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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 dermatite at&#243;pica &#40;DA&#41; &#233; doen&#231;a inflamat&#243;ria cut&#226;nea cr&#244;nica com recidiva e impacto significativo na qualidade de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> Globalmente&#44; sua preval&#234;ncia est&#225; aumentando&#44; afetando at&#233; 20&#37; das crian&#231;as e 10&#37; dos adultos&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2&#8211;5</span></a> As terapias anti&#8208;inflamat&#243;rias t&#243;picas s&#227;o o primeiro passo no tratamento das crises de DA&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6&#44;7</span></a> Corticosteroides t&#243;picos &#40;CT&#41; s&#227;o a base do tratamento na maioria dos pacientes com DA&#44; e muitas vezes requerem tratamento a longo prazo com CT por muitos anos&#46; Baixa ades&#227;o ao tratamento &#233; comum na DA e pode levar &#224; falha do tratamento&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8&#8211;10</span></a> A resist&#234;ncia &#224; CT pode ser parcialmente decorrente da n&#227;o ades&#227;o em raz&#227;o da fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> A fobia a CT&#44; tamb&#233;m conhecida como corticofobia&#44; define os sentimentos e cren&#231;as negativas relacionadas a CT vivenciadas por pacientes e seus cuidadores&#46; A preval&#234;ncia de corticofobia na DA varia de 21&#37; a 84&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> Educa&#231;&#227;o em sa&#250;de &#40;ES&#41; &#233; o termo utilizado para descrever as capacidades das pessoas em atender &#224;s complexas demandas relacionadas &#224; sa&#250;de na sociedade moderna&#46; Ela resulta das atividades de educa&#231;&#227;o e comunica&#231;&#227;o em sa&#250;de e determina a capacidade individual de ter acesso a&#44; compreender e utilizar a informa&#231;&#227;o para promover e manter uma boa sa&#250;de&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#44;14</span></a> O presente estudo prop&#244;s avaliar o efeito da ES na corticofobia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Pacientes e local do estudo</span><p id="par0010" class="elsevierStylePara elsevierViewall">Realizou&#8208;se um estudo transversal prospectivo no Servi&#231;o de Dermatologia de um Hospital de n&#237;vel dois&#44; entre setembro de 2019 e fevereiro de 2020&#46; Foram inclu&#237;dos pacientes com dermatite at&#243;pica&#44; com pelo menos duas consultas de Dermatologia&#46; Foram definidos dois grupos de acordo com a idade do paciente&#58; &#8804; 15 anos e &#62;<span class="elsevierStyleHsp" style=""></span>15 anos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Question&#225;rios</span><p id="par0015" class="elsevierStylePara elsevierViewall">Os pais dos pacientes com &#8804; 15 anos e os pacientes com<span class="elsevierStyleHsp" style=""></span>&#62; 15 anos foram convidados a responder a tr&#234;s question&#225;rios&#58; TOPICOP&#169;&#44; HLS&#8208;EU&#8208;PT e um question&#225;rio de caracteriza&#231;&#227;o da doen&#231;a e de dados demogr&#225;ficos&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O question&#225;rio TOPICOP&#169; &#233; uma escala validada para a avalia&#231;&#227;o de fobia a CT em pacientes com DA e em seus pais&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> A viabilidade e a compreens&#227;o do escore no TOPICOP&#169; foram abordadas em diferentes pa&#237;ses&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> A vers&#227;o original est&#225; em ingl&#234;s&#44; mas as vers&#245;es em portugu&#234;s e em outros idiomas est&#227;o dispon&#237;veis em <a href="http://www.edudermatologie.com/">http&#58;&#47;&#47;www&#46;edudermatologie&#46;com</a>&#46; O question&#225;rio &#233; composto por 12 itens&#44; que abrangem &#8220;preocupa&#231;&#245;es&#8221; &#40;6 itens&#41; e &#8220;cren&#231;as&#8221; &#40;6 itens&#41;&#46; S&#227;o oferecidas quatro op&#231;&#245;es de resposta&#44; que variam de &#8220;discordo totalmente&#8221; a &#8220;concordo totalmente&#8221;&#44; com pontos atribu&#237;dos a cada uma &#40;0&#44; 1&#44; 2 ou 3&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">O question&#225;rio <span class="elsevierStyleItalic">European Health Literacy Survey</span> &#40;HLS&#8208;EU&#41; &#233; uma ferramenta validada para medir a ES da popula&#231;&#227;o geral&#44; tamb&#233;m validada na l&#237;ngua portuguesa &#40;HLS&#8208;EU&#8208;PT&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;17</span></a> O HLS&#8208;EU&#8208;PT inclui 47 quest&#245;es&#44; que integram tr&#234;s dom&#237;nios de sa&#250;de diferentes&#58; cuidados de sa&#250;de&#44; preven&#231;&#227;o de doen&#231;as e promo&#231;&#227;o da sa&#250;de&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;18</span></a> Para cada item&#44; os pacientes classificam a dificuldade percebida de determinada tarefa em uma escala Likert de quatro categorias de resposta &#40;muito f&#225;cil&#44; f&#225;cil&#44; dif&#237;cil e muito dif&#237;cil&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Um terceiro question&#225;rio foi aplicado para fornecer dados cl&#237;nicos adicionais&#46; Isso incluiu informa&#231;&#245;es demogr&#225;ficas como sexo&#44; idade&#44; trabalhar na &#225;rea da sa&#250;de e caracter&#237;sticas da doen&#231;a&#44; como dura&#231;&#227;o da doen&#231;a&#44; hist&#243;ria familiar de DA&#44; hist&#243;ria pessoal de asma e&#47;ou rinite al&#233;rgica e tratamentos anteriores de DA&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lise estat&#237;stica</span><p id="par0035" class="elsevierStylePara elsevierViewall">O escore no TOPICOP&#169; foi calculado como 100&#37; vezes a soma de todas as respostas divididas pela soma m&#225;xima poss&#237;vel para as perguntas inclu&#237;das&#44; com um escore resultante de 0 a 100&#37; de fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> O escore pode ser ainda categorizado como baixo &#40;&#8804; 23&#41;&#44; intermedi&#225;rio &#40;24&#8208;50&#41; e alto &#40;&#62; 50&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> Para o HLS&#8208;EU&#8208;PT&#44; um escore de item baseado na m&#233;dia foi calculado para cada paciente com pelo menos 80&#37; de respostas&#46; O escore do &#237;ndice foi transformado em uma m&#233;trica unificada de 0 a 50 usando a seguinte f&#243;rmula&#58; &#40;m&#233;dia&#8211;1&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>50&#247;3&#46; O escore final &#233; inserido em um dos quatro n&#237;veis de ES&#58; &#8220;inadequado&#8221; &#40;0&#8208;25&#41;&#44; &#8220;problem&#225;tico&#8221; &#40;&#62; 25&#8208;33&#41;&#44; &#8220;suficiente&#8221; &#40;&#62; 33&#8208;42&#41; e &#8220;excelente&#8221; &#40;&#62; 42&#8208;50&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> Os resultados s&#227;o expressos em porcentagens ou m&#233;dias<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio&#8208;padr&#227;o&#44; e as an&#225;lises estat&#237;sticas foram realizadas no <span class="elsevierStyleItalic">software</span> SPSS vers&#227;o 22 &#40;SPSS Inc&#46;&#44; IBM&#8208;SPSS&#44; Chicago&#44; IL&#41;&#46; As vari&#225;veis foram testadas quanto &#224; normalidade com o teste de Kolmogorov&#8208;Smirnov&#46; Para a an&#225;lise univariada&#44; as rela&#231;&#245;es entre o escore do TOPICOP&#169; e a covari&#225;vel foram avaliadas por meio do teste de correla&#231;&#227;o de Pearson&#46; Quando necess&#225;rio&#44; o teste <span class="elsevierStyleItalic">t</span> de Student foi utilizado&#46; O teste de correla&#231;&#227;o de Pearson e a regress&#227;o linear univariada foram utilizados para medir o efeito da ES &#40;fornecida pelo escore no question&#225;rio HLS&#8208;EU&#8208;PT&#41; na fobia a CT &#40;medida pelo question&#225;rio TOPICOP&#169;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os dados ausentes n&#227;o foram substitu&#237;dos&#46; A signific&#226;ncia estat&#237;stica foi fixada em p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">&#201;tica</span><p id="par0045" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica