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a incapacidade &#233; compar&#225;vel a outras condi&#231;&#245;es cr&#244;nicas&#44; como artrite reumatoide&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> e esclerose m&#250;ltipla&#44; e seu tratamento &#233; &#224;s vezes desafiador&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Devido ao comprometimento multissist&#234;mico&#44; e n&#227;o apenas cut&#226;neo e articular&#44; diversas considera&#231;&#245;es devem ser contabilizadas em seu tratamento&#44; o que inegavelmente se traduz em custos tanto para o sistema de sa&#250;de quanto para os pacientes&#58; tratamentos m&#250;ltiplos ou combinados&#44; tratamentos mais caros&#44; consultas ambulatoriais e emergenciais causadas pela doen&#231;a ou suas complica&#231;&#245;es e hospitaliza&#231;&#245;es que podem ser prolongadas&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Nos Estados Unidos&#44; o custo total anual de cuidados de sa&#250;de para todas as causas foi de 33&#44;82 USD &#40;d&#243;lares americanos&#41; para os que interropem o plano de sa&#250;de e 60&#44;73 USD para aqueles que mudam de plano de sa&#250;de&#44; com cerca de 20&#37; desse custo n&#227;o relacionado &#224;s despesas com os medicamentos prescritos&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Os aspectos econ&#244;micos da sa&#250;de s&#227;o cada vez mais importantes em todos os sistemas de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Na Col&#244;mbia&#44; em decorr&#234;ncia das defici&#234;ncias no sistema de sa&#250;de&#44; os pacientes t&#234;m maior probabilidade de incorrer em despesas do pr&#243;prio bolso&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> As despesas do pr&#243;prio bolso relacionadas &#224; sa&#250;de referem&#8208;se a custos com transporte para consultas m&#233;dicas&#44; alimenta&#231;&#227;o&#44; copagamento&#44; compra de medicamentos ou qualquer servi&#231;o ou exame que n&#227;o &#233; coberto pelo sistema de sa&#250;de e deve ser pago pelo pr&#243;prio paciente&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Particularmente&#44; incorrer nessas despesas parece ser catastr&#243;fico por causa da falta de cobertura de sa&#250;de para pacientes desempregados&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> At&#233; agora&#44; os estudos de custos da psor&#237;ase t&#234;m sido realizados principalmente junto com a avalia&#231;&#227;o da efic&#225;cia dos tratamentos biol&#243;gicos&#46; Estudos de custos na pr&#225;tica cl&#237;nica di&#225;ria s&#227;o escassos&#44; e os poucos existentes enfocam os custos diretos da doen&#231;a&#44; com poucas&#44; mas importantes informa&#231;&#245;es sobre os custos indiretos&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Por exemplo&#44; 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Col&#244;mbia&#41; de setembro de 2018 a mar&#231;o de 2019&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Todos os pacientes com mais de 18 anos de idade&#44; com diagn&#243;stico de psor&#237;ase leve e moderada&#8208;grave com qualquer uma de suas variantes cl&#237;nicas foram considerados eleg&#237;veis e convidados a participar&#46; Os pacientes foram exclu&#237;dos caso se recusassem a participar ou n&#227;o pudessem comparecer &#224;s consultas do estudo&#46; O tamanho da amostra foi obtido por conveni&#234;ncia&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O resultado prim&#225;rio foi a medida das despesas do pr&#243;prio bolso em pacientes com psor&#237;ase&#46; As despesas do pr&#243;prio bolso foram medidas por um question&#225;rio que levou em considera&#231;&#227;o vari&#225;veis econ&#244;micas quantitativas&#44; tais como&#58; dinheiro total gasto nos &#250;ltimos seis meses em produtos m&#233;dicos&#44; como term&#244;metros&#44; seringas&#44; agulhas&#44; compressas&#44; gaze&#44; algod&#227;o&#44; medicamentos&#44; consultas m&#233;dicas&#44; alimentos comprados durante o comparecimento &#224;s consultas m&#233;dicas&#44; copagamentos de consultas m&#233;dicas ou fototerapia&#44; consultas m&#233;dicas privadas em medicina geral&#44; especialistas&#44; medicina alternativa e&#47;ou psicologia&#44; transporte &#40;&#244;nibus&#44; t&#225;xi&#44; metr&#244;&#44; ve&#237;culo pr&#243;prio&#44; caminhada ou outros&#41;&#44; e&#47;ou hospedagem&#44; no caso de consultas em outras cidades ou munic&#237;pios&#46; Os produtos m&#233;dicos foram calculados de acordo com os pre&#231;os das farm&#225;cias e o dinheiro medido em pesos colombianos &#40;PC&#41; e convertido para d&#243;lares americanos &#40;USD&#41;&#44; de acordo com a taxa de c&#226;mbio representativa do mercado &#40;Fonte&#58; Banco de la Rep&#250;blica de Colombia&#59; Valor de c&#226;mbio&#58; 3177&#44;94 PC em 24 de abril de 2019&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Outras vari&#225;veis econ&#244;micas e cl&#237;nicas como situa&#231;&#227;o ocupacional &#40;empregado&#44; desempregado ou aposentado&#41;&#44; causa do desemprego&#44; se aplic&#225;vel &#40;por doen&#231;a ou outra causa&#41;&#44; absente&#237;smo no trabalho&#44; medido em n&#250;mero de dias que o paciente n&#227;o trabalhou devido &#224; doen&#231;a nos &#250;ltimos seis meses&#44; com ou sem licen&#231;a m&#233;dica&#59; &#205;ndice de &#193;rea e Gravidade da Psor&#237;ase &#40;PASI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Area and Severity Index of Psoriasis</span>&#41;&#44; &#205;ndice de Qualidade de Vida Dermatol&#243;gica &#40;DLQI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Dermatological Quality of Life Index</span>&#41;&#44; que avalia 10 quest&#245;es em rela&#231;&#227;o ao impacto da doen&#231;a cut&#226;nea nas esferas social&#44; familiar&#44; sexual e laboral&#44; respondendo&#58; muit&#237;ssimo &#40;3 pontos&#41;&#44; muito &#40;2 pontos&#41;&#44; pouco &#40;1 ponto&#41; e nada &#40;0 pontos&#41; com um escore final entre 0&#8208;30&#44; sendo 0 o menor comprometimento na qualidade de vida e 30 o m&#225;ximo&#59; tempo de evolu&#231;&#227;o da doen&#231;a em anos&#44; comorbidades &#40;diabetes&#44; hipertens&#227;o&#44; dislipidemia&#44; s&#237;ndrome metab&#243;lica&#44; doen&#231;a cardiovascular&#44; obesidade&#44; c&#226;ncer&#44; outros&#41;&#44; tipo de tratamento &#40;t&#243;pico&#44; sist&#234;mico&#44; fototerapia&#44; biol&#243;gico&#44; outros ou nenhum&#41; e causa de abandono do tratamento&#44; se aplic&#225;vel &#40;custos&#44; transporte&#44; cuidado insuficiente&#44; falta de disponibilidade de consultas&#44; desfilia&#231;&#227;o do provedor de servi&#231;o de sa&#250;de&#44; outras causas&#41; tamb&#233;m foram considerados na pesquisa&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Todos os pacientes com psor&#237;ase foram convidados a participar e submetidos a um exame f&#237;sico completo e a um question&#225;rio&#44; que foram conduzidos por um residente de dermatologia do terceiro ano&#44; previamente treinado&#46; Para reduzir os vieses de informa&#231;&#227;o&#44; os pacientes foram sensibilizados sobre a relev&#226;ncia da veracidade das informa&#231;&#245;es&#46; Um teste piloto foi realizado em cinco pacientes a fim de determinar o desempenho do examinador ao utilizar o protocolo padronizado e para verificar a compreens&#227;o dos pacientes sobre o objetivo do estudo e as informa&#231;&#245;es necess&#225;rias&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A an&#225;lise descritiva das despesas do pr&#243;prio bolso&#44; caracter&#237;sticas sociodemogr&#225;ficas e cl&#237;nicas dos pacientes foi realizada por meio de frequ&#234;ncias absolutas e relativas para as vari&#225;veis qualitativas e m&#233;dia&#44; mediana&#44; desvio&#8208;padr&#227;o e intervalo para as quantitativas&#46; A rela&#231;&#227;o das caracter&#237;sticas dos pacientes com as despesas do pr&#243;prio bolso foi analisada com modelos lineares generalizados&#44; fam&#237;lia gaussiana&#44; identidade de v&#237;nculo&#46; S&#227;o apresentadas diferen&#231;as m&#233;dias brutas e ajustadas por PASI&#44; DLQI&#44; situa&#231;&#227;o ocupacional&#44; tratamento com intervalos de confian&#231;a de 95&#37; &#40;IC95&#37;&#41; e valores de p&#46; A signific&#226;ncia estat&#237;stica foi estabelecida em 0&#44;05&#46; As an&#225;lises estat&#237;sticas foram realizadas no software