Association between disease activity and quality of life among patients with rheumatoid arthritis

Abstract The aim of this study is the association between the scores of disease activity, functional capacity and quality of life among patients diagnosed with rheumatoid arthritis, under clinical treatment at the Regional University Hospital of Campos Gerais - Wallace Thadeu de Mello and Silva. The sample was composed by volunteer patients, who freely underwent 3 research questionnaires. With the results of the survey, the disease activity score was correlated to the functional capacity and the quality-of-life scores. A mean of 3.87 and 1.2 was observed for the disease activity and the functional capacity scores, respectively, yet not achieving a correlation between those two variables. A strong correlation between the disease activity and the "functional capacity", "general health status" and "mental health" domains was found. The lowest average observed corresponded to "physical limitation", from the quality-of-life questionnaire. There was no statistically significant correlation between disease activity and functional capacity, although disease activity seems to affect the mental health, general health status and functional capacity of patients.

Myeloperoxidase as an important predictor of cardiovascular risk in individuals with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis is an inflammatory disease with joint manifestations. In the presence of extra-articular manifestations, the morbidity and severity of the disease increase. Glucocorticoid is used as a treatment and may result in side effects related to cardiovascular risk. METHODS: This was a cross-sectional study including 59 volunteers with rheumatoid arthritis receiving treatment at a hospital of Campos Gerais that aimed to establish the relation between cardiovascular risk, glucocorticoid treatment and myeloperoxidase in these patients. Subjects were divided into two groups: using (n = 39) and without glucocorticoids (n = 20). They underwent clinical evaluation, physical examination and blood samples were taken. Statistical analysis was performed using Student's t test and Mann-Whitney test. Logistic regression was performed to assess the cardiovascular risk. The significance level was 5% (α = 0.05). Calculations were performed using the Statistical Package for the Social Science version 21.0. RESULTS: There has been a significant difference between groups in blood glucose values (p = 0.012), which can be explained by the different percentage of diabetic patients in the groups. When assessing cardiovascular risk using the predictors of glucocorticoid dose, time of glucocorticoid use, myeloperoxidase, and C-reactive protein together, these were responsible for significantly predicting this risk (p = 0.015). CONCLUSION: A significant relation between the predictor myeloperoxidase alone was also demonstrated (p = 0.037), it may be an important predictor of cardiovascular risk among individuals with rheumatoid arthritis.

Fast real-time SDRE controllers using neural networks.

This paper describes the implementation of fast state-dependent Riccati equation (SDRE) control algorithms through the use of shallow and deep artificial neural networks (ANN). Several ANNs are trained to replicate an SDRE controller developed for a satellite attitude dynamics simulator (SADS) to display the technique's efficacy. The neural controllers have reduced computational complexity compared with the original SDRE controller, allowing its execution at a significantly higher rate. One of the neural controllers was validated using the SADS in a practical experiment. The experimental results indicate that the training error is sufficiently small for the neural controller to perform equivalently to the original SDRE controller.

Relationship between corticotherapy and increased cardiac risk in patients with rheumatoid arthritis

Rheumatoid arthritis is an autoimmune inflammatory joint disease with global prevalence of 0.4% to 1.0%. Extra-articular manifestations increase its morbidity and severity, and cardiovascular diseases present the greatest risk. Therapeutic approaches have been used to treat rheumatoid arthritis, often involving the use of multiple classes of drugs with different mechanisms and forms of action. Corticosteroid therapy is widely used in this therapeutic combination; however, its use has been widely questioned because of its high toxicity and some negative effects, including the possibility of increased cardiovascular risk, depending on the dosage. Some studies have provided important insights into how glucocorticoids have an impact on cardiac complications in patients with rheumatoid arthritis. Most of these studies have concluded that exposure to these drugs at high or cumulative doses is associated with increased risk of death, as well as possibly being associated with the presence of a positive rheumatoid factor.

MONARCH plus: abemaciclib plus endocrine therapy in women with HR+/HER2- advanced breast cancer: the multinational randomized phase III study.