M&#233;dica em Pesquisa do Hospital&#46; Foram tomadas medidas para manter a privacidade dos pacientes&#44; processando anonimamente os question&#225;rios&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas dos pacientes s&#227;o mostradas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Foram inclu&#237;dos 61 pacientes&#44; 36 &#40;59&#44;0&#37;&#41; do sexo feminino&#44; com m&#233;dia de idade de 20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;8 anos&#46; Havia 25 pacientes &#40;41&#44;0&#37;&#41; &#8804; 15 anos e 37 &#40;60&#44;7&#37;&#41;<span class="elsevierStyleHsp" style=""></span>&#62; 15 anos&#46; Dez &#40;16&#44;4&#37;&#41; dos respondentes trabalhavam na &#225;rea da sa&#250;de&#46; A dura&#231;&#227;o m&#233;dia da DA era de 12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;4 anos&#46; Outras doen&#231;as at&#243;picas &#40;asma e&#47;ou rinite al&#233;rgica&#41; estavam presentes em 35 pacientes &#40;57&#44;4&#37;&#41;&#44; e 31 &#40;50&#44;8&#37;&#41; tinham hist&#243;ria familiar de DA&#46; A maioria dos pacientes tinha doen&#231;a de baixo grau &#40;38 pacientes&#44; 62&#44;3&#37;&#41;&#46; Cinquenta e nove pacientes &#40;96&#44;7&#37;&#41; confirmaram o tratamento com CT&#46; A distribui&#231;&#227;o de outros tratamentos na DA est&#225; descrita na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Os n&#237;veis de TOPICOP&#169; variaram de 8&#44;3 a 88&#44;9&#44; com escore m&#233;dio de 44&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;0&#44; o que indica n&#237;vel moderado de fobia a CT&#46; Nove pacientes &#40;14&#44;8&#37;&#41; apresentaram escore baixo no TOPICOP&#169;&#44; 31 &#40;50&#44;8&#37;&#41; escore intermedi&#225;rio e 21 &#40;34&#44;4&#37;&#41; escore alto&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O escore no question&#225;rio HLS&#8208;EU&#8208;PT variou de 1&#44;1 a 47&#44;9&#44; com escore m&#233;dio de 30&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5&#44; considerado n&#237;vel de ES problem&#225;tico&#46; ES inadequada estava presente em 13 &#40;21&#44;3&#37;&#41;&#44; ES problem&#225;tica em 26 &#40;42&#44;6&#37;&#41;&#44; ES suficiente em 16 &#40;26&#44;2&#37;&#41; e excelente em 6 &#40;9&#44;8&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">N&#227;o foi encontrada diferen&#231;a estatisticamente significativa para o escore TOPICOP&#169; entre os respondedores que eram cuidadores &#40;pacientes &#8804; 15 anos&#41; e os respondedores que eram pacientes &#40;&#62; 15 anos&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;189&#41;&#46; Da mesma maneira&#44; n&#227;o foi encontrada diferen&#231;a estatisticamente significativa para os escores do TOPICOP&#169; entre profissionais da &#225;rea da sa&#250;de e de outras &#225;reas&#44; hist&#243;ria familiar de DA&#44; hist&#243;ria pessoal de outras doen&#231;as at&#243;picas e gravidade da doen&#231;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; O escore no TOPICOP&#169; mostrou estar negativamente correlacionado com o escore do HLS&#8208;EU&#8208;PT &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;382&#59; r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;146&#41;&#44; com n&#237;veis mais altos de TOPICOP&#169; mostrando estar associados a escores mais baixos no HLS&#8208;EU&#8208;PT &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">Os CT s&#227;o o tratamento anti&#8208;inflamat&#243;rio de primeira linha na DA&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">6</span></a> A corticofobia pode prejudicar o regime de tratamento adequado&#44; induzindo doen&#231;a n&#227;o controlada&#44; com impacto negativo na qualidade de vida&#46; A quantidade certa de CT a ser utilizada e a frequ&#234;ncia de aplica&#231;&#245;es s&#227;o algumas das preocupa&#231;&#245;es que devem ser abordadas com esses pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a> O medo dos efeitos colaterais dos CT pode ser uma grande preocupa&#231;&#227;o em pacientes com DA e seus cuidadores&#44; e est&#225; frequentemente associado &#224; resist&#234;ncia ao uso de CT&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;20&#44;21</span></a> Atrofia cut&#226;nea&#44; p&#250;rpura&#44; telangiectasias&#44; estrias&#44; dermatite perioral e acne s&#227;o alguns dos eventos adversos que podem ocorrer com administra&#231;&#227;o prolongada e inadequada de CT&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a> A absor&#231;&#227;o percut&#226;nea aumentada pode ser respons&#225;vel por efeitos adversos sist&#234;micos&#44; como supress&#227;o do eixo hipot&#225;lamo&#8208;hip&#243;fise&#8208;adrenal e glaucoma&#44; mas o risco parece ser baixo&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">23&#44;24</span></a> Em geral&#44; o tratamento em longo prazo com CT &#233; considerado seguro tanto em adultos como em crian&#231;as&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">23&#44;25&#8211;27</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Atualmente&#44; o acesso &#224;s informa&#231;&#245;es m&#233;dicas est&#225; dispon&#237;vel nos meios de comunica&#231;&#227;o&#44; como jornais&#44; revistas e internet&#46; No entanto&#44; muitas dessas informa&#231;&#245;es n&#227;o s&#227;o produzidas por profissionais de sa&#250;de e podem induzir erroneamente o paciente ao subtratamento com CT&#46; De fato&#44; estudo coreano mostrou que a internet &#40;49&#44;2&#37;&#41;&#44; a televis&#227;o ou outros meios de transmiss&#227;o &#40;45&#44;2&#37;&#41;&#44; m&#233;dicos&#47;profissionais da sa&#250;de &#40;37&#44;3&#37;&#41; e revistas&#47;jornais eram fontes de informa&#231;&#227;o associadas &#224; fobia a esteroides&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> Os pacientes podem ter dificuldades em selecionar informa&#231;&#245;es m&#233;dicas corretas e confi&#225;veis&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O TOPICOP&#169; &#233; atualmente o &#250;nico escore validado para avaliar a fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> No presente estudo&#44; o question&#225;rio TOPICOP&#169; mostrou n&#237;vel m&#233;dio de 44&#44;8&#37; na popula&#231;&#227;o avaliada&#44; o que indica n&#237;vel moderado de fobia a CT&#46; Outros grupos relataram n&#237;veis semelhantes de corticofobia&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">16&#44;19&#44;29</span></a> Stalder et al&#46; relataram escore m&#233;dio global no TOPICOP&#169; de 44&#44;7&#37; em um estudo multic&#234;ntrico prospectivo realizado com 1&#46;796 participantes de 17 pa&#237;ses&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> Em estudo menor&#44; Bos et al&#46; encontraram escore TOPICOP&#169; de 44&#37; em um grupo de 29 pais de pacientes com DA na Holanda&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> Estudo franc&#234;s realizado por Dufresne et al&#46; com 191 pais encontrou escore TOPICOP&#169; de 39&#44;8&#37;&#44; um pouco menor do que os outros estudos&#44; mas esses pais participaram de um programa de educa&#231;&#227;o terap&#234;utica&#44; o que pode ter sido respons&#225;vel pelos melhores resultados&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">O principal objetivo do presente estudo foi avaliar a associa&#231;&#227;o entre fobia a CT e ES&#46; O &#237;ndice geral de ES relatado para Portugal foi de 33&#44;0&#44; onde 11&#37; demonstraram escore de ES &#8220;inadequado&#8221;&#44; e 38&#37; tinham escore &#8220;problem&#225;tico&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> O presente estudo mostrou escore m&#233;dio no HLS&#8208;EU&#8208;PT de 30&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 e 63&#44;9&#37; apresentaram n&#237;veis mais baixos &#40;&#8220;inadequado&#8221; e &#8220;problem&#225;tico&#8221;&#41;&#46; Curiosamente&#44; correla&#231;&#227;o negativa significativa foi encontrada entre o escore TOPICOP&#169; e o escore do HLS&#8208;EU&#8208;PT&#46; Al&#233;m disso&#44; menor ES foi preditora de maior corticofobia&#46; Isso refor&#231;a a import&#226;ncia da ES na assist&#234;ncia &#224; sa&#250;de&#46; Os resultados do presente estudo contrastam com os