CHIN AN LIN
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- The right to vaccination and the individual duty in collective health during a pandemic(2022) FRANCO, Juliana Bertoldi; GUTIERREZ, Pilar Lecussan; CABAR, Fabio Roberto; LIN, Chin An
- Bioethical principles and values during pandemics(2020) LIN, Chin An; GRUNSPUN, Henrique; NAZARETH, Janice Caron; OLIVEIRA, Reinaldo Ayer de
- Medical resident-centred supervision and burnout prevention(2020) NUNES, Maria do Patrocinio Tenorio; LIN, Chin An; SANTOS, Renato Antunes dos
- External validity of type 2 diabetes clinical trials on cardiovascular outcomes for a multimorbid population(2021) LAZAR NETO, Felippe; MENDES, Thiago Bosco; MATOS, Paulo Marcelo Pontes Gomes; OLIVEIRA, Julio Cesar de; FAVARATO, Maria Helena Sampaio; LIN, Chin An; MARTINS, Milton ArrudaAim: 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.
- Acupuncture for Climacteric-Like Symptoms in Breast Cancer Improves Sleep, Mental and Emotional Health: A Randomized Trial(2022) D'ALESSANDRO, Eduardo Guilherme; SILVA, Alexandre Valotta da; CECATTO, Rebeca Boltes; BRITO, Christina May Moran de; AZEVEDO, Raymundo Soares; LIN, Chin AnObjective: 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.
- A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture(2015) PAI, Hong Jin; AZEVEDO, Raymundo Soares; BRAGA, Alfesio Luis Ferreira; MARTINS, Lourdes Conceicao; SARAIVA-ROMANHOLO, Beatriz M.; MARTINS, Milton de Arruda; LIN, Chin AnOBJECTIVES: This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma. METHODS: This was a randomized, controlled, crossover trial conducted at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. A total of 74 patients withmild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short-and long-acting beta-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (alpha=0.05). RESULTS: In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0.001) and vitality (p=0.019). Sham acupuncture also led to significant differences in symptoms, but these were not different from those seen with real acupuncture. Spirometry and exhaled NO levels did not show a difference between sham and real acupuncture treatment. In addition, no significant difference was demonstrated between treatments regarding the quality of life evaluation. CONCLUSION: Real and sham acupuncture have different effects and outcomes on asthma control. The crossover approach was not effective in this study because both interventions led to improvement of asthma symptoms, quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.
- Contributions of residents from multiple specializations in managing the COVID-19 pandemic in the largest public hospital Brazil(2020) BAPTISTA, Fabiola Vieira Duarte; AGUIAR, Marilia Ribeiro de Azevedo; MOREIRA, Joanne Alves; SOUSA, Felipe Carvalho Barros; PLENNS, Glauco Cabral Marinho; SIMAO, Raif Restivo; RUFFINI, Vitor Maia Teles; LIN, Chin An; NUNES, Maria do Patrocinio Tenorio
- Scarce Resource Allocation for Critically ill Patients During the COVID-19 Pandemic: A Public Health Emergency in Sao Paulo Brazil(2021) LIN, Chin An; FRANCO, Juliana Bertoldi; RIBEIRO, Sabrina Correa da Costa; DADALTO, Luciana; LETAIF, Leila Suemi Harima
- Association between Traffic Air Pollution and Reduced Forced Vital Capacity: A Study Using Personal Monitors for Outdoor Workers(2016) SANTOS, Ubiratan Paula; GARCIA, Maria Lucia Siqueira Bueno; BRAGA, Alfesio Luis Ferreira; PEREIRA, Luiz Alberto Amador; LIN, Chin An; ANDRE, Paulo Afonso de; ANDRE, Carmen Diva Saldiva de; SINGER, Julio da Motta; SALDIVA, Paulo Hilario NascimentoBackground 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 Sao 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 mu g/m(3)), those with the highest level of exposure (all measures >39.6 mu g/m(3)) 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.
- The applicability of the ""surprise question"" as a prognostic tool in patients with severe chronic comorbidities in a university teaching outpatient setting(2023) LIN, C. A.; PIRES, P. P.; FREITAS, L. V.; REIS, P. V. S.; SILVA, F. D.; HERBST, L. G.; NUNES, R.; LIN, C. J.; NUNES, M. P. T.Background Life expectancy in recent decades has increased the prevalence of chronic diseases in the population, requiring an approach to new health topics, such as discussions on quality of life and expectations about death and dying. The concept of advance directives (ADs) gives individuals the opportunity to make known their decisions about the treatments they would like to receive at the end of life. Despite the recognition of relevance in clinical practice, the applicability of the concept presents challenges, including establishing the appropriate prognosis for each patient and the ideal time to approach the patient. Some prognostic tools were developed, such as the surprise question (SQ): ""Would you be surprised if your patient died in 12 months?"", which is used in some clinical settings to predict patient deaths and to make decisions regarding ADs. The main objective of the present study was to evaluate the behavior of second-year resident physicians (PGY-2) when the SQ was applied. Method In our observational study, from July 1, 2016, to February 28, 2017, (PGY-2) in the Internal Medicine Residency Program (IMRP) applied SQ to all patients with multiple and varied chronic no communicable comorbidities, who were followed up at the general medicine outpatient clinic (GMOC) of a tertiary university hospital in Sao Paulo- Brazil. The frequency of the outcome (death or non-death within 12 months) was analyzed by correlating it with the clinical data (impact of the studied variables). Results Eight hundred forty patients entered the study. Fitfty-two of them (6.2%) died within one year. PGY-2 predicted that two hundred and fourteen patients (25.5% of total) would die within a year (answer No to SQ), of which, 32 (14.9%) did so. The correct residents' prognosis for the subgroup of 626 patients (answer ""Yes"" to SQ) was NPV = 96.8% (CI = 95.4%-98.2%) and PPV = 14.9% (CI 10.1%-19, 6%). Answering ""Yes"" to SQ correlated negatively to addressing AD while the outcomes death and the answer No to SQ were positively correlated, according to the number of comorbidities. Conclusion The SQ, in addition to care, contributed to health education, communication and care planning shared by the doctor and patient.