AIM: To compare the efficacy, safety, and tolerability of abemaciclib plus endocrine therapy (ET) versus ET alone in postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer (ABC) from China, Brazil, India, and South Africa. METHODS: This randomized, double-blind, phase III study was conducted between 9 December 2016 and 29 March 2019. Postmenopausal women with HR-positive, HER2-negative ABC with no prior systemic therapy in an advanced setting (cohort A) or progression on prior ET (cohort B) received abemaciclib (150 mg twice daily) or placebo plus: anastrozole (1 mg/day) or letrozole (2.5 mg/day) (cohort A) or fulvestrant (500 mg per label) (cohort B). The primary endpoint was progression-free survival (PFS) in cohort A, analyzed using the stratified log-rank test. Secondary endpoints were PFS in cohort B (key secondary endpoint), objective response rate (ORR), and safety. This interim analysis was planned after 119 PFS events in cohort A. RESULTS: In cohort A, 207 patients were randomly assigned to the abemaciclib arm and 99 to the placebo arm. Abemaciclib significantly improved PFS versus placebo (median: not reached versus 14.7 months; hazard ratio 0.499; 95% confidence intervals (CI) 0.346-0.719; p = 0.0001). ORR was 65.9% in the abemaciclib arm and 36.1% in the placebo arm (p < 0.0001, measurable disease population). In cohort B, 104 patients were randomly assigned to the abemaciclib arm and 53 to the placebo arm. Abemaciclib significantly improved PFS versus placebo (median: 11.5 versus 5.6 months; hazard ratio 0.376; 95% CI 0.240-0.588; p < 0.0001). ORR was 50.0% in the abemaciclib arm and 10.5% in the placebo arm (p < 0.0001, measurable disease population). The most frequent grade ⩾3 adverse events in the abemaciclib arms were neutropenia, leukopenia, and anemia (both cohorts), and lymphocytopenia (cohort B). CONCLUSION: The addition of abemaciclib to ET demonstrated significant and clinically meaningful improvement in PFS and ORR, without new safety signals observed in this population.Trial Registration: ClinicalTrials.gov identifier: NCT02763566.

Corporeidade, masculinidades e o cuidado à saúde de homens frequentadores de academias de musculação / Corporeality, masculinities and health care for men who attend weight training gyms / Corporalidad, masculinidades y cuidado de la salud para hombres que asisten a gimnasios de musculación

Apreender o discurso coletivo de homens frequentadores de academias de musculação sobre a corporeidade, as masculinidades e o cuidado à saúde. Método: Estudo descritivo, qualitativo, realizado com 50 homens praticantes de musculação e Cross Training em 10 academias privadas em um município da Bahia, Brasil, entre os meses agosto a outubro de 2017. Os dados foram analisados sob o método do Discurso do Sujeito Coletivo e interpretados à luz dos referenciais teóricos de corporeidade e masculinidades. Resultados: A relação entre a corporeidade, as masculinidades e os cuidados de saúde estão estruturadas no alcance da satisfação corporal que está intimamente ligada ao imaginário social do corpo atlético e esteticamente equilibrado; sob a inspieração de atletas famosos. Há mobilização masculina para realizar transformações corporais de investimento na estética e imagem corporal, influenciada pela prática da musculação e/ou do Cross Training, que também mobilizam a prática de cuidados de saúde corporais e estéticas. Conclusão: Há expressiva concentração masculina da cultura do corpo atlético, influenciado pela prática da musculação e do Cross Training, que os tornam capazes de manter as atividades da vida diária como o trabalho, melhoria do desempenho físico, do controle de doenças e agravos em saúde e do alcance e/ou manutenção do bem-estar e da qualidade de vida.