achados de Dufresne et al&#46;&#44; nos quais o escore de educa&#231;&#227;o em sa&#250;de foi associado de maneira significativa &#224; maior fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> A maioria dos pais corticof&#243;bicos em seu estudo tinha acesso direto a recursos cient&#237;ficos e <span class="elsevierStyleItalic">online</span>&#44; e o escore TOPICOP&#169; mais alto foi associado a anos completos ap&#243;s a gradua&#231;&#227;o&#46; Entretanto&#44; esses autores apresentaram um grupo mais homog&#234;neo&#44; ao incluir apenas pais de crian&#231;as com DA &#40;&#60; 18 anos&#41;&#46; A inclus&#227;o de um grupo de pais de pacientes mais jovens e um grupo de pacientes mais velhos pode ser uma limita&#231;&#227;o do presente estudo&#44; j&#225; que torna a coorte mais heterog&#234;nea e pode impactar na an&#225;lise geral do grupo&#46; Outra limita&#231;&#227;o foi o pequeno n&#250;mero de pacientes em cada grupo&#46; Estudos futuros com coortes maiores e mais homog&#234;neas devem ser realizados para confirmar os achados do presente estudo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Os m&#233;dicos devem desenvolver t&#233;cnicas de ensino para educar adequadamente seus pacientes sobre a doen&#231;a e o tratamento recomendado&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> Entretanto&#44; a fobia a CT tamb&#233;m est&#225; presente entre os profissionais de sa&#250;de e pode afetar a perspectiva dos pacientes &#40;ou seus cuidadores&#41; sobre o uso e a ades&#227;o ao tratamento com CT&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">29&#44;31</span></a> A educa&#231;&#227;o desses profissionais pode melhorar a ades&#227;o dos pacientes ao tratamento&#46; Foi demonstrado que ter confian&#231;a no m&#233;dico est&#225; associado de maneira significativa ao fato de tomar a medica&#231;&#227;o como indicado&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a> A educa&#231;&#227;o da equipe da farm&#225;cia para fornecer aconselhamento ao paciente tamb&#233;m se mostrou eficaz na redu&#231;&#227;o da fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> Os m&#233;dicos devem fornecer instru&#231;&#245;es detalhadas por escrito dos tratamentos com CT e responder a quaisquer preocupa&#231;&#245;es que os pacientes e cuidadores possam ter&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A promo&#231;&#227;o da ES deve ser prioridade na sa&#250;de p&#250;blica&#46; A melhora das compet&#234;ncias cr&#237;ticas individuais e sociais relativas &#224; sa&#250;de ir&#225; maximizar o comprometimento com comportamentos saud&#225;veis&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclus&#227;o</span><p id="par0100" class="elsevierStylePara elsevierViewall">A corticofobia &#233; obst&#225;culo para um regime terap&#234;utico adequado em doen&#231;as cut&#226;neas como a DA&#46; A facilidade de acesso a informa&#231;&#245;es sobre CT e seus efeitos colaterais podem&#44; paradoxalmente&#44; contribuir para o medo e a preocupa&#231;&#227;o relacionados a eles&#46; Os pacientes precisam ser capazes de selecionar e filtrar o conte&#250;do confi&#225;vel&#46; A ES &#233; respons&#225;vel pela capacidade e escolha cr&#237;tica em comportamentos de sa&#250;de&#46; O presente estudo sugere que maior ES est&#225; associada a menor fobia a CT&#44; mas s&#227;o necess&#225;rios mais estudos para esclarecer essa associa&#231;&#227;o&#46; Que seja de conhecimento dos autores&#44; este estudo fornece a primeira avalia&#231;&#227;o da fobia a CT em Portugal&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Suporte financeiro</span><p id="par0110" class="elsevierStylePara elsevierViewall">Nenhum</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Contribui&#231;&#227;o dos autores</span><p id="par0115" class="elsevierStylePara elsevierViewall">Tiago Fernandes Gomes&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; revis&#227;o cr&#237;tica da literatura&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Katarina Kieselova&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Victoria Guiote&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#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="par0130" class="elsevierStylePara elsevierViewall">Martinha Henrique&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Felicidade Santiago&#58; Concep&#231;&#227;o e planejamento do estudo&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflito de interesses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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    "fechaRecibido" => "2021-10-05"
    "fechaAceptado" => "2021-11-08"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Dermatite at&#243;pica"
            1 => "Educa&#231;&#227;o em sa&#250;de"
            2 => "Esteroides"
            3 => "Terap&#234;utica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Os corticosteroides t&#243;picos &#40;CT&#41; s&#227;o a base do tratamento nas crises de dermatite at&#243;pica &#40;DA&#41;&#46; Os medos e as preocupa&#231;&#245;es em rela&#231;&#227;o aos CT s&#227;o conhecidos como corticofobia&#46; A corticofobia &#233; comum em pacientes com DA e pode levar &#224; aplica&#231;&#227;o sub&#8208;&#243;tima de CT e &#224; falha do tratamento&#46; A educa&#231;&#227;o em sa&#250;de &#40;ES&#41; pode influenciar a corticofobia&#46; Os question&#225;rios TOPICOP&#169; e HLS&#8208;EU&#8208;PT foram desenvolvidos para avaliar corticofobia e ES&#44; respectivamente&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a rela&#231;&#227;o entre corticofobia e o grau de ES em pacientes com DA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal prospectivo em pacientes com DA acompanhados em um Servi&#231;o de Dermatologia&#44; entre setembro de 2019 e fevereiro de 2020&#46; Os pacientes&#44; ou seus pais &#40;se os pacientes tivessem &#8804; 15 anos&#41;&#44; foram convidados a responder os question&#225;rios TOPICOP&#169;&#44; HLS&#8208;EU&#8208;PT e um question&#225;rio sobre as caracter&#237;sticas da doen&#231;a e dados demogr&#225;ficos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 61 pacientes &#40;59&#44;0&#37; do sexo feminino&#44; m&#233;dia de idade de 20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;8 anos&#44; dura&#231;&#227;o m&#233;dia da doen&#231;a de 12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;4 anos&#41;&#46; O escore m&#233;dio do TOPICOP&#169; foi de 44&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;0 &#40;8&#44;3 a 88&#44;9&#41; e o escore m&#233;dio do HLS&#8208;EU&#8208;PT foi de 30&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 &#40;1&#44;0 a 47&#44;9&#41;&#46; O escore do TOPICOP&#169; correlacionou&#8208;se negativamente com o escore do HLS&#8208;EU&#8208;PT &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#44; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;382&#44; r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;146&#41;&#46; N&#227;o houve diferen&#231;a estat&#237;stica entre o escore do TOPICOP&#169; e as caracter&#237;sticas da doen&#231;a &#40;gravidade da doen&#231;a&#44; hist&#243;ria familiar de DA&#44; hist&#243;ria pessoal de outras doen&#231;as at&#243;picas&#41;&#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">Coorte pequena e heterog&#234;nea composta por pacientes e pais de pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O grau de corticofobia &#233; similar aos valores relatados em outros estudos&#46; A ES mostrou uma correla&#231;&#227;o inversa com a corticofobia&#46; A ES mais baixa mostrou ser um preditor de maior corticofobia&#46; A promo&#231;&#227;o da educa&#231;&#227;o em sa&#250;de &#233; essencial para o uso correto de CT e&#44; portanto&#44; o controle ideal da DA&#46;</p></span>"
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          3 => array:2 [
            "identificador" => "abst0020"
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          4 => array:2 [
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            "titulo" => "Limita&#231;&#245;es do estudo"
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          5 => array:2 [
