-year students, respectively). Conclusions: The prevalence of experimentation with water-pipe tobacco smoking and other forms of tobacco use is high among aspiring physicians. Our findings highlight the need for better preventive education programs at medical schools, not only to protect the health of aspiring physicians but also to help them meet the challenge posed by this new epidemic.
- Women and smoking: Risks, impacts, and challenges(2011) LOMBARDI, Elisa Maria Siqueira; PRADO, Gustavo Faibichew; SANTOS, Libiratan de Paula; FERNANDES, Frederico Leon ArrabalSmoking among women has drawn increasing attention because of the increase (or less pronounced decrease) in its prevalence when compared with that observed for men, as well as because of the specific effects that smoking has on women's health. For the 2010 ""World No Tobacco Day"", the World Health Organization chose the theme ""Gender and tobacco with an emphasis on marketing to women"", with the aim of encouraging policies to combat marketing strategies employed by the tobacco industry and to curb the epidemic of smoking among women. In this article, we discuss the characteristics of smoking among women, addressing factors such as smoking prevalence, nicotine dependence, the role of the tobacco industry, health risks, approaches to smoking cessation, treatment strategies, and prevention measures.