To apprehend the collective discourse of men who attend gym training centers on corporeality, masculinities and health care. Method: Descriptive, qualitative study, conducted with 50 men practicing weight training and Cross Training in 10 private gyms in a municipality in Bahia, Brazil, between August and October 2017. The data were analyzed using the Collective Subject Discourse method and interpreted in the light of the theoretical references of corporeality and masculinities. Results: The relationship between corporeality, masculinities and health care are structured to achieve body satisfaction that is closely linked to the social imagery of the athletic and aesthetically balanced body; under the inspiration of famous athletes. There is a male mobilization to carry out body transformations of investment in aesthetics and body image, influenced by the practice of bodybuilding and / or Cross Training, which also mobilize the practice of body and aesthetic health care. Conclusion: There is an expressive male concentration of the culture of the athletic body, influenced by the practice of weight training and Cross Training, which make them capable of maintaining activities of daily living such as work, improvement of physical performance, control of diseases and health problems. and the reach and / or maintenance of well-being and quality of life.

Aprehender el discurso colectivo de hombres que asisten a centros de formación de gimnasios sobre corporeidad, masculinidades y cuidados de la salud. Método: Estudio descriptivo, cualitativo, realizado con 50 hombres practicando pesas y Cross Training en 10 gimnasios privados de un municipio de Bahía, Brasil, entre agosto y octubre de 2017. Los datos fueron analizados mediante el método de Discurso Colectivo del Sujeto. e interpretado a la luz de los referentes teóricos de corporalidad y masculinidades. Resultados: La relación entre corporeidad, masculinidades y cuidados de la salud se estructuran para lograr la satisfacción corporal que está estrechamente ligada al imaginario social del cuerpo atlético y estéticamente equilibrado; bajo la inspiración de deportistas famosos. Existe una movilización masculina para realizar transformaciones corporales de inversión en estética e imagen corporal, influenciada por la práctica del culturismo y / o Cross Training, que también movilizan la práctica del cuidado corporal y de la salud estética. Conclusión: Existe una concentración expresiva masculina de la cultura del cuerpo atlético, influenciada por la práctica del entrenamiento con pesas y Cross Training, que los hacen capaces de mantener actividades de la vida diaria como el trabajo, la mejora del rendimiento físico, el control de enfermedades y problemas de salud. y el alcance y / o mantenimiento del bienestar y la calidad de vida.

Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity: The CECCY Trial.

BACKGROUND: Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with ß-blockers remains controversial. OBJECTIVES: This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity. METHODS: The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/m2) to receive carvedilol or placebo until chemotherapy completion. The primary endpoint was prevention of a ≥10% reduction in LVEF at 6 months. Secondary outcomes were effects of carvedilol on troponin I, B-type natriuretic peptide, and diastolic dysfunction. RESULTS: Primary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 ± 3.64 mm to 45.2 ± 3.2 mm vs. 44.9 ± 3.6 mm to 46.4 ± 4.0 mm; p = 0.057). CONCLUSIONS: In this largest clinical trial of ß-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction. (Carvedilol Effect in Preventing Chemotherapy-Induced Cardiotoxicity [CECCY]; NCT01724450).

Relações Entre Ações de uma Invervenção Educativa na Adesão ao Tratamento e no RNI de Pacientes em Uso de Antagonistas de Vitamina K / Relationship Between Educative Intervention on Treatment Adherence and INR of Patients on Vitamin K Antagonists

Avaliar se uma intervenção educacional interfere na adesão ao tratamento, meta terapêutica e frequência de eventos hemorrágicos de pacientes em uso de antagonistas de vitamina K e se características socioeconômicas/clínicas possuem efeito sobre os resultados encontrados. Método: Estudo analítico intervencionista não controlado qualitativo. Foram incluídos 49 pacientes e aplicados os questionários de medida de adesão ao tratamento (MAT) e socioeconômico. Posteriormente foram realizadas ligações mensais educativas sobre anticoagulação e foram coletadas informações sobre eventos hemorrágicos e valores de RNI. Ao termino da intervenção foi aplicado mais um questionário MAT. Foram comparados os dados antes e após a intervenção. Resultados: Os pacientes foram considerados mais aderentes após a intervenção (p=0,04) e houve diminuição na frequência de eventos hemorrágicos (p=0,01), existindo nenhuma relação com as variáveis socioeconômicas ou clínicas. Não houve melhora significativa em relação à meta de RNI (p=0,06), porém o estado civil desses pacientes teve associação com a estabilidade terapêutica (p=0,04). Conclusões: A intervenção melhorou a aderência e diminuiu os eventos hemorrágicos dos pacientes, não tendo influência sobre a meta terapêutica. Pacientes com cônjuge apresentaram melhores metas terapêuticas se comparados aos solteiros. Não houve interferência de outras variáveis socioeconômicas ou clínicas sobre os desfechos encontrados