            "identificador" => "abst0030"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Gomes TF&#44; Kieselova K&#44; Guiote V&#44; Henrique M&#44; Santiago F&#46; A low level of health literacy is a predictor of corticophobia in atopic dermatitis&#46; An Bras Dermatol&#46; 2022&#59;97&#58;704&#8211;9&#46;</p>"
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      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Departamento de Dermatologia&#44; Centro Hospitalar de Leiria&#44; Leiria&#44; Portugal&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracteriza&#231;&#227;o da popula&#231;&#227;o&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">n&#160;&#40;&#37;&#41;&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&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#40;m&#237;n&#8211;m&#225;x&#41;&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
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                  \t\t\t\t">Idade&#44; anos&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  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;8 &#40;1&#8211;49&#41;</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">&#8804; 15 anos&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">25 &#40;41&#44;0&#41;&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>&#62; 15 anos&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">36 &#40;59&#44;0&#41;&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">Sexo&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">Feminino&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">35 &#40;57&#44;4&#41;&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">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">26 &#40;42&#44;6&#41;&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">Dura&#231;&#227;o da doen&#231;a&#44; anos&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  " rowspan="22" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;4 &#40;0&#8211;47&#44;0&#41;</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">Profissional da Sa&#250;de&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">Sim&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">10 &#40;16&#44;4&#41;&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">N&#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">51 &#40;83&#44;6&#41;&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">Hist&#243;ria familiar de DA&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">Sim&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 &#40;50&#44;8&#41;&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">N&#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">30 &#40;49&#44;2&#41;&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">Hist&#243;ria pessoal de asma e&#47;ou rinite al&#233;rgica&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">Sim&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">35 &#40;57&#44;4&#41;&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">N&#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">26 &#40;42&#44;6&#41;&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">Gravidade da DA&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">Leve&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">38 &#40;62&#44;3&#41;&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">Moderada a grave&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 &#40;37&#44;7&#41;&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">Tratamentos atuais e&#47;ou anteriores&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">Hidratante&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">59 &#40;96&#44;7&#41;&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">Corticosteroide 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">59 &#40;96&#44;7&#41;&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">Inibidor t&#243;pico da calcineurina&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">21 &#40;34&#44;4&#41;&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">Corticosteroides sist&#234;micos&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">16 &#40;26&#44;2&#41;&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">Ciclosporina&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 &#40;23&#44;0&#41;&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">Metotrexato&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 &#40;9&#44;8&#41;&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">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">5 &#40;8&#44;2&#41;&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">Dupilumabe&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 &#40;3&#44;3&#41;&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">TOPICOP&#169;&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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;0 &#40;8&#44;3&#8211;88&#44;9&#41;</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">Baixo &#40;n&#44; &#37;&#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">9 &#40;14&#44;8&#41;&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">Moderado &#40;n&#44; &#37;&#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">31 &#40;50&#44;8&#41;&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">Alto &#40;n&#44; &#37;&#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">21 &#40;34&#44;4&#41;&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">M&#233;dia do HLS&#8208;EU&#8208;PT&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  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 &#40;1&#44;1&#8211;47&#44;9&#41;</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">Inadequado &#40;n&#44; &#37;&#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">13 &#40;21&#44;3&#41;&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">Problem&#225;tico &#40;n&#44; &#37;&#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">26 &#40;42&#44;6&#41;&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">Suficiente &#40;n&#44; &#37;&#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">16 &#40;26&#44;2&#41;&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">Excelente &#40;n&#44; &#37;&#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">6 &#40;9&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TOPICOP &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade</span></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>&#8804; 15 anos&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">40&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;8&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&#44;189&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>&#62; 15 anos&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">47&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;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="" 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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Profissional da sa&#250;de</span></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>Sim&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">34&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;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">0&#44;073&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&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&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;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="" 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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria familiar de DA</span></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>Sim&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&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;4&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&#44;583&nbsp;\t\t\t\t\t\t\n
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Artigo original
Baixo nível de educação em saúde como preditor de corticofobia na dermatite atópica
Tiago Fernandes Gomes
Autor para correspondência
tiagofgomesd@gmail.com

Autor para correspondência.
