Fátima de Lima Paula

Profile of elderly admitted to public hospitals of Niterói (RJ) due to falls

OBJECTIVE to describe the common characteristics of elderly people admitted to public hospitals of Niterói (RJ) due to falls. METHODS Cross-sectional study with 110 elderly patients (60 years and more) admitted to public hospitals in Niteroi - RJ, with fractures after falls. Data were collected by a multidimensional questionnaire. Multiple correspondence and cluster analysis were used to describe the characteristics of this population. RESULTS The results indicated four groups. The first group was formed by individuals with better physical conditions who did not have a hip fracture, were more independent, used to go out more than twice a week, had good vision, had a short hospital stay, and were discharged to their homes. There was a group with worse conditions including those who were less independent, had a long hospital stay (more than 30 days), and died at the hospital. A third group was formed by those who had had a hip fracture, had poor vision, and used to go out less than once a week. The fourth group was comprised of those who stayed in the hospital from 11 to 30 days and used to go out once or twice a week. CONCLUSIONS The multiple correspondence analysis proved to be a good technique to identify subgroups with common characteristics, which provides tools for the creation of strategies for fall prevention programs.

Envelhecimento, depressão e quedas: um estudo com os participantes do Projeto Prev-Quedas

INTRODUCAO: No Brasil a depressao e um problema de saude publica, tendo 10 milhoes de pessoas com esse diagnostico. A queda de idosos e outro comprometedor da saude, que muitas vezes apresenta uma combinacao com a depressao. OBJETIVOS: Verificar a associacao entre estados depressivos e numero de quedas. MATERIAIS E METODOS: Estudo seccional em que foi aplicado o GDS-15 e um questionario especifico. Os dados foram trabalhados no programa R pelo teste Qui-Quadrado, ao nivel de significância de 95%. Foram incluidas idosas que participam do Projeto Prev-Quedas e o criterio de exclusao foi apresentar deficiencia auditiva nao corrigida ou apresentar estagios avancados de disturbios cognitivos e/ou doencas mentais que impedissem o entendimento das perguntas. DISCUSSAO E RESULTADOS: Foram entrevistadas 78 idosas, com idade media de 72 anos. O percentual de pessoas com possivel quadro de depressao foi de 21,8%. Nao foi encontrada associacao entre depressao e as variaveis idade, estado civil, morar com alguem (p > 0,05). Foi encontrada associacao entre quedas e depressao (p < 0,01). CONCLUSAO: A tendencia a estados depressivos encontrada na amostra foi considerada alta, acima da media nacional observada em 1999. A associacao encontrada entre o quadro de depressao e um maior numero de quedas sofridas pelos participantes pode indicar a necessidade de maior atencao das politicas publicas ao problema. A ausencia de medidas preventivas estaria ligada ao pior padrao de qualidade de vida relacionada a saude.

Relação entre plano de saúde e a realização do exame Papanicolaou: uma aplicação de escore de propensão usando um inquérito amostral complexo

Cervical uterine cancer is the second most common malignancy affecting women worldwide. Papanicolaou smear is a simple screening test that can detect the disease at an early and curable stage. Although indicated to every adult woman, Pap smear screening covers less than 70% of Brazilian women. This study aimed to evaluate if private health care insurance coverage was associated with Papanicolaou smear screening. We analyzed data from 6,299 women aged 35 years or older, resident in Rio de Janeiro state, who had been interviewed in the National Household Sample Survey (PNAD) in 2003. In order to minimize the occurrence of biases, we utilized the propensity score matching method, considering all information from sample design in the scores estimation (sample weights, strata and primary sampling units). A sub-sample of 2,348 women was then obtained, with socioeconomic and biological covariates equally distributed between the groups with and without private health insurance coverage (1,174 pairs). Logistic regression model was then used and the results showed that the chance of Papanicolaou smear screening is 26.1% higher (OR=1.261; p=0,096; CI 95%= [0.96;1.66]) for women with health insurance coverage when compared to women without health insurance coverage at 10% of significance. The results indicate the need of extending periodic cervical cancer screening for all women, reducing the inequalities still present nowadays.

Readmission of older patients after hospital discharge for hip fracture: a multilevel approach

ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases.

Elderly readmission and death after discharge from treatment of hip fracture, occurred in public hospitals from 2008 to 2010, Rio de Janeiro

OBJECTIVES To estimate the risk of death and readmission of a cohort of elderly patients discharged after hip fracture treatment from hospitals of the public health system; to describe the causes of these events; and to compare the rates of readmission and death observed with those of the elderly population hospitalized in public hospitals of Rio de Janeiro city. METHODS Data on deaths and readmissions were obtained through the linkage of these two data sources: the Hospital Information System of the Sistema Único de Saúde and the Mortality Information System from the city of Rio de Janeiro. The time frame for the study was 2008 to 2011. The population consisted of 2,612 individuals aged 60 years or older with nonelective hospitalization for hip fracture who were followed for a year after discharge. RESULTS The readmission rate in one year, excluding the deaths in this period, was 17.8%, and the death rate was 18.6%. The most common causes of death were circulatory system diseases (29.5%). Approximately 15% of the causes of readmissions were surgical complications. The state hospitals showed lower readmission risks and higher death risks compared with the federal and municipal hospitals. It was observed that there is an excess risk of readmission and hospitalization of the study population compared with the elderly population hospitalized in the public hospitals of the city. CONCLUSION Hospitalization of elderly individuals for hip fracture causes adverse outcomes such as readmissions and deaths. Many of these outcomes can be prevented from actions recommended in the National Policy for the Elderly Health.