SPSS&#44; vers&#227;o 21 licenciado pela Universidade CES&#46; Este estudo foi aprovado pelo Comit&#234; de Pesquisa e &#201;tica da Universidade CES&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Dos 100 pacientes que participaram do estudo&#44; 49&#37; eram mulheres&#46; A m&#233;dia de idade foi de 54&#44;7 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44;1&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; O n&#237;vel de escolaridade apresentou propor&#231;&#245;es iguais de pacientes com Ensino Superior &#40;universidade&#41; <span class="elsevierStyleItalic">versus</span> pacientes com Ensino Fundamental I&#44; Fundamental II&#44; Ensino M&#233;dio e sem nenhuma escolaridade&#59; 99&#37; dos pacientes eram filiados a um sistema de sa&#250;de&#44; 80&#37; deles como contribuintes&#59; 54&#37; dos pacientes estavam empregados&#44; dos quais oito faltaram ao trabalho&#44; tr&#234;s com licen&#231;a m&#233;dica e cinco sem licen&#231;a&#46; Os restantes 46&#37; eram aposentados ou estavam desempregados na mesma propor&#231;&#227;o&#44; com apenas 2&#37; atribuindo isso &#224; psor&#237;ase&#46; A m&#233;dia dos escores do PASI e do DLQI foi de 4&#44;8 e 7&#44;2&#44; respectivamente&#44; como mostrado na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">A maior parte das despesas do pr&#243;prio bolso foi utilizada para compra de medicamentos e transporte de &#244;nibus&#44; no valor m&#225;ximo de at&#233; 440&#44;50 e 528&#44;60 USD&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Os pacientes gastam em m&#233;dia 13&#44;38 USD com o transporte de &#244;nibus&#46; A m&#233;dia das despesas do pr&#243;prio bolso relacionada a cuidados m&#233;dicos medidos em 2019 para produtos m&#233;dicos&#44; medicamentos&#44; exames e alimenta&#231;&#227;o foi de 1&#44;85&#44; 63&#44;20&#44; 1&#44;50 e 2&#44;35 USD&#44; respectivamente&#46; Em rela&#231;&#227;o a copagamentos m&#233;dicos para consultas ou sess&#245;es de fototerapia&#44; o custo foi de 3&#44;36 e 0&#44;57 USD&#46; As consultas particulares com m&#233;dico da fam&#237;lia&#44; especialistas&#44; medicina alternativa e psicologia mostraram uma m&#233;dia de 2&#44;77&#44; 2&#44;02&#44; 1&#44;82 e 0&#44;62 USD&#44; respetivamente&#46; Entre os 100 participantes&#44; a despesa total foi de 11&#46;131&#44;90 USD no per&#237;odo de seis meses&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">As diferen&#231;as nas m&#233;dias dos fatores associados &#224;s despesas do pr&#243;prio bolso relacionadas &#224; assist&#234;ncia m&#233;dica s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; Primeiramente&#44; foi realizada uma an&#225;lise bruta das vari&#225;veis&#44; na qual as vari&#225;veis PASI e fototerapia foram significativas&#46; Ao ajustar o modelo para as vari&#225;veis PASI&#44; DLQI&#44; situa&#231;&#227;o ocupacional e tratamento&#44; apenas as vari&#225;veis DLQI e fototerapia foram significativas&#46; Para o DLQI&#44; a diferen&#231;a m&#233;dia foi 5&#44;42 com um intervalo de confian&#231;a de 95&#37; &#40;IC 95&#37;&#58; 1&#44;57&#8208;9&#44;28&#41;&#59; isso significa que para cada aumento de um ponto no DLQI&#44; as despesas do pr&#243;prio bolso aumentam em 5&#44;42 USD em um per&#237;odo de seis meses&#46; Al&#233;m disso&#44; a fototerapia tamb&#233;m apresentou diferen&#231;a estatisticamente significativa nas m&#233;dias&#44; em compara&#231;&#227;o a n&#227;o ter nenhum tipo de tratamento&#44; com diferen&#231;a m&#233;dia de 33&#44;38 &#40;IC 95&#37;&#58; 8&#44;64&#8208;58&#44;14&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0065" class="elsevierStylePara elsevierViewall">Neste estudo&#44; objetivamos quantificar as despesas do pr&#243;prio bolso em pacientes com psor&#237;ase e analisar sua rela&#231;&#227;o com as caracter&#237;sticas ocupacionais dos pacientes em uma coorte de um Ambulat&#243;rio de Dermatologia&#46; Identificamos que o principal gasto do pr&#243;prio bolso &#233; com rem&#233;dios&#44; transporte e copagamento de consultas m&#233;dicas&#44; e as principais caracter&#237;sticas associadas com as despesas do pr&#243;prio bolso foram o DLQI e o tratamento com fototerapia&#46; Documentamos um total de 11&#46;131&#44;90 USD gastos nos &#250;ltimos seis meses entre os 100 participantes&#46; A maior parte das despesas do pr&#243;prio bolso foi destinada &#224; compra de medicamentos e transporte&#44; com valor m&#225;ximo de 440&#44;50 e 528&#44;60 USD&#44; respectivamente&#46; Os pacientes gastaram em m&#233;dia 13&#44;38 USD em transporte de &#244;nibus&#46; A m&#233;dia dos gastos foi de 111&#44;30 USD por paciente em um per&#237;odo de seis meses&#46; Nossos achados s&#227;o consistentes com estudos anteriores&#44; que documentaram comportamento semelhante em rela&#231;&#227;o &#224;s despesas do pr&#243;prio bolso&#46; Em um estudo realizado nos Estados Unidos&#44; Javitz et al&#46; relataram despesas do pr&#243;prio bolso semelhantes&#44; de 356&#44;00 USD por paciente por ano&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Outros estudos mostraram despesas do pr&#243;prio bolso&#44; como 706&#44;00 USD por paciente em um per&#237;odo de seis meses&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> e at&#233; 1&#46;255&#44;00 USD <span class="elsevierStyleItalic">vs</span>&#46; 913&#44;00 USD em pacientes n&#227;o psori&#225;sicos com um p estatisticamente significativo de 0&#44;001&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Al&#233;m disso&#44; Gunnarson descreveu um estudo australiano que relatou despesas anuais do pr&#243;prio bolso para medicamentos isentos de prescri&#231;&#227;o &#40;MIP&#41; e medicamentos prescritos de aproximadamente 250&#44;00 AUD &#40;d&#243;lares australianos&#41; por pessoa&#44; no per&#237;odo de 1997 a 1999&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Nos Estados Unidos&#44; tamb&#233;m foram realizados estudos medindo os custos diretos e indiretos em rela&#231;&#227;o &#224; psor&#237;ase&#44; os maiores at&#233; agora&#44; publicados em 2008&#44; onde se constatou que os custos indiretos chegavam a 2&#46;748&#44;00 USD por ano por trabalhador&#44; superando at&#233; mesmo doen&#231;as gastrintestinais graves como colite ulcerativa&#44; refluxo gastroesof&#225;gico&#44; doen&#231;a diverticular e &#250;lcera p&#233;ptica&#44; compar&#225;vel &#224;queles descritos no estudo de Schmitt e Ford&#44; no qual foram relatados gastos de 2&#46;571&#44;00 USD por trabalhador por ano&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Na Su&#237;&#231;a&#44; o custo com despesas do pr&#243;prio bolso e consultas ambulatoriais no ano de 2005 foi de 1&#46;141&#44;00 a 7&#46;957&#44;00 euros por paciente por ano&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Moreno et al&#46; consideraram custos indiretos relacionados a licen&#231;a m&#233;dica&#44; aposentadoria precoce&#44; assist&#234;ncia ao paciente e despesas do pr&#243;prio bolso pagas pelo paciente decorrentes da artrite psori&#225;sica &#40;AP&#41; e apresentaram um custo indireto m&#233;dio anual por paciente de 2&#46;066&#44;29 USD&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Kawalec et al&#46; tamb&#233;m documentaram despesas do pr&#243;prio bolso mais altas pagas por pacientes em decorr&#234;ncia de AP&#44; com custo indireto m&#233;dio anual por paciente chegando a 1261&#44;00 euros&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Nosso estudo apresentou despesas menores porque o mesmo n&#227;o mediu os custos indiretos na forma de absente&#237;smo no trabalho e n&#227;o havia nenhum paciente com AP&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O presente estudo mostrou uma m&#233;dia de PASI e DLQI de 4&#44;8 e 7&#44;2&#44; respectivamente&#46; Em um estudo conduzido na Col&#244;mbia em 2014 sobre os custos diretos da psor&#237;ase&#44; os escores m&#233;dios do PASI e DLQI documentados foram de 5&#44;7 e 8&#44;2&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Em nosso caso&#44; um DLQI de 7&#44;2 em m&#233;dia representa um impacto moderado na qualidade de vida&#44; por&#233;m n&#227;o se correlacionou com o n&#237;vel de PASI&#44; o que pode ser explicado pelo n&#250;mero significativo de participantes que apresentava apenas envolvimento palmoplantar&#46; Isso reafirma o grande preju&#237;zo na qualidade de vida&#44; independentemente