, Katarina Kieselova, Victoria Guiote, Martinha Henrique, Felicidade Santiago
Departamento de Dermatologia, Centro Hospitalar de Leiria, Leiria, Portugal
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s&#227;o a base do tratamento na maioria dos pacientes com DA&#44; e muitas vezes requerem tratamento a longo prazo com CT por muitos anos&#46; Baixa ades&#227;o ao tratamento &#233; comum na DA e pode levar &#224; falha do tratamento&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8&#8211;10</span></a> A resist&#234;ncia &#224; CT pode ser parcialmente decorrente da n&#227;o ades&#227;o em raz&#227;o da fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> A fobia a CT&#44; tamb&#233;m conhecida como corticofobia&#44; define os sentimentos e cren&#231;as negativas relacionadas a CT vivenciadas por pacientes e seus cuidadores&#46; A preval&#234;ncia de corticofobia na DA varia de 21&#37; a 84&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> Educa&#231;&#227;o em sa&#250;de &#40;ES&#41; &#233; o termo utilizado para descrever as capacidades das pessoas em atender &#224;s complexas demandas relacionadas &#224; sa&#250;de na sociedade moderna&#46; Ela resulta das atividades de educa&#231;&#227;o e comunica&#231;&#227;o em sa&#250;de e determina a capacidade individual de ter acesso a&#44; compreender e utilizar a informa&#231;&#227;o para promover e manter uma boa sa&#250;de&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#44;14</span></a> O presente estudo prop&#244;s avaliar o efeito da ES na corticofobia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Pacientes e local do estudo</span><p id="par0010" class="elsevierStylePara elsevierViewall">Realizou&#8208;se um estudo transversal prospectivo no Servi&#231;o de Dermatologia de um Hospital de n&#237;vel dois&#44; entre setembro de 2019 e fevereiro de 2020&#46; Foram inclu&#237;dos pacientes com dermatite at&#243;pica&#44; com pelo menos duas consultas de Dermatologia&#46; Foram definidos dois grupos de acordo com a idade do paciente&#58; &#8804; 15 anos e &#62;<span class="elsevierStyleHsp" style=""></span>15 anos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Question&#225;rios</span><p id="par0015" class="elsevierStylePara elsevierViewall">Os pais dos pacientes com &#8804; 15 anos e os pacientes com<span class="elsevierStyleHsp" style=""></span>&#62; 15 anos foram convidados a responder a tr&#234;s question&#225;rios&#58; TOPICOP&#169;&#44; HLS&#8208;EU&#8208;PT e um question&#225;rio de caracteriza&#231;&#227;o da doen&#231;a e de dados demogr&#225;ficos&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O question&#225;rio TOPICOP&#169; &#233; uma escala validada para a avalia&#231;&#227;o de fobia a CT em pacientes com DA e em seus pais&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> A viabilidade e a compreens&#227;o do escore no TOPICOP&#169; foram abordadas em diferentes pa&#237;ses&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> A vers&#227;o original est&#225; em ingl&#234;s&#44; mas as vers&#245;es em portugu&#234;s e em outros idiomas est&#227;o dispon&#237;veis em <a href="http://www.edudermatologie.com/">http&#58;&#47;&#47;www&#46;edudermatologie&#46;com</a>&#46; O question&#225;rio &#233; composto por 12 itens&#44; que abrangem &#8220;preocupa&#231;&#245;es&#8221; &#40;6 itens&#41; e &#8220;cren&#231;as&#8221; &#40;6 itens&#41;&#46; S&#227;o oferecidas quatro op&#231;&#245;es de resposta&#44; que variam de &#8220;discordo totalmente&#8221; a &#8220;concordo totalmente&#8221;&#44; com pontos atribu&#237;dos a cada uma &#40;0&#44; 1&#44; 2 ou 3&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">O question&#225;rio <span class="elsevierStyleItalic">European Health Literacy Survey</span> &#40;HLS&#8208;EU&#41; &#233; uma ferramenta validada para medir a ES da popula&#231;&#227;o geral&#44; tamb&#233;m validada na l&#237;ngua portuguesa &#40;HLS&#8208;EU&#8208;PT&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;17</span></a> O HLS&#8208;EU&#8208;PT inclui 47 quest&#245;es&#44; que integram tr&#234;s dom&#237;nios de sa&#250;de diferentes&#58; cuidados de sa&#250;de&#44; preven&#231;&#227;o de doen&#231;as e promo&#231;&#227;o da sa&#250;de&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;18</span></a> Para cada item&#44; os pacientes classificam a dificuldade percebida de determinada tarefa em uma escala Likert de quatro categorias de resposta &#40;muito f&#225;cil&#44; f&#225;cil&#44; dif&#237;cil e muito dif&#237;cil&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Um terceiro question&#225;rio foi aplicado para fornecer dados cl&#237;nicos adicionais&#46; Isso incluiu informa&#231;&#245;es demogr&#225;ficas como sexo&#44; idade&#44; trabalhar na &#225;rea da sa&#250;de e caracter&#237;sticas da doen&#231;a&#44; como dura&#231;&#227;o da doen&#231;a&#44; hist&#243;ria familiar de DA&#44; hist&#243;ria pessoal de asma e&#47;ou rinite al&#233;rgica e tratamentos anteriores de DA&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lise estat&#237;stica</span><p id="par0035" class="elsevierStylePara elsevierViewall">O escore no TOPICOP&#169; foi calculado como 100&#37; vezes a soma de todas as respostas divididas pela soma m&#225;xima poss&#237;vel para as perguntas inclu&#237;das&#44; com um escore resultante de 0 a 100&#37; de fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> O escore pode ser ainda categorizado como baixo &#40;&#8804; 23&#41;&#44; intermedi&#225;rio &#40;24&#8208;50&#41; e alto &#40;&#62; 50&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> Para o HLS&#8208;EU&#8208;PT&#44; um escore de item baseado na m&#233;dia foi calculado para cada paciente com pelo menos 80&#37; de respostas&#46; O escore do &#237;ndice foi transformado em uma m&#233;trica unificada de 0 a 50 usando a seguinte f&#243;rmula&#58; &#40;m&#233;dia&#8211;1&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>50&#247;3&#46; O escore final &#233; inserido em um dos quatro n&#237;veis de ES&#58; &#8220;inadequado&#8221; &#40;0&#8208;25&#41;&#44; &#8220;problem&#225;tico&#8221; &#40;&#62; 25&#8208;33&#41;&#44; &#8220;suficiente&#8221; &#40;&#62; 33&#8208;42&#41; e &#8220;excelente&#8221; &#40;&#62; 42&#8208;50&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> Os resultados s&#227;o expressos em porcentagens ou m&#233;dias<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio&#8208;padr&#227;o&#44; e as an&#225;lises estat&#237;sticas foram realizadas no <span class="elsevierStyleItalic">software</span> SPSS vers&#227;o 22 &#40;SPSS Inc&#46;&#44; IBM&#8208;SPSS&#44; Chicago&#44; IL&#41;&#46; As vari&#225;veis foram testadas quanto &#224; normalidade com o teste de Kolmogorov&#8208;Smirnov&#46; Para a an&#225;lise univariada&#44; as rela&#231;&#245;es entre o escore do TOPICOP&#169; e a covari&#225;vel foram avaliadas por meio do teste de correla&#231;&#227;o de Pearson&#46; Quando necess&#225;rio&#44; o teste <span class="elsevierStyleItalic">t</span> de Student foi utilizado&#46; O teste de correla&#231;&#227;o de Pearson e a regress&#227;o linear univariada foram utilizados para medir o efeito da ES &#40;fornecida pelo escore no question&#225;rio HLS&#8208;EU&#8208;PT&#41; na fobia a CT &#40;medida pelo question&#225;rio TOPICOP&#169;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os dados ausentes n&#227;o foram substitu&#237;dos&#46; A signific&#226;ncia estat&#237;stica foi fixada em p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">&#201;tica</span><p id="par0045" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica M&#233;dica em