Objectives: To evaluate if an educational intervention interfere in treatment adherence, therapeutic ranges and hemorrhagic.events of patients on vitamin K antagonists; and if social, economic and clinical.characteristics are associated with the ending points. Methods: It's an interventionist analytic study. 49 patients were included.and an adherence.and social/economic questionnaires were applied. Then, monthly educative phone calls.were performed about anticoagulation and information about hemorrhagic,events and INR were collected. When intervention,were done, another adherence questionnaire was applied. Data before and after intervention were compared. Results: Patients had their adherence improved (p=0,04) and there was a fall on the prevalence,of hemorrhagic events (p=0,01) with,no,social/clinical variables association. There were no significant,changes,on the therapeutic ranges (p=0,06), although there was a relationship,between marital state and INR,stability (p=0,04). Conclusions: Educational intervention increased adherence,and decreased hemorrhagic events. Marital state has been associated with better therapeutic,ranges. No other social, economic.or clinical.variable has been associated with the ending points

The importance of protected areas for conservation of bare-faced curassow (Crax fasciolata spix, 1825) (Galliformes: Cracidae) in the São Paulo State, Brazil / A importância das áreas protegidas na conservação do mutum-de-penacho (Crax fasciolata spix, 1825) (Galliformes: Cracidae) no estado de São Paulo, Brasil

Abstract The Bare-faced Curassow Crax fasciolata (Cracidae:Cracinae) is a vulnerable species that was classified as critically endangered by the São Paulo State -Brazil, in 2008. Specialists recommended "searches for areas where there may be a few remaining populations and protection of the last remaining semideciduous forest in the State". Protected areas were investigated in the Cerrado and semideciduous forest in São Paulo State by camera trapping to evaluate the presence of the Bare-faced Curassow. Eight protected areas in Cerrado biome were investigated, but the Bare-faced Curassows was recorded only at Furnas do Bom Jesus State Park (2,069 ha), São Paulo State despite the large sampling effort in larger protected areas such as the Santa Bárbara Ecological Station (2,712 ha) and Jataí Ecological Station (9,074 ha); the largest protected area of Cerrado biome in São Paulo State. This record of C. fasciolata is important for the Conservation Action Plan for the Cracid family and shows the importance of monitoring biodiversity and conserving even relatively small remnants of native vegetation for the conservation of this species.

Resumo O mutum-de-penacho Crax fasciolata (Cracidae:Cracinae) é uma espécie ameaçada de extinção e foi considerada criticamente em perigo em 2008 no estado de São Paulo. As recomendações dos especialistas para a conservação da espécie no estado foram "a pesquisa por áreas onde poderia existir populações remanescentes e a proteção de remanescentes de floresta semidecidual". Neste trabalho, oito Unidades de Conservação foram investigadas em áreas com vegetação de Cerrado e de floresta semidecidual por meio de armadilhas fotográficas digitais para verificar a presença do mutum-de-penacho (Crax fasciolata). Entretanto, o mutum-de-penacho foi registrado apenas no Parque Estadual Furnas do Bom Jesus, que possui 2.069 ha, apesar do maior esforço amostral em áreas maiores, como a Estação Ecológica de Santa Bárbara (2.712 ha) e Estação Ecológica de Jataí (9.074),- a maior Unidade de Conservação do bioma Cerrado no estado de São Paulo. O registro do mutum-de-penacho no Parque Estadual Furnas do Bom Jesus é muito importante para o Plano de Ação e Conservação da família Cracidae e mostra a importância do monitoramento da biodiversidade e a conservação de remanescentes de vegetação nativa, mesmo pequenos, para a conservação dessa espécie.