do n&#237;vel de PASI ou da gravidade da doen&#231;a&#46; Esse componente por si s&#243; pode impactar na esfera laboral dos pacientes&#44; como Mansouri et al&#46; mostraram em seu estudo sobre trabalho e afastamento por doen&#231;a entre pacientes com psor&#237;ase&#44; em que a maioria dos pacientes &#40;68&#37;&#41; apresentou n&#237;veis de PASI abaixo de 10&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Este estudo tamb&#233;m encontrou diferen&#231;as estatisticamente significativas para o DLQI na rela&#231;&#227;o com as despesas do pr&#243;prio bolso&#46; Isso pode ser explicado pois quanto maior o impacto na qualidade de vida&#44; mais doente o paciente se sente&#44; e consequentemente compra mais medicamentos ou tem maior frequ&#234;ncia nas consultas&#44; independentemente do n&#237;vel do PASI&#46; Esse resultado tamb&#233;m poderia ser explicado de maneira inversa&#58; com maiores gastos&#44; h&#225; maior impacto na qualidade de vida&#46; Uma revis&#227;o da literatura n&#227;o encontrou estudos comparando despesas do pr&#243;prio bolso com a qualidade de vida&#59; entretanto&#44; nos poucos estudos encontrados em rela&#231;&#227;o aos custos indiretos e impacto na qualidade de vida &#40;QV&#41;&#44; &#233; bem conhecido o fato de que esses encargos financeiros est&#227;o associados a uma menor qualidade de vida dos pacientes&#44; e que o impacto psicol&#243;gico da psor&#237;ase pode desempenhar um papel na produtividade dos pacientes no trabalho e&#44; portanto&#44; em sua renda&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;20&#44;21</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Sch&#246;ffski et al&#46; descobriram que os pacientes com DLQI mais alto foram os que apresentaram custos mais elevados&#59; entretanto&#44; ao contr&#225;rio do presente estudo&#44; os custos diretos tamb&#233;m foram inclu&#237;dos&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Al&#233;m disso&#44; em um estudo de Hawro et al&#46;&#44; 23&#37; dos pacientes relataram que a psor&#237;ase influenciou negativamente sua escolha de carreira profissional&#59; os autores prop&#245;em que a psor&#237;ase resulta em estigmatiza&#231;&#227;o&#44; com rejei&#231;&#227;o social e sofrimento psicol&#243;gico&#44; com subsequentes mudan&#231;as comportamentais de longo prazo que levam a uma pior situa&#231;&#227;o econ&#244;mica e um impacto negativo na QV dos pacientes&#44; mesmo gastando mais tempo em terapia&#44; o que pode ser traduzido no presente estudo em despesas mais altas com MIP&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Uma revis&#227;o sistem&#225;tica sugeriu que quanto mais grave a doen&#231;a&#44; maiores s&#227;o as despesas do pr&#243;prio bolso&#59; al&#233;m disso&#44; o fato de ser uma doen&#231;a associada a m&#250;ltiplas comorbidades aumenta muito mais os custos indiretos&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;24</span></a> Isso n&#227;o se correlaciona com o presente estudo&#44; uma vez que diferen&#231;as estatisticamente significativas n&#227;o foram encontradas entre as despesas do pr&#243;prio bolso e os n&#237;veis de PASI&#44; que podem ser diferentes de outros estudos&#44; mas n&#227;o compar&#225;veis&#44; uma vez que levam em considera&#231;&#227;o a produtividade no trabalho e n&#227;o as despesas do pr&#243;prio bolso&#46; Ayala et al&#46; relataram que a menor QV no trabalho e situa&#231;&#227;o financeira&#47;renda est&#227;o correlacionadas &#224; gravidade da psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">No presente estudo&#44; 93&#37; dos pacientes estavam em tratamento&#44; 34&#37; com tratamento oral ou biol&#243;gico&#44; e a maioria &#40;87&#37;&#41; tamb&#233;m recebia tratamento t&#243;pico&#46; Isso est&#225; de acordo com a literatura mundial&#44; na qual o tratamento t&#243;pico &#233; o principal&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;20</span></a> Em rela&#231;&#227;o a tratamento e custos&#44; a fototerapia apresentou diferen&#231;a estatisticamente significativa nas m&#233;dias&#44; em compara&#231;&#227;o a n&#227;o realizar nenhum tipo de tratamento&#46; A proposta do presente estudo &#233; que o aumento nas despesas do pr&#243;prio bolso &#233; explicado pelo comparecimento &#224;s consultas de fototerapia&#44; o que ocorre em m&#233;dia duas a tr&#234;s vezes por semana&#44; e se traduz em maiores despesas com transporte&#44; copagamento e alimenta&#231;&#227;o durante o atendimento na consulta&#46; Outros estudos tamb&#233;m encontraram uma rela&#231;&#227;o em termos de custos indiretos que aumentaram significativamente apenas no caso de fototerapia&#44; quando comparada a outras modalidades de tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Como limita&#231;&#227;o de nosso estudo&#44; identificamos a falta de medida da perda de produtividade no trabalho e o absente&#237;smo laboral&#44; traduzido em perdas financeiras com licen&#231;as m&#233;dicas&#46; Entretanto&#44; que seja de nosso conhecimento&#44; este &#233; o primeiro trabalho publicado sobre as despesas do pr&#243;prio bolso da psor&#237;ase na Col&#244;mbia&#44; um pa&#237;s onde as pessoas alocam 3&#44;1&#37; de suas despesas totais para pagamentos de sa&#250;de&#44; o que &#233; uma porcentagem consider&#225;vel&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> As despesas do pr&#243;prio bolso s&#227;o importantes para os pacientes porque&#44; em grande parte&#44; eles desconhecem os custos dos diferentes tratamentos para psor&#237;ase e&#44; al&#233;m da efic&#225;cia e seguran&#231;a&#44; as despesas do pr&#243;prio bolso s&#227;o um dos fatores mais importantes na decis&#227;o sobre um tratamento para psor&#237;ase&#46; <a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Estudos recentes sobre custos indiretos em pacientes com psor&#237;ase descritos por Villacorta&#44; Feldman e Lopes enfocam a perda de produtividade no trabalho&#59; em vez disso&#44; o presente estudo fornece informa&#231;&#245;es adicionais sobre as despesas do pr&#243;prio bolso custeadas pelos pacientes&#44; como medicamentos e transporte para sess&#245;es de fototerapia&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">28&#8211;30</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0115" class="elsevierStylePara elsevierViewall">As despesas do pr&#243;prio bolso evidenciadas neste estudo se assemelham com o demonstrado em estudos anteriores&#46; O presente estudo encontrou diferen&#231;as estatisticamente significativas para o DLQI em rela&#231;&#227;o &#224;s despesas do pr&#243;prio bolso&#44; independentemente do n&#237;vel do PASI&#46; O tratamento fototer&#225;pico tamb&#233;m apresentou diferen&#231;as estatisticamente significativas na rela&#231;&#227;o com as despesas do pr&#243;prio bolso&#44; quando comparado aos demais tratamentos&#44; pois requer maiores gastos com transporte&#44; copagamento e alimenta&#231;&#227;o durante o atendimento na consulta&#46; N&#227;o houve correla&#231;&#227;o entre as despesas do pr&#243;prio bolso e a situa&#231;&#227;o ocupacional&#44; o PASI ou outros tipos de tratamento&#46; A maior parte do dinheiro foi utilizada para comprar medicamentos e no transporte de &#244;nibus&#46; Entre os 100 participantes&#44; a despesa total foi de 11&#46;131&#44;90 USD no per&#237;odo de seis meses&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0120" class="elsevierStylePara elsevierViewall">Universidade CES&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0125" class="elsevierStylePara elsevierViewall">Ana Mar&#237;a Maya&#8208;Rico&#58; Desenho e planejamento do estudo&#59; reda&#231;&#227;o e edi&#231;&#227;o do manuscrito&#59; coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">&#193;ngela Londo&#241;o&#8208;Garc&#237;a&#58; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; desenho e planejamento do estudo&#59; reda&#231;&#227;o e edi&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Arlex Uriel Palacios&#8208;Barahona&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; desenho e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Sol Beatriz Jimenez&#8208;Tamayo&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; desenho e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Estefan&#237;a Muriel&#8208;Lopera&#58; Reda&#231;&#227;o e edi&#231;&#227;o do