Pesquisa do Hospital&#46; Foram tomadas medidas para manter a privacidade dos pacientes&#44; processando anonimamente os question&#225;rios&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas dos pacientes s&#227;o mostradas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Foram inclu&#237;dos 61 pacientes&#44; 36 &#40;59&#44;0&#37;&#41; do sexo feminino&#44; com m&#233;dia de idade de 20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;8 anos&#46; Havia 25 pacientes &#40;41&#44;0&#37;&#41; &#8804; 15 anos e 37 &#40;60&#44;7&#37;&#41;<span class="elsevierStyleHsp" style=""></span>&#62; 15 anos&#46; Dez &#40;16&#44;4&#37;&#41; dos respondentes trabalhavam na &#225;rea da sa&#250;de&#46; A dura&#231;&#227;o m&#233;dia da DA era de 12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;4 anos&#46; Outras doen&#231;as at&#243;picas &#40;asma e&#47;ou rinite al&#233;rgica&#41; estavam presentes em 35 pacientes &#40;57&#44;4&#37;&#41;&#44; e 31 &#40;50&#44;8&#37;&#41; tinham hist&#243;ria familiar de DA&#46; A maioria dos pacientes tinha doen&#231;a de baixo grau &#40;38 pacientes&#44; 62&#44;3&#37;&#41;&#46; Cinquenta e nove pacientes &#40;96&#44;7&#37;&#41; confirmaram o tratamento com CT&#46; A distribui&#231;&#227;o de outros tratamentos na DA est&#225; descrita na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Os n&#237;veis de TOPICOP&#169; variaram de 8&#44;3 a 88&#44;9&#44; com escore m&#233;dio de 44&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;0&#44; o que indica n&#237;vel moderado de fobia a CT&#46; Nove pacientes &#40;14&#44;8&#37;&#41; apresentaram escore baixo no TOPICOP&#169;&#44; 31 &#40;50&#44;8&#37;&#41; escore intermedi&#225;rio e 21 &#40;34&#44;4&#37;&#41; escore alto&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O escore no question&#225;rio HLS&#8208;EU&#8208;PT variou de 1&#44;1 a 47&#44;9&#44; com escore m&#233;dio de 30&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5&#44; considerado n&#237;vel de ES problem&#225;tico&#46; ES inadequada estava presente em 13 &#40;21&#44;3&#37;&#41;&#44; ES problem&#225;tica em 26 &#40;42&#44;6&#37;&#41;&#44; ES suficiente em 16 &#40;26&#44;2&#37;&#41; e excelente em 6 &#40;9&#44;8&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">N&#227;o foi encontrada diferen&#231;a estatisticamente significativa para o escore TOPICOP&#169; entre os respondedores que eram cuidadores &#40;pacientes &#8804; 15 anos&#41; e os respondedores que eram pacientes &#40;&#62; 15 anos&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;189&#41;&#46; Da mesma maneira&#44; n&#227;o foi encontrada diferen&#231;a estatisticamente significativa para os escores do TOPICOP&#169; entre profissionais da &#225;rea da sa&#250;de e de outras &#225;reas&#44; hist&#243;ria familiar de DA&#44; hist&#243;ria pessoal de outras doen&#231;as at&#243;picas e gravidade da doen&#231;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; O escore no TOPICOP&#169; mostrou estar negativamente correlacionado com o escore do HLS&#8208;EU&#8208;PT &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;382&#59; r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;146&#41;&#44; com n&#237;veis mais altos de TOPICOP&#169; mostrando estar associados a escores mais baixos no HLS&#8208;EU&#8208;PT &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">Os CT s&#227;o o tratamento anti&#8208;inflamat&#243;rio de primeira linha na DA&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">6</span></a> A corticofobia pode prejudicar o regime de tratamento adequado&#44; induzindo doen&#231;a n&#227;o controlada&#44; com impacto negativo na qualidade de vida&#46; A quantidade certa de CT a ser utilizada e a frequ&#234;ncia de aplica&#231;&#245;es s&#227;o algumas das preocupa&#231;&#245;es que devem ser abordadas com esses pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a> O medo dos efeitos colaterais dos CT pode ser uma grande preocupa&#231;&#227;o em pacientes com DA e seus cuidadores&#44; e est&#225; frequentemente associado &#224; resist&#234;ncia ao uso de CT&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;20&#44;21</span></a> Atrofia cut&#226;nea&#44; p&#250;rpura&#44; telangiectasias&#44; estrias&#44; dermatite perioral e acne s&#227;o alguns dos eventos adversos que podem ocorrer com administra&#231;&#227;o prolongada e inadequada de CT&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a> A absor&#231;&#227;o percut&#226;nea aumentada pode ser respons&#225;vel por efeitos adversos sist&#234;micos&#44; como supress&#227;o do eixo hipot&#225;lamo&#8208;hip&#243;fise&#8208;adrenal e glaucoma&#44; mas o risco parece ser baixo&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">23&#44;24</span></a> Em geral&#44; o tratamento em longo prazo com CT &#233; considerado seguro tanto em adultos como em crian&#231;as&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">23&#44;25&#8211;27</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Atualmente&#44; o acesso &#224;s informa&#231;&#245;es m&#233;dicas est&#225; dispon&#237;vel nos meios de comunica&#231;&#227;o&#44; como jornais&#44; revistas e internet&#46; No entanto&#44; muitas dessas informa&#231;&#245;es n&#227;o s&#227;o produzidas por profissionais de sa&#250;de e podem induzir erroneamente o paciente ao subtratamento com CT&#46; De fato&#44; estudo coreano mostrou que a internet &#40;49&#44;2&#37;&#41;&#44; a televis&#227;o ou outros meios de transmiss&#227;o &#40;45&#44;2&#37;&#41;&#44; m&#233;dicos&#47;profissionais da sa&#250;de &#40;37&#44;3&#37;&#41; e revistas&#47;jornais eram fontes de informa&#231;&#227;o associadas &#224; fobia a esteroides&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> Os pacientes podem ter dificuldades em selecionar informa&#231;&#245;es m&#233;dicas corretas e confi&#225;veis&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O TOPICOP&#169; &#233; atualmente o &#250;nico escore validado para avaliar a fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> No presente estudo&#44; o question&#225;rio TOPICOP&#169; mostrou n&#237;vel m&#233;dio de 44&#44;8&#37; na popula&#231;&#227;o avaliada&#44; o que indica n&#237;vel moderado de fobia a CT&#46; Outros grupos relataram n&#237;veis semelhantes de corticofobia&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">16&#44;19&#44;29</span></a> Stalder et al&#46; relataram escore m&#233;dio global no TOPICOP&#169; de 44&#44;7&#37; em um estudo multic&#234;ntrico prospectivo realizado com 1&#46;796 participantes de 17 pa&#237;ses&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> Em estudo menor&#44; Bos et al&#46; encontraram escore TOPICOP&#169; de 44&#37; em um grupo de 29 pais de pacientes com DA na Holanda&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> Estudo franc&#234;s realizado por Dufresne et al&#46; com 191 pais encontrou escore TOPICOP&#169; de 39&#44;8&#37;&#44; um pouco menor do que os outros estudos&#44; mas esses pais participaram de um programa de educa&#231;&#227;o terap&#234;utica&#44; o que pode ter sido respons&#225;vel pelos melhores resultados&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">O principal objetivo do presente estudo foi avaliar a associa&#231;&#227;o entre fobia a CT e ES&#46; O &#237;ndice geral de ES relatado para Portugal foi de 33&#44;0&#44; onde 11&#37; demonstraram escore de ES &#8220;inadequado&#8221;&#44; e 38&#37; tinham escore &#8220;problem&#225;tico&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> O presente estudo mostrou escore m&#233;dio no HLS&#8208;EU&#8208;PT de 30&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 