Cancer immunology and melanoma immunotherapy

Abstract: The stimulation of the immune system, in order to generate an attack against cancer cells, similarly to that which occurs in infectious disease, has long been matter of interest in oncology; however, only limited success has been achieved, with different treatment strategies tested in recent years. The development of new immune checkpoint inhibitors is currently changing this scenario, and immunotherapy is becoming a real choice among traditional cytotoxic treatments to fight cancer. Recent reports have shown efficacy and safety with the use of pembrolizumab, nivolumab, and ipilimumab for the treatment of different neoplasms, especially melanoma. In this article, we propose a review of the mechanisms of action involved in cancer immunology, the response evaluation of immunotherapies, and its toxicity profile, as well as a summary of the main clinical trials that led to the adoption of these new drugs for melanoma treatment.

Cancer immunology and melanoma immunotherapy.

The stimulation of the immune system, in order to generate an attack against cancer cells, similarly to that which occurs in infectious disease, has long been matter of interest in oncology; however, only limited success has been achieved, with different treatment strategies tested in recent years. The development of new immune checkpoint inhibitors is currently changing this scenario, and immunotherapy is becoming a real choice among traditional cytotoxic treatments to fight cancer. Recent reports have shown efficacy and safety with the use of pembrolizumab, nivolumab, and ipilimumab for the treatment of different neoplasms, especially melanoma. In this article, we propose a review of the mechanisms of action involved in cancer immunology, the response evaluation of immunotherapies, and its toxicity profile, as well as a summary of the main clinical trials that led to the adoption of these new drugs for melanoma treatment.

Cardiac safety of (neo)adjuvant trastuzumab in the community setting: a single-center experience.

BACKGROUND: Trastuzumab improves the survival of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). The incidence and long-term impact of trastuzumab-related cardiotoxicity in the community setting is of great clinical importance. MATERIAL AND METHODS: Patients with HER2-positive BC treated with (neo)adjuvant trastuzumab were retrospectively evaluated. Cardiotoxicity was defined as cardiac death or absolute decrease in left ventricular ejection fraction of at least 10% to a value less than 50%, or symptomatic heart failure. RESULTS: We evaluated 237 patients: median age 53 years (range 27-83 years). 40.5% of these patients had received neoadjuvant and 59.5% adjuvant chemotherapy. The majority (83.9%) were treated with an anthracycline-based regimen. Median exposure to trastuzumab was 8 months (range 2-12 months). Cardiotoxicity was diagnosed in 20.2%, but symptoms only occurred in 3.8%. 41.6% recovered cardiac function. None of the risk factors were associated with cardiotoxicity. CONCLUSION: The incidence of trastuzumab-related cardiotoxicity found in this study was slightly higher than those reported in randomized clinical trials. Nevertheless, most patients were asymptomatic. We describe the cardiac outcomes of a non-selected population, which possibly reflects those found in the 'real world'. The risks versus benefits of trastuzumab use remain in favor of treatment, but cardiotoxicity should be monitored.

Maintenance capecitabine and bevacizumab versus bevacizumab alone after initial first-line bevacizumab and docetaxel for patients with HER2-negative metastatic breast cancer (IMELDA): a randomised, open-label, phase 3 trial.