manuscrito&#59; coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A psor&#237;ase &#233; uma doen&#231;a cr&#244;nica que acarreta grandes custos para o sistema de sa&#250;de&#46; Na Col&#244;mbia&#44; devido a defici&#234;ncias desse sistema&#44; os pacientes t&#234;m maior probabilidade de incorrer em despesas do pr&#243;prio bolso&#44; um custo que nunca foi quantificado no pa&#237;s&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Quantificar as despesas autofinanciadas e analisar sua rela&#231;&#227;o com as caracter&#237;sticas cl&#237;nicas e laborais em uma coorte de pacientes com psor&#237;ase&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foi realizado um estudo transversal e unic&#234;ntrico&#44; que avaliou pacientes com psor&#237;ase&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Um total de 100 pacientes com psor&#237;ase foram analisados&#46; Identificamos que os pacientes com maior &#237;ndice de qualidade de vida em dermatologia e em tratamento fototer&#225;pico eram os que apresentavam maiores despesas autofinanciadas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006 e 0&#44;005&#44; respectivamente&#41;&#46; N&#227;o foi encontrada nenhuma correla&#231;&#227;o entre essas despesas autofinanciadas e status ocupacional&#44; &#237;ndice de gravidade da &#225;rea de psor&#237;ase ou outros tipos de tratamento&#46; A maior parte do dinheiro destinou&#8208;se &#224; compra de medicamentos e transporte de &#244;nibus&#44; com valores m&#225;ximos de at&#233; US&#36; 440&#44;50 e 528&#44;60&#44; respectivamente&#46; Entre os 100 participantes&#44; a despesa total foi de US&#36; 11&#46;131&#44;90 em um per&#237;odo de seis meses&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Falta de medidas de produtividade do trabalho e absente&#237;smo laboral secund&#225;rio a licen&#231;as m&#233;dicas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">As despesas do pr&#243;prio bolso se assemelham com estudos anteriores&#46; Foram encontradas diferen&#231;as estatisticamente significativas para o DLQI em rela&#231;&#227;o &#224;s despesas do pr&#243;prio bolso&#44; independentemente do n&#237;vel do PASI&#46; O tratamento fototer&#225;pico tamb&#233;m apresentou diferen&#231;as estatisticamente significativas em rela&#231;&#227;o &#224;s despesas do pr&#243;prio bolso&#44; quando comparado aos demais tratamentos&#44; pois requer maiores gastos com transporte&#44; copagamento e alimenta&#231;&#227;o durante o atendimento na consulta&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o terminou o Ensino Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino Superior e P&#243;s&#8208;Gradua&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Rela&#231;&#227;o com o sistema de sa&#250;de</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Contribuinte&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Benefici&#225;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Situa&#231;&#227;o ocupacional</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empregado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desempregado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pensionista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Causa do desemprego ou pens&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a &#40;psor&#237;ase&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empregado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Absente&#237;smo no trabalho</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nunca faltou ao trabalho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Faltou ao trabalho com &#8220;licen&#231;a m&#233;dica&#8221;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Faltou ao trabalho sem &#8220;licen&#231;a m&#233;dica&#8221;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desempregado ou pensionista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PASI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DLQI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;2 &#40;7&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tempo desde o diagn&#243;stico &#40;anos&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;3 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidades</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nenhuma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertens&#227;o arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome metab&#243;lica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a cardiovascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C&#226;ncer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamento</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T&#243;pico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sist&#234;mico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fototerapia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Biol&#243;gico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#233;dia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Desvio&#8208;padr&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#237;nimo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#225;ximo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#44;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Medica&#231;&#227;o</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">63&#44;20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Copagamento de consultas m&#233;dicas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Copagamento de fototerapia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Consultas particulares</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medicina da fam&#237;lia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Especialistas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medicina alternativa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Psicologia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Transporte</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#212;nibus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T&#225;xi&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;veis no modelo</th><th class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Biol&#243;gico&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "The indirect costs of multiple sclerosis&#58; Systematic review and meta&#8208;analysis"
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                            0 => "E&#46; Stawowcyk"
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                        "tituloSerie" => "Expert Rev Pharmacoecon Outcomes Res&#46;"
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                        "volumen" => "15"
                        "paginaInicial" => "759"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The global&#44; regional&#44; and national burden of psoriasis in 195 countries and territories&#44; 1990 to 2017&#58; A systematic analysis from the Global Burden of Disease Study 2017"
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                          "etal" => false
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                            0 => "S&#46; Mehrmal"
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                            2 => "N&#46; Nedley"
                            3 => "R&#46;L&#46; Giesey"
                            4 => "G&#46;R&#46; Delost"
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                      "doi" => "10.1016/j.jaad.2020.04.139"
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                        "tituloSerie" => "J Am Acad Dermatol&#46;"
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                        "volumen" => "84"
                        "paginaInicial" => "46"
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                      "titulo" => "Health care resource use&#44; productivity&#44; and costs among patients with moderate to severe plaque psoriasis in the United States"
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                          "etal" => true
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Artigo original
Despesas autofinanciadas por pacientes com psoríase em um serviço ambulatorial de referência em dermatologia
Ana María Maya‐Rico
Autor para correspondência
ladermatologa@gmail.com

Autor para correspondência.