e 63&#44;9&#37; apresentaram n&#237;veis mais baixos &#40;&#8220;inadequado&#8221; e &#8220;problem&#225;tico&#8221;&#41;&#46; Curiosamente&#44; correla&#231;&#227;o negativa significativa foi encontrada entre o escore TOPICOP&#169; e o escore do HLS&#8208;EU&#8208;PT&#46; Al&#233;m disso&#44; menor ES foi preditora de maior corticofobia&#46; Isso refor&#231;a a import&#226;ncia da ES na assist&#234;ncia &#224; sa&#250;de&#46; Os resultados do presente estudo contrastam com os achados de Dufresne et al&#46;&#44; nos quais o escore de educa&#231;&#227;o em sa&#250;de foi associado de maneira significativa &#224; maior fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> A maioria dos pais corticof&#243;bicos em seu estudo tinha acesso direto a recursos cient&#237;ficos e <span class="elsevierStyleItalic">online</span>&#44; e o escore TOPICOP&#169; mais alto foi associado a anos completos ap&#243;s a gradua&#231;&#227;o&#46; Entretanto&#44; esses autores apresentaram um grupo mais homog&#234;neo&#44; ao incluir apenas pais de crian&#231;as com DA &#40;&#60; 18 anos&#41;&#46; A inclus&#227;o de um grupo de pais de pacientes mais jovens e um grupo de pacientes mais velhos pode ser uma limita&#231;&#227;o do presente estudo&#44; j&#225; que torna a coorte mais heterog&#234;nea e pode impactar na an&#225;lise geral do grupo&#46; Outra limita&#231;&#227;o foi o pequeno n&#250;mero de pacientes em cada grupo&#46; Estudos futuros com coortes maiores e mais homog&#234;neas devem ser realizados para confirmar os achados do presente estudo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Os m&#233;dicos devem desenvolver t&#233;cnicas de ensino para educar adequadamente seus pacientes sobre a doen&#231;a e o tratamento recomendado&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> Entretanto&#44; a fobia a CT tamb&#233;m est&#225; presente entre os profissionais de sa&#250;de e pode afetar a perspectiva dos pacientes &#40;ou seus cuidadores&#41; sobre o uso e a ades&#227;o ao tratamento com CT&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">29&#44;31</span></a> A educa&#231;&#227;o desses profissionais pode melhorar a ades&#227;o dos pacientes ao tratamento&#46; Foi demonstrado que ter confian&#231;a no m&#233;dico est&#225; associado de maneira significativa ao fato de tomar a medica&#231;&#227;o como indicado&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a> A educa&#231;&#227;o da equipe da farm&#225;cia para fornecer aconselhamento ao paciente tamb&#233;m se mostrou eficaz na redu&#231;&#227;o da fobia a CT&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> Os m&#233;dicos devem fornecer instru&#231;&#245;es detalhadas por escrito dos tratamentos com CT e responder a quaisquer preocupa&#231;&#245;es que os pacientes e cuidadores possam ter&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A promo&#231;&#227;o da ES deve ser prioridade na sa&#250;de p&#250;blica&#46; A melhora das compet&#234;ncias cr&#237;ticas individuais e sociais relativas &#224; sa&#250;de ir&#225; maximizar o comprometimento com comportamentos saud&#225;veis&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclus&#227;o</span><p id="par0100" class="elsevierStylePara elsevierViewall">A corticofobia &#233; obst&#225;culo para um regime terap&#234;utico adequado em doen&#231;as cut&#226;neas como a DA&#46; A facilidade de acesso a informa&#231;&#245;es sobre CT e seus efeitos colaterais podem&#44; paradoxalmente&#44; contribuir para o medo e a preocupa&#231;&#227;o relacionados a eles&#46; Os pacientes precisam ser capazes de selecionar e filtrar o conte&#250;do confi&#225;vel&#46; A ES &#233; respons&#225;vel pela capacidade e escolha cr&#237;tica em comportamentos de sa&#250;de&#46; O presente estudo sugere que maior ES est&#225; associada a menor fobia a CT&#44; mas s&#227;o necess&#225;rios mais estudos para esclarecer essa associa&#231;&#227;o&#46; Que seja de conhecimento dos autores&#44; este estudo fornece a primeira avalia&#231;&#227;o da fobia a CT em Portugal&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Suporte financeiro</span><p id="par0110" class="elsevierStylePara elsevierViewall">Nenhum</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Contribui&#231;&#227;o dos autores</span><p id="par0115" class="elsevierStylePara elsevierViewall">Tiago Fernandes Gomes&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; revis&#227;o cr&#237;tica da literatura&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Katarina Kieselova&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Victoria Guiote&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#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="par0130" class="elsevierStylePara elsevierViewall">Martinha Henrique&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Felicidade Santiago&#58; Concep&#231;&#227;o e planejamento do estudo&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflito de interesses</span><p id="par0140" 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">Os corticosteroides t&#243;picos &#40;CT&#41; s&#227;o a base do tratamento nas crises de dermatite at&#243;pica &#40;DA&#41;&#46; Os medos e as preocupa&#231;&#245;es em rela&#231;&#227;o aos CT s&#227;o conhecidos como corticofobia&#46; A corticofobia &#233; comum em pacientes com DA e pode levar &#224; aplica&#231;&#227;o sub&#8208;&#243;tima de CT e &#224; falha do tratamento&#46; A educa&#231;&#227;o em sa&#250;de &#40;ES&#41; pode influenciar a corticofobia&#46; Os question&#225;rios TOPICOP&#169; e HLS&#8208;EU&#8208;PT foram desenvolvidos para avaliar corticofobia e ES&#44; respectivamente&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a rela&#231;&#227;o entre corticofobia e o grau de ES em pacientes com DA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal prospectivo em pacientes com DA acompanhados em um Servi&#231;o de Dermatologia&#44; entre setembro de 2019 e fevereiro de 2020&#46; Os pacientes&#44; ou seus pais &#40;se os pacientes tivessem &#8804; 15 anos&#41;&#44; foram convidados a responder os question&#225;rios TOPICOP&#169;&#44; HLS&#8208;EU&#8208;PT e um question&#225;rio sobre as caracter&#237;sticas da doen&#231;a e dados demogr&#225;ficos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 61 pacientes &#40;59&#44;0&#37; do sexo feminino&#44; m&#233;dia de idade de 20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;8 anos&#44; dura&#231;&#227;o m&#233;dia da doen&#231;a de 12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;4 anos&#41;&#46; O escore m&#233;dio do TOPICOP&#169; foi de 44&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;0 &#40;8&#44;3 a 88&#44;9&#41; e o escore m&#233;dio do HLS&#8208;EU&#8208;PT foi de 30&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 &#40;1&#44;0 a 47&#44;9&#41;&#46; O escore do TOPICOP&#169; correlacionou&#8208;se negativamente com o escore do HLS&#8208;EU&#8208;PT &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#44; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;382&#44; r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;146&#41;&#46; N&#227;o houve diferen&#231;a estat&#237;stica entre o escore do TOPICOP&#169; e as caracter&#237;sticas da doen&#231;a &#40;gravidade da doen&#231;a&#44; hist&#243;ria familiar de DA&#44; hist&#243;ria pessoal de outras doen&#231;as at&#243;picas&#41;&#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">Coorte pequena e heterog&#234;nea composta por pacientes e pais de pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O grau de corticofobia &#233; similar aos valores