BACKGROUND: Longer duration of first-line chemotherapy for patients with metastatic breast cancer is associated with prolonged overall survival and improved progression-free survival. We investigated capecitabine added to maintenance bevacizumab after initial treatment with bevacizumab and docetaxel in this setting. METHODS: We did this open-label randomised phase 3 trial at 54 hospitals in Brazil, China, Egypt, France, Hong Kong, India, Italy, Poland, Spain, and Turkey. We enrolled patients with HER2-negative measurable metastatic breast cancer; each received three to six cycles of first-line bevacizumab (15 mg/kg) and docetaxel (75-100 mg/m(2)) every 3 weeks. Progression-free patients were randomly assigned with an interactive voice-response system by block (size four) randomisation (1:1) to receive either bevacizumab and capecitabine or bevacizumab only (bevacizumab 15 mg/kg on day 1; capecitabine 1000 mg/m(2) twice per day on days 1-14, every 3 weeks) until progression, stratified by oestrogen receptor status (positive vs negative), visceral metastases (present vs absent), response status (stable disease vs response vs non-measurable), and lactate dehydrogenase concentration (≤1·5 vs >1·5 × upper limit of normal). Neither patients nor investigators were masked to allocation. The primary endpoint was progression-free survival (from randomisation) in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT00929240. FINDINGS: Between July 16, 2009, and March 7, 2011 (when enrolment was prematurely terminated), 284 patients received initial bevacizumab and docetaxel; 185 (65%) were randomly assigned (91 to bevacizumab and capecitabine versus 94 to bevacizumab only). Progression-free survival was significantly longer in the bevacizumab and capecitabine group than in the bevacizumab only group (median 11·9 months [95% CI 9·8-15·4] vs 4·3 months [3·9-6·8]; stratified hazard ratio 0·38 [95% CI 0·27-0·55]; two-sided log-rank p<0·0001), as was overall survival (median 39·0 months [95% CI 32·3-not reached] vs 23·7 months [18·5-31·7]; stratified HR 0·43 [95% CI 0·26-0·69]; two-sided log-rank p=0·0003). Results for time to progression were consistent with those for progression-free survival. 78 (86%) patients in the bevacizumab and capecitabine group and 72 (77%) in the bevacizumab only group had an objective response. Clinical benefit was recorded in 92 (98%) patients in the bevacizumab alone group and 90 (99%) in the bevacizumab and capecitabine group. Mean change from baseline in global health score did not differ significantly between groups. Grade 3 or worse adverse events during the maintenance phase were more common with bevacizumab and capecitabine than with bevacizumab only (45 [49%] of 91 patients vs 25 [27%] of 92 patients). The most common grade 3 or worse events were hand-foot syndrome (28 [31%] in the bevacizumab and capecitabine group vs none in the bevacizumab alone group), hypertension (eight [9%] vs three [3%]), and proteinuria (three [3%] vs four [4%]). Serious adverse events were reported by ten (11%) patients in the bevacizumab and capecitabine group and seven (8%) patients in the bevacizumab only group. INTERPRETATION: Despite prematurely terminated accrual and the lack of information about post-progression treatment, both progression-free survival and overall survival were significantly improved with bevacizumab and capecitabine compared with bevacizumab alone as maintenance treatment. These results might inform future maintenance trials and current first-line treatment strategies for HER2-negative metastatic breast cancer. FUNDING: F Hoffmann-La Roche.

Características clínico-epidemiológicas dos atendimentos do pronto-socorro psiquiatrico do Hospital Säo Vicente de Paulo em 1995 / Clinical-Epidemiological Characteristics of the Population Assisted in the Psychiatric Emergency Room of the Sao Vicente de Paulo Hospital in 1995

Foi realizado um estudo descritivo avaliando os atendimentos do pronto-socorro do Hospital Sao Vicente de Paulo, especializado em psiquiatria, no periodo de 01/01/95 a 31/12/95, os quais totalizaram 12.337. O estudo foi feito selecionando-se uma amostra aleatoria e sistematica de 950 Guias de Atendimento de Emergencia (GAE), as quais corresponderam a 7,7 por cento do total de atendimentos. Buscou-se identificar os atendimentos nao caracterizados como emergencia psiquiatrica, verificando sua procedencia e outras caracteristicas como sexo, idade, horario de chegada no hospital. o esudo constatou que 43,47 por cento dos atendimentos do Pronto-Socorro do Hospital Sao Vicente de Paulo nao se caracterizam como emergencia e que Ceilandia contribui com 29,2 por cento da demanda geral e o entorno com 18,4 por cento. Quanto as caracteristicas pessoais dos pacientes, observou-se que nao houve predominancia de um sexo em relacao ao outro e que as faixas etarias predominantes foram as de 25 a 35 anos e de 35 a 45 anos, respectivamente, por 30,8 por cento e 25,7 por cento. O conhecimento do perfil dos atendimentos pode subsidiar a reestruturacao dos servicos, proposta pela reforma psiquiatrica e pela III Conferencia de Saude do DF.