, Ángela Londoño‐García, Arlex Uriel Palacios‐Barahona, Sol Beatriz Jimenez‐Tamayo, Estefanía Muriel‐Lopera
Universidad CES, Medellín, Colômbia
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    "titulo" => "Despesas autofinanciadas por pacientes com psor&#237;ase em um servi&#231;o ambulatorial de refer&#234;ncia em dermatologia"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A psor&#237;ase &#233; uma doen&#231;a cr&#244;nica que afeta principalmente a pele e as articula&#231;&#245;es&#44; com uma preval&#234;ncia global estimada entre 0&#44;6&#37; e 6&#44;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Na Col&#244;mbia&#44; a psor&#237;ase tem uma carga estimada de 43&#44;6 DALY &#40;do ingl&#234;s <span class="elsevierStyleItalic">Disability&#8208;Adjusted Life&#8208;Years</span>&#44; ou seja incapacidade ajustada aos anos de vida&#41;&#41; por 100&#46;000 indiv&#237;duos e cerca de 3&#37; das consultas em servi&#231;os de Dermatologia&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a> Em pacientes com psor&#237;ase moderada a grave&#44; a incapacidade &#233; compar&#225;vel a outras condi&#231;&#245;es cr&#244;nicas&#44; como artrite reumatoide&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> e esclerose m&#250;ltipla&#44; e seu tratamento &#233; &#224;s vezes desafiador&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Devido ao comprometimento multissist&#234;mico&#44; e n&#227;o apenas cut&#226;neo e articular&#44; diversas considera&#231;&#245;es devem ser contabilizadas em seu tratamento&#44; o que inegavelmente se traduz em custos tanto para o sistema de sa&#250;de quanto para os pacientes&#58; tratamentos m&#250;ltiplos ou combinados&#44; tratamentos mais caros&#44; consultas ambulatoriais e emergenciais causadas pela doen&#231;a ou suas complica&#231;&#245;es e hospitaliza&#231;&#245;es que podem ser prolongadas&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Nos Estados Unidos&#44; o custo total anual de cuidados de sa&#250;de para todas as causas foi de 33&#44;82 USD &#40;d&#243;lares americanos&#41; para os que interropem o plano de sa&#250;de e 60&#44;73 USD para aqueles que mudam de plano de sa&#250;de&#44; com cerca de 20&#37; desse custo n&#227;o relacionado &#224;s despesas com os medicamentos prescritos&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Os aspectos econ&#244;micos da sa&#250;de s&#227;o cada vez mais importantes em todos os sistemas de sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Na Col&#244;mbia&#44; em decorr&#234;ncia das defici&#234;ncias no sistema de sa&#250;de&#44; os pacientes t&#234;m maior probabilidade de incorrer em despesas do pr&#243;prio bolso&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> As despesas do pr&#243;prio bolso relacionadas &#224; sa&#250;de referem&#8208;se a custos com transporte para consultas m&#233;dicas&#44; alimenta&#231;&#227;o&#44; copagamento&#44; compra de medicamentos ou qualquer servi&#231;o ou exame que n&#227;o &#233; coberto pelo sistema de sa&#250;de e deve ser pago pelo pr&#243;prio paciente&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Particularmente&#44; incorrer nessas despesas parece ser catastr&#243;fico por causa da falta de cobertura de sa&#250;de para pacientes desempregados&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> At&#233; agora&#44; os estudos de custos da psor&#237;ase t&#234;m sido realizados principalmente junto com a avalia&#231;&#227;o da efic&#225;cia dos tratamentos biol&#243;gicos&#46; Estudos de custos na pr&#225;tica cl&#237;nica di&#225;ria s&#227;o escassos&#44; e os poucos existentes enfocam os custos diretos da doen&#231;a&#44; com poucas&#44; mas importantes informa&#231;&#245;es sobre os custos indiretos&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Por exemplo&#44; os custos indiretos anuais atribu&#237;veis &#224; psor&#237;ase variam entre US&#36; 23&#44;9 e 35&#44;4 bilh&#245;es de d&#243;lares nos Estados Unidos&#44; o que reitera a carga econ&#244;mica substancial secund&#225;ria a essa doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Como na Col&#244;mbia faltam evid&#234;ncias relacionadas ao comportamento das despesas do pr&#243;prio bolso em pacientes com psor&#237;ase&#44; o objetivo deste estudo foi quantificar esses custos e analisar sua rela&#231;&#227;o com as caracter&#237;sticas ocupacionais dos pacientes em uma coorte de pacientes com psor&#237;ase atendida em um Ambulat&#243;rio de Dermatologia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Estudo transversal e unic&#234;ntrico realizado no centro dermatol&#243;gico da Escola de Medicina da Universidade CES Sabaneta &#40;Sabaneta&#44; Col&#244;mbia&#41; de setembro de 2018 a mar&#231;o de 2019&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Todos os pacientes com mais de 18 anos de idade&#44; com diagn&#243;stico de psor&#237;ase leve e moderada&#8208;grave com qualquer uma de suas variantes cl&#237;nicas foram considerados eleg&#237;veis e convidados a participar&#46; Os pacientes foram exclu&#237;dos caso se recusassem a participar ou n&#227;o pudessem comparecer &#224;s consultas do estudo&#46; O tamanho da amostra foi obtido por conveni&#234;ncia&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O resultado prim&#225;rio foi a medida das despesas do pr&#243;prio bolso em pacientes com psor&#237;ase&#46; As despesas do pr&#243;prio bolso foram medidas por um question&#225;rio que levou em considera&#231;&#227;o vari&#225;veis econ&#244;micas quantitativas&#44; tais como&#58; dinheiro total gasto nos &#250;ltimos seis meses em produtos m&#233;dicos&#44; como term&#244;metros&#44; seringas&#44; agulhas&#44; compressas&#44; gaze&#44; algod&#227;o&#44; medicamentos&#44; consultas m&#233;dicas&#44; alimentos comprados durante o comparecimento &#224;s consultas m&#233;dicas&#44; copagamentos de consultas m&#233;dicas ou fototerapia&#44; consultas m&#233;dicas privadas em medicina geral&#44; especialistas&#44; medicina alternativa e&#47;ou psicologia&#44; transporte &#40;&#244;nibus&#44; t&#225;xi&#44; metr&#244;&#44; ve&#237;culo pr&#243;prio&#44; caminhada ou outros&#41;&#44; e&#47;ou hospedagem&#44; no caso de consultas em outras cidades ou munic&#237;pios&#46; Os produtos m&#233;dicos foram calculados de acordo com os pre&#231;os das farm&#225;cias e o dinheiro medido em pesos colombianos &#40;PC&#41; e convertido para d&#243;lares americanos &#40;USD&#41;&#44; de acordo com a taxa de c&#226;mbio representativa do mercado &#40;Fonte&#58; Banco de la Rep&#250;blica de Colombia&#59; Valor de c&#226;mbio&#58; 3177&#44;94 PC em 24 de abril de 2019&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Outras vari&#225;veis econ&#244;micas e cl&#237;nicas como situa&#231;&#227;o ocupacional &#40;empregado&#44; desempregado ou aposentado&#41;&#44; causa do desemprego&#44; se aplic&#225;vel &#40;por doen&#231;a ou outra causa&#41;&#44; absente&#237;smo no trabalho&#44; medido em n&#250;mero de dias que o paciente n&#227;o trabalhou devido &#224; doen&#231;a nos &#250;ltimos seis meses&#44; com ou sem licen&#231;a m&#233;dica&#59; &#205;ndice de &#193;rea e Gravidade da Psor&#237;ase &#40;PASI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Area and Severity Index of Psoriasis</span>&#41;&#44; &#205;ndice de Qualidade de Vida Dermatol&#243;gica &#40;DLQI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Dermatological Quality of Life Index</span>&#41;&#44; que avalia 10 quest&#245;es em rela&#231;&#227;o ao impacto da doen&#231;a cut&#226;nea nas esferas social&#44; familiar&#44; sexual e laboral&#44; respondendo&#58; muit&#237;ssimo &#40;3 pontos&#41;&#44; muito &#40;2 pontos&#41;&#44; pouco &#40;1 ponto&#41; e nada &#40;0 pontos&#41; com um escore final entre 0&#8208;30&#44; sendo 0 o menor comprometimento na qualidade de vida e 30 o m&#225;ximo&#59; tempo de evolu&#231;&#227;o da doen&#231;a em anos&#44; comorbidades &#40;diabetes&#44; hipertens&#227;o&#44; dislipidemia&#44; s&#237;ndrome metab&#243;lica&#44; doen&#231;a cardiovascular&#44; obesidade&#44; c&#226;ncer&#44; outros&#41;&#44; tipo de tratamento &#40;t&#243;pico&#44; sist&#234;mico&#44; fototerapia&#44; biol&#243;gico&#44; outros ou nenhum&#41; e causa de abandono do tratamento&#44; se aplic&#225;vel &#40;custos&#44; transporte&#44; cuidado insuficiente&#44; falta de disponibilidade de consultas&#44; desfilia&#231;&#227;o do provedor de servi&#231;o de sa&#250;de&#44; outras causas&#41; tamb&#233;m foram considerados na pesquisa&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Todos os pacientes com psor&#237;ase foram convidados a participar e submetidos a um exame f&#237;sico completo e a um question&#225;rio&#44; que foram conduzidos por um residente de dermatologia do terceiro ano&#44; previamente treinado&#46; Para reduzir os vieses de informa&#231;&#227;o&#44; os pacientes foram sensibilizados sobre a relev&#226;ncia da veracidade das informa&#231;&#245;es&#46; Um teste piloto foi realizado em cinco pacientes a fim de determinar o desempenho do examinador ao utilizar o protocolo padronizado e para verificar a compreens&#227;o dos pacientes sobre o objetivo do estudo e as informa&#231;&#245;es necess&#225;rias&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A an&#225;lise descritiva das despesas do pr&#243;prio bolso&#44; caracter&#237;sticas sociodemogr&#225;ficas e cl&#237;nicas dos pacientes foi realizada por meio de frequ&#234;ncias absolutas e relativas para as vari&#225;veis qualitativas e m&#233;dia&#44; mediana&#44; desvio&#8208;padr&#227;o e intervalo para as quantitativas&#46; A rela&#231;&#227;o das caracter&#237;sticas dos pacientes com as despesas do pr&#243;prio bolso foi analisada com modelos lineares generalizados&#44; fam&#237;lia gaussiana&#44; identidade de v&#237;nculo&#46; S&#227;o apresentadas diferen&#231;as m&#233;dias brutas e ajustadas por PASI&#44; DLQI&#44; situa&#231;&#227;o ocupacional&#44; tratamento com intervalos de confian&#231;a de 95&#37; &#40;IC95&#37;&#41; e valores de p&#46; A signific&#226;ncia estat&#237;stica foi estabelecida em 0&#44;05&#46; As an&#225;lises estat&#237;sticas foram realizadas no software SPSS&#44; vers&#227;o 21 licenciado pela Universidade CES&#46; Este estudo foi aprovado pelo Comit&#234; de Pesquisa e &#201;tica da Universidade CES&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Dos 100 pacientes que participaram do estudo&#44; 49&#37; eram mulheres&#46; A m&#233;dia de idade foi de 54&#44;7 anos &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44;1&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; O n&#237;vel de escolaridade apresentou propor&#231;&#245;es iguais de pacientes com Ensino Superior &#40;universidade&#41; <span class="elsevierStyleItalic">versus</span> pacientes com Ensino Fundamental I&#44; Fundamental II&#44; Ensino M&#233;dio e sem nenhuma escolaridade&#59; 99&#37; dos pacientes eram filiados a um sistema de sa&#250;de&#44; 80&#37; deles como contribuintes&#59; 54&#37; dos pacientes estavam empregados&#44; dos quais oito faltaram ao trabalho&#44; tr&#234;s com licen&#231;a m&#233;dica e cinco sem licen&#231;a&#46; Os restantes 46&#37; eram aposentados ou estavam desempregados na mesma propor&#231;&#227;o&#44; com apenas 2&#37; atribuindo isso &#224; psor&#237;ase&#46; A m&#233;dia dos escores do PASI e do DLQI foi de 4&#44;8 e 7&#44;2&#44; respectivamente&#44; como mostrado na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">A maior parte das despesas do pr&#243;prio bolso foi utilizada para compra de medicamentos e transporte de &#244;nibus&#44; no valor m&#225;ximo de at&#233; 440&#44;50 e 528&#44;60 USD&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Os pacientes gastam em m&#233;dia 13&#44;38 USD com o transporte de &#244;nibus&#46; A m&#233;dia das despesas do pr&#243;prio bolso relacionada a cuidados m&#233;dicos medidos em 2019 para produtos m&#233;dicos&#44; medicamentos&#44; exames e alimenta&#231;&#227;o foi de 1&#44;85&#44; 63&#44;20&#44; 1&#44;50 e 2&#44;35 USD&#44; respectivamente&#46; Em rela&#231;&#227;o a copagamentos m&#233;dicos para consultas ou sess&#245;es de fototerapia&#44; o custo foi de 3&#44;36 e 0&#44;57 USD&#46; As consultas particulares com m&#233;dico da fam&#237;lia&#44; especialistas&#44; medicina alternativa e psicologia mostraram uma m&#233;dia de 2&#44;77&#44; 2&#44;02&#44; 1&#44;82 e 0&#44;62 USD&#44; respetivamente&#46; Entre os 100 participantes&#44; a despesa total foi de 11&#46;131&#44;90 USD no per&#237;odo de seis meses&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">As diferen&#231;as nas m&#233;dias dos fatores associados &#224;s despesas do pr&#243;prio bolso relacionadas &#224; assist&#234;ncia m&#233;dica s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; Primeiramente&#44; foi realizada uma an&#225;lise bruta das vari&#225;veis&#44; na qual as vari&#225;veis PASI e fototerapia foram significativas&#46; Ao ajustar o modelo para as vari&#225;veis PASI&#44; DLQI&#44; situa&#231;&#227;o ocupacional e tratamento&#44; apenas as vari&#225;veis DLQI e fototerapia foram significativas&#46; Para o DLQI&#44; a diferen&#231;a m&#233;dia foi 5&#44;42 com um intervalo de confian&#231;a de 95&#37; &#40;IC 95&#37;&#58; 1&#44;57&#8208;9&#44;28&#41;&#59; isso significa que para cada aumento de um ponto no DLQI&#44; as despesas do pr&#243;prio bolso aumentam em 5&#44;42 USD em um per&#237;odo de seis meses&#46; Al&#233;m disso&#44; a fototerapia tamb&#233;m apresentou diferen&#231;a estatisticamente significativa nas m&#233;dias&#44; em compara&#231;&#227;o a n&#227;o ter nenhum tipo de tratamento&#44; com diferen&#231;a m&#233;dia de 33&#44;38 &#40;IC 95&#37;&#58; 8&#44;64&#8208;58&#44;14&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0065" class="elsevierStylePara elsevierViewall">Neste estudo&#44; objetivamos quantificar as despesas do pr&#243;prio bolso em pacientes com psor&#237;ase e analisar sua rela&#231;&#227;o com as caracter&#237;sticas ocupacionais dos pacientes em uma coorte de um Ambulat&#243;rio de Dermatologia&#46; Identificamos que o principal gasto do pr&#243;prio bolso &#233; com rem&#233;dios&#44; transporte e copagamento de consultas m&#233;dicas&#44; e as principais caracter&#237;sticas associadas com as despesas do pr&#243;prio bolso foram o DLQI e o tratamento com fototerapia&#46; Documentamos um total de 11&#46;131&#44;90 USD gastos nos &#250;ltimos seis meses entre os 100 participantes&#46; A maior parte das despesas do pr&#243;prio bolso foi destinada &#224; compra de medicamentos e transporte&#44; com valor m&#225;ximo de 440&#44;50 e 528&#44;60 USD&#44; respectivamente&#46; Os pacientes gastaram em m&#233;dia 13&#44;38 USD em transporte de &#244;nibus&#46; A m&#233;dia dos gastos foi de 111&#44;30 USD por paciente em um per&#237;odo de seis meses&#46; Nossos achados s&#227;o consistentes com estudos anteriores&#44; que documentaram comportamento semelhante em rela&#231;&#227;o &#224;s despesas do pr&#243;prio bolso&#46; Em um estudo realizado nos Estados Unidos&#44; Javitz et al&#46; relataram despesas do pr&#243;prio bolso semelhantes&#44; de 356&#44;00 USD por paciente por ano&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Outros estudos mostraram despesas do pr&#243;prio bolso&#44; como 706&#44;00 USD por paciente em um per&#237;odo de seis meses&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> e at&#233; 1&#46;255&#44;00 USD <span class="elsevierStyleItalic">vs</span>&#46; 913&#44;00 USD em pacientes n&#227;o psori&#225;sicos com um p estatisticamente significativo de 0&#44;001&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Al&#233;m disso&#44; Gunnarson descreveu um estudo australiano que relatou despesas anuais do pr&#243;prio bolso para medicamentos isentos de prescri&#231;&#227;o &#40;MIP&#41; e medicamentos prescritos de aproximadamente 250&#44;00 AUD &#40;d&#243;lares australianos&#41; por pessoa&#44; no per&#237;odo de 1997 a 1999&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Nos Estados Unidos&#44; tamb&#233;m foram realizados estudos medindo os custos diretos e indiretos em rela&#231;&#227;o &#224; psor&#237;ase&#44; os maiores at&#233; agora&#44; publicados em 2008&#44; onde se constatou que os custos indiretos chegavam a 2&#46;748&#44;00 USD por ano por