relatados em outros estudos&#46; A ES mostrou uma correla&#231;&#227;o inversa com a corticofobia&#46; A ES mais baixa mostrou ser um preditor de maior corticofobia&#46; A promo&#231;&#227;o da educa&#231;&#227;o em sa&#250;de &#233; essencial para o uso correto de CT e&#44; portanto&#44; o controle ideal da DA&#46;</p></span>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#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">51 &#40;83&#44;6&#41;&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">Hist&#243;ria familiar de DA&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">Sim&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 &#40;50&#44;8&#41;&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">N&#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">30 &#40;49&#44;2&#41;&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">Hist&#243;ria pessoal de asma e&#47;ou rinite al&#233;rgica&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">Sim&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">35 &#40;57&#44;4&#41;&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">N&#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">26 &#40;42&#44;6&#41;&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">Gravidade da DA&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">Leve&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">38 &#40;62&#44;3&#41;&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">Moderada a grave&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 &#40;37&#44;7&#41;&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">Tratamentos atuais e&#47;ou anteriores&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">Hidratante&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">59 &#40;96&#44;7&#41;&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">Corticosteroide 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">59 &#40;96&#44;7&#41;&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">Inibidor t&#243;pico da calcineurina&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">21 &#40;34&#44;4&#41;&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">Corticosteroides sist&#234;micos&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">16 &#40;26&#44;2&#41;&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">Ciclosporina&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 &#40;23&#44;0&#41;&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">Metotrexato&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 &#40;9&#44;8&#41;&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">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">5 &#40;8&#44;2&#41;&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">Dupilumabe&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 &#40;3&#44;3&#41;&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">TOPICOP&#169;&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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;0 &#40;8&#44;3&#8211;88&#44;9&#41;</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">Baixo &#40;n&#44; &#37;&#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">9 &#40;14&#44;8&#41;&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">Moderado &#40;n&#44; &#37;&#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">31 &#40;50&#44;8&#41;&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">Alto &#40;n&#44; &#37;&#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">21 &#40;34&#44;4&#41;&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">M&#233;dia do HLS&#8208;EU&#8208;PT&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  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 &#40;1&#44;1&#8211;47&#44;9&#41;</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">Inadequado &#40;n&#44; &#37;&#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">13 &#40;21&#44;3&#41;&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">Problem&#225;tico &#40;n&#44; &#37;&#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">26 &#40;42&#44;6&#41;&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">Suficiente &#40;n&#44; &#37;&#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">16 &#40;26&#44;2&#41;&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">Excelente &#40;n&#44; &#37;&#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">6 &#40;9&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3688194.png"
              ]
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Caracteriza&#231;&#227;o da popula&#231;&#227;o</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TOPICOP &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade</span></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>&#8804; 15 anos&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
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                  \t\t\t\t">40&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 15 anos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria pessoal de asma e&#47;ou rinite al&#233;rgica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Update on Atopic Dermatitis"
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                          "autores" => array:6 [
                            0 => "T&#46; Torres"
                            1 => "E&#46;O&#46; Ferreira"
                            2 => "M&#46; Gon&#231;alo"
                            3 => "P&#46; Mendes-Bastos"
                            4 => "M&#46; Selores"
                            5 => "P&#46; Filipe"
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                    0 => array:2 [
                      "doi" => "10.20344/amp.11963"
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                        "volumen" => "32"
                        "paginaInicial" => "606"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atopic Dermatitis in America Study&#58; A Cross&#8208;Sectional Study Examining the Prevalence and Disease Burden of Atopic Dermatitis in the US Adult Population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46;C&#46;C&#46; Fuxench"
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                            2 => "M&#46; Boguniewicz"
                            3 => "J&#46; Boyle"
                            4 => "L&#46; Fonacier"
                            5 => "J&#46;M&#46; Gelfand"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jid.2018.08.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Invest Dermatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "139"
                        "paginaInicial" => "583"
                        "paginaFinal" => "590"
                        "link" => array:1 [
                          0 => array:2 [
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                          "autores" => array:2 [
                            0 => "R&#46; Sacotte"
                            1 => "J&#46;I&#46; Silverberg"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2018.05.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "595"
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                          "etal" => false
                          "autores" => array:2 [
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                      "doi" => "10.1016/j.jaci.2013.08.031"
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                        "tituloSerie" => "J Allergy Clin Immunol&#46;"
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                        "volumen" => "132"
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