trabalhador&#44; superando at&#233; mesmo doen&#231;as gastrintestinais graves como colite ulcerativa&#44; refluxo gastroesof&#225;gico&#44; doen&#231;a diverticular e &#250;lcera p&#233;ptica&#44; compar&#225;vel &#224;queles descritos no estudo de Schmitt e Ford&#44; no qual foram relatados gastos de 2&#46;571&#44;00 USD por trabalhador por ano&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Na Su&#237;&#231;a&#44; o custo com despesas do pr&#243;prio bolso e consultas ambulatoriais no ano de 2005 foi de 1&#46;141&#44;00 a 7&#46;957&#44;00 euros por paciente por ano&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Moreno et al&#46; consideraram custos indiretos relacionados a licen&#231;a m&#233;dica&#44; aposentadoria precoce&#44; assist&#234;ncia ao paciente e despesas do pr&#243;prio bolso pagas pelo paciente decorrentes da artrite psori&#225;sica &#40;AP&#41; e apresentaram um custo indireto m&#233;dio anual por paciente de 2&#46;066&#44;29 USD&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Kawalec et al&#46; tamb&#233;m documentaram despesas do pr&#243;prio bolso mais altas pagas por pacientes em decorr&#234;ncia de AP&#44; com custo indireto m&#233;dio anual por paciente chegando a 1261&#44;00 euros&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Nosso estudo apresentou despesas menores porque o mesmo n&#227;o mediu os custos indiretos na forma de absente&#237;smo no trabalho e n&#227;o havia nenhum paciente com AP&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O presente estudo mostrou uma m&#233;dia de PASI e DLQI de 4&#44;8 e 7&#44;2&#44; respectivamente&#46; Em um estudo conduzido na Col&#244;mbia em 2014 sobre os custos diretos da psor&#237;ase&#44; os escores m&#233;dios do PASI e DLQI documentados foram de 5&#44;7 e 8&#44;2&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Em nosso caso&#44; um DLQI de 7&#44;2 em m&#233;dia representa um impacto moderado na qualidade de vida&#44; por&#233;m n&#227;o se correlacionou com o n&#237;vel de PASI&#44; o que pode ser explicado pelo n&#250;mero significativo de participantes que apresentava apenas envolvimento palmoplantar&#46; Isso reafirma o grande preju&#237;zo na qualidade de vida&#44; independentemente do n&#237;vel de PASI ou da gravidade da doen&#231;a&#46; Esse componente por si s&#243; pode impactar na esfera laboral dos pacientes&#44; como Mansouri et al&#46; mostraram em seu estudo sobre trabalho e afastamento por doen&#231;a entre pacientes com psor&#237;ase&#44; em que a maioria dos pacientes &#40;68&#37;&#41; apresentou n&#237;veis de PASI abaixo de 10&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Este estudo tamb&#233;m encontrou diferen&#231;as estatisticamente significativas para o DLQI na rela&#231;&#227;o com as despesas do pr&#243;prio bolso&#46; Isso pode ser explicado pois quanto maior o impacto na qualidade de vida&#44; mais doente o paciente se sente&#44; e consequentemente compra mais medicamentos ou tem maior frequ&#234;ncia nas consultas&#44; independentemente do n&#237;vel do PASI&#46; Esse resultado tamb&#233;m poderia ser explicado de maneira inversa&#58; com maiores gastos&#44; h&#225; maior impacto na qualidade de vida&#46; Uma revis&#227;o da literatura n&#227;o encontrou estudos comparando despesas do pr&#243;prio bolso com a qualidade de vida&#59; entretanto&#44; nos poucos estudos encontrados em rela&#231;&#227;o aos custos indiretos e impacto na qualidade de vida &#40;QV&#41;&#44; &#233; bem conhecido o fato de que esses encargos financeiros est&#227;o associados a uma menor qualidade de vida dos pacientes&#44; e que o impacto psicol&#243;gico da psor&#237;ase pode desempenhar um papel na produtividade dos pacientes no trabalho e&#44; portanto&#44; em sua renda&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;20&#44;21</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Sch&#246;ffski et al&#46; descobriram que os pacientes com DLQI mais alto foram os que apresentaram custos mais elevados&#59; entretanto&#44; ao contr&#225;rio do presente estudo&#44; os custos diretos tamb&#233;m foram inclu&#237;dos&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Al&#233;m disso&#44; em um estudo de Hawro et al&#46;&#44; 23&#37; dos pacientes relataram que a psor&#237;ase influenciou negativamente sua escolha de carreira profissional&#59; os autores prop&#245;em que a psor&#237;ase resulta em estigmatiza&#231;&#227;o&#44; com rejei&#231;&#227;o social e sofrimento psicol&#243;gico&#44; com subsequentes mudan&#231;as comportamentais de longo prazo que levam a uma pior situa&#231;&#227;o econ&#244;mica e um impacto negativo na QV dos pacientes&#44; mesmo gastando mais tempo em terapia&#44; o que pode ser traduzido no presente estudo em despesas mais altas com MIP&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Uma revis&#227;o sistem&#225;tica sugeriu que quanto mais grave a doen&#231;a&#44; maiores s&#227;o as despesas do pr&#243;prio bolso&#59; al&#233;m disso&#44; o fato de ser uma doen&#231;a associada a m&#250;ltiplas comorbidades aumenta muito mais os custos indiretos&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;24</span></a> Isso n&#227;o se correlaciona com o presente estudo&#44; uma vez que diferen&#231;as estatisticamente significativas n&#227;o foram encontradas entre as despesas do pr&#243;prio bolso e os n&#237;veis de PASI&#44; que podem ser diferentes de outros estudos&#44; mas n&#227;o compar&#225;veis&#44; uma vez que levam em considera&#231;&#227;o a produtividade no trabalho e n&#227;o as despesas do pr&#243;prio bolso&#46; Ayala et al&#46; relataram que a menor QV no trabalho e situa&#231;&#227;o financeira&#47;renda est&#227;o correlacionadas &#224; gravidade da psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">No presente estudo&#44; 93&#37; dos pacientes estavam em tratamento&#44; 34&#37; com tratamento oral ou biol&#243;gico&#44; e a maioria &#40;87&#37;&#41; tamb&#233;m recebia tratamento t&#243;pico&#46; Isso est&#225; de acordo com a literatura mundial&#44; na qual o tratamento t&#243;pico &#233; o principal&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;20</span></a> Em rela&#231;&#227;o a tratamento e custos&#44; a fototerapia apresentou diferen&#231;a estatisticamente significativa nas m&#233;dias&#44; em compara&#231;&#227;o a n&#227;o realizar nenhum tipo de tratamento&#46; A proposta do presente estudo &#233; que o aumento nas despesas do pr&#243;prio bolso &#233; explicado pelo comparecimento &#224;s consultas de fototerapia&#44; o que ocorre em m&#233;dia duas a tr&#234;s vezes por semana&#44; e se traduz em maiores despesas com transporte&#44; copagamento e alimenta&#231;&#227;o durante o atendimento na consulta&#46; Outros estudos tamb&#233;m encontraram uma rela&#231;&#227;o em termos de custos indiretos que aumentaram significativamente apenas no caso de fototerapia&#44; quando comparada a outras modalidades de tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Como limita&#231;&#227;o de nosso estudo&#44; identificamos a falta de medida da perda de produtividade no trabalho e o absente&#237;smo laboral&#44; traduzido em perdas financeiras com licen&#231;as m&#233;dicas&#46; Entretanto&#44; que seja de nosso conhecimento&#44; este &#233; o primeiro trabalho publicado sobre as despesas do pr&#243;prio bolso da psor&#237;ase na Col&#244;mbia&#44; um pa&#237;s onde as pessoas alocam 3&#44;1&#37; de suas despesas totais para pagamentos de sa&#250;de&#44; o que &#233; uma porcentagem consider&#225;vel&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> As despesas do pr&#243;prio bolso s&#227;o importantes para os pacientes porque&#44; em grande parte&#44; eles desconhecem os custos dos diferentes tratamentos para psor&#237;ase e&#44; al&#233;m da efic&#225;cia e seguran&#231;a&#44; as despesas do pr&#243;prio bolso s&#227;o um dos fatores mais importantes na decis&#227;o sobre um tratamento para psor&#237;ase&#46; <a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Estudos recentes sobre custos indiretos em pacientes com psor&#237;ase descritos por Villacorta&#44; Feldman e Lopes enfocam a perda de produtividade no trabalho&#59; em vez disso&#44; o presente estudo fornece informa&#231;&#245;es adicionais sobre as despesas do pr&#243;prio bolso custeadas pelos pacientes&#44; como medicamentos e transporte para sess&#245;es de fototerapia&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">28&#8211;30</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0115" class="elsevierStylePara elsevierViewall">As despesas do pr&#243;prio bolso evidenciadas neste estudo se assemelham com o demonstrado em estudos anteriores&#46; O presente estudo encontrou diferen&#231;as estatisticamente significativas para o DLQI em rela&#231;&#227;o &#224;s despesas do pr&#243;prio bolso&#44; independentemente do n&#237;vel do PASI&#46; O tratamento fototer&#225;pico tamb&#233;m apresentou diferen&#231;as estatisticamente significativas na rela&#231;&#227;o com as despesas do pr&#243;prio bolso&#44; quando comparado aos demais tratamentos&#44; pois requer maiores gastos com transporte&#44; copagamento e alimenta&#231;&#227;o durante o atendimento na consulta&#46; N&#227;o houve correla&#231;&#227;o entre as despesas do pr&#243;prio bolso e a situa&#231;&#227;o ocupacional&#44; o PASI ou outros tipos de tratamento&#46; A maior parte do dinheiro foi utilizada para comprar medicamentos e no transporte de &#244;nibus&#46; Entre os 100 participantes&#44; a despesa total foi de 11&#46;131&#44;90 USD no per&#237;odo de seis meses&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0120" class="elsevierStylePara elsevierViewall">Universidade CES&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0125" class="elsevierStylePara elsevierViewall">Ana Mar&#237;a Maya&#8208;Rico&#58; Desenho e planejamento do estudo&#59; reda&#231;&#227;o e edi&#231;&#227;o do manuscrito&#59; coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">&#193;ngela Londo&#241;o&#8208;Garc&#237;a&#58; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; desenho e planejamento do estudo&#59; reda&#231;&#227;o e edi&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Arlex Uriel Palacios&#8208;Barahona&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; desenho e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Sol Beatriz Jimenez&#8208;Tamayo&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; desenho e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Estefan&#237;a Muriel&#8208;Lopera&#58; Reda&#231;&#227;o e edi&#231;&#227;o do manuscrito&#59; coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A psor&#237;ase &#233; uma doen&#231;a cr&#244;nica que acarreta grandes custos para o sistema de sa&#250;de&#46; Na Col&#244;mbia&#44; devido a defici&#234;ncias desse sistema&#44; os pacientes t&#234;m maior probabilidade de incorrer em despesas do pr&#243;prio bolso&#44; um custo que nunca foi quantificado no pa&#237;s&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Quantificar as despesas autofinanciadas e analisar sua rela&#231;&#227;o com as caracter&#237;sticas cl&#237;nicas e laborais em uma coorte de pacientes com psor&#237;ase&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foi realizado um estudo transversal e unic&#234;ntrico&#44; que avaliou pacientes com psor&#237;ase&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Um total de 100 pacientes com psor&#237;ase foram analisados&#46; Identificamos que os pacientes com maior &#237;ndice de qualidade de vida em dermatologia e em tratamento fototer&#225;pico eram os que apresentavam maiores despesas autofinanciadas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006 e 0&#44;005&#44; respectivamente&#41;&#46; N&#227;o foi encontrada nenhuma correla&#231;&#227;o entre essas despesas autofinanciadas e status ocupacional&#44; &#237;ndice de gravidade da &#225;rea de psor&#237;ase ou outros tipos de tratamento&#46; A maior parte do dinheiro destinou&#8208;se &#224; compra de medicamentos e transporte de &#244;nibus&#44; com valores m&#225;ximos de at&#233; US&#36; 440&#44;50 e 528&#44;60&#44; respectivamente&#46; Entre os 100 participantes&#44; a despesa total foi de US&#36; 11&#46;131&#44;90 em um per&#237;odo de seis meses&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Falta de medidas de produtividade do trabalho e absente&#237;smo laboral secund&#225;rio a licen&#231;as m&#233;dicas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">As despesas do pr&#243;prio bolso se assemelham com estudos anteriores&#46; Foram encontradas diferen&#231;as estatisticamente significativas para o DLQI em rela&#231;&#227;o &#224;s despesas do pr&#243;prio bolso&#44; independentemente do n&#237;vel do PASI&#46; O tratamento fototer&#225;pico tamb&#233;m apresentou diferen&#231;as estatisticamente significativas em rela&#231;&#227;o &#224;s despesas do pr&#243;prio bolso&#44; quando comparado aos demais tratamentos&#44; pois requer maiores gastos com transporte&#44; copagamento e alimenta&#231;&#227;o durante o atendimento na consulta&#46;</p></span>"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;7 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#237;vel de escolaridade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Menor do que o Ensino M&#233;dio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terminou o Ensino M&#233;dio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o terminou o Ensino Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ensino Superior e P&#243;s&#8208;Gradua&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Rela&#231;&#227;o com o sistema de sa&#250;de</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Contribuinte&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Benefici&#225;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Situa&#231;&#227;o ocupacional</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empregado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desempregado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pensionista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Causa do desemprego ou pens&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a &#40;psor&#237;ase&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empregado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Absente&#237;smo no trabalho</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nunca faltou ao trabalho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Faltou ao trabalho com &#8220;licen&#231;a m&#233;dica&#8221;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Faltou ao trabalho sem &#8220;licen&#231;a m&#233;dica&#8221;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desempregado ou pensionista&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PASI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DLQI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;2 &#40;7&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tempo desde o diagn&#243;stico &#40;anos&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;3 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidades</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nenhuma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertens&#227;o arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome metab&#243;lica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a cardiovascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C&#226;ncer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamento</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T&#243;pico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sist&#234;mico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fototerapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Biol&#243;gico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;1&#44;57&#8208;9&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Situa&#231;&#227;o ocupacional</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empregado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desempregado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fototerapia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Biol&#243;gico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;4&#44;61&nbsp;\t\t\t\t\t\t\n
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