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Risk of Potential Drug-Drug Interactions among Brazilian Elderly A Population-Based, Cross-Sectional Study

AbstractBackground Drug-drug interactions (DDIs) are one of the main causes of adverse reactions related to medications, being responsible for up to 23% of hospital admissions. However, only a few studies have evaluated this problem in elderly Brazilians. Objectives To determine the prevalence of potential DDIs (PDDIs) in community-dwelling elderly people in Brazil, analyse these interactions with regard to severity and clinical implications, and identify associated factors. Methods A population-based cross-sectional study was carried out involving 2143 elderly (aged ≥60 years) residents of the metropolitan area of Sao Paulo, Brazil. Data were obtained from the SABE (Saúde, Bem estar e Envelhecimento [Health, Well-Being, and Aging]) survey, which is a multicentre study carried out in seven countries of Latin America and the Caribbean, coordinated by the Pan-American Health Organization. PDDIs were analysed using a computerized program and categorized according to level of severity, onset, mechanism and documentation in the literature. The STATA software statistical package was used for data analysis, and logistic regression was conducted to determine whether variables were associated with PDDIs. Results Analysis revealed that 568 (26.5%) of the elderly population included in the study were taking medications that could lead to a DDI. Almost two-thirds (64.4%) of the elderly population exposed to PDDIs were women, 50.7% were aged ≥75 years, 71.7% reported having fair or poor health and 65.8% took 2–5 medications. A total of 125 different PDDIs were identified; the treatment combination of an ACE inhibitor with a thiazide or loop diuretic (associated with hypotension) was the most frequent cause of PDDIs (n=322 patients; 56.7% of individuals with PDDIs). Analysis of the PDDIs revealed that 70.4% were of moderate severity, 64.8% were supported by good quality evidence and 56.8% were considered of delayed onset. The multivariate analysis showed that the risk of a PDDI was significantly increased among elderly individuals using six or more medications (odds ratio [OR] 3.37) and in patients with hypertension (OR 2.56), diabetes mellitus (OR 1.73) or heart problems (OR 3.36). Conclusions Approximately one-quarter of the elderly population living in Sao Paulo could be taking two or more potentially interacting medicines. Polypharmacy predisposes elderly individuals to PDDIs. More than half of these drug combinations (57.6%, n=72) were part of commonly employed treatment regimens and may be responsible for adverse reactions that compromise the safety of elderly individuals, especially at home. Educational initiatives are needed to avoid unnecessary risks.

Contribuição dos arranjos domiciliares para o suprimento de demandas assistenciais dos idosos com comprometimento funcional em São Paulo, Brasil

OBJETIVO: Apresentar os resultados do Projeto Saude, Bem-Estar e Envelhecimento na America Latina e Caribe (SABE) no que tange ao desempenho funcional, as demandas assistenciais e aos arranjos familiares dos idosos do Municipio de Sao Paulo, Brasil. METODOS: Em 2000, foram entrevistados 2 143 individuos com 60 anos ou mais, utilizando-se o questionario padronizado do SABE. A amostra foi obtida em dois estagios, utilizando-se setores censitarios com reposicao e com probabilidade proporcional a populacao. A complementacao da amostra de pessoas de 75 anos ou mais foi realizada atraves da localizacao de moradias proximas aos setores selecionados. Os dados finais foram ponderados, de forma a serem expandidos. O desempenho funcional foi medido pela capacidade dos idosos de executar atividades basicas de vida diaria (ABVD, atravessar um comodo da casa, comer, deitar-se e levantar da cama, usar o vaso sanitario, vestir-se e despir-se e tomar banho) e atividades instrumentais de vida diaria (AIVD, comprar e preparar alimentos, realizar tarefas domesticas leves e pesadas, ir a outros lugares sozinho, usar o telefone, tomar os proprios medicamentos e manejar dinheiro), sendo a limitacao funcional (demanda assistencial) definida como a necessidade de ajuda para executar pelo menos uma dessas atividades. Os 66 tipos de arranjos domiciliares identificados foram agrupados em sete categorias, de acordo com a presenca ou nao de co-residentes e o grau de parentesco entre o idoso e os co-residentes. RESULTADOS: Dos entrevistados, 19,2% apresentaram limitacoes funcionais nas atividades basicas e 26,5% nas atividades instrumentais, sendo a maior proporcao entre mulheres e na velhice avancada. A proporcao de idosos com limitacoes que recebeu ajuda variou, nas atividades basicas, de 25,6% (para deitar-se e levantar da cama) a 70,5% (para comer), e nas instrumentais, de 79,7% (para a execucao de tarefas domesticas leves) a 97,8% (para comprar alimentos). Quanto aos arranjos familiares, a maioria dos idosos morava com o conjuge e os filhos ou apenas com os filhos (32,1%) ou somente com o conjuge (20,0%). O arranjo domiciliar em que a maior proporcao de idosos com limitacao funcional recebia ajuda (56,4%) foi aquele no qual o idoso residia tambem com nao-familiares. CONCLUSAO: Os idosos com limitacoes funcionais nao estao sendo assistidos suficientemente pela familia ou co-residentes, e as politicas publicas nao suprem esse deficit assistencial. Dado o acelerado processo de envelhecimento da populacao, o sistema de assistencia corre o risco de se tornar nao so insuficiente, mas caotico.

Education and mortality from cancer in São Paulo, Brazil.

This study investigated social class differentials in cancer mortality in São Paulo county, Brazil, for the period 1978 to 1982. A measure of socioeconomic status based on education was used, and cancer risk by level of education was estimated by a case-control approach in which other cancers were considered as controls. For most cancers, the socioeconomic differences in risk were similar to those found in western Europe and North America. For lung cancer, however, the highest risk was observed in men and women with the most education. Other cancers related to tobacco--cancer of the larynx, pharynx, and esophagus--showed a negative association with education. The differences between social classes in consumption habits of alcohol and maté and the use of black tobacco are probably responsible for these contrasting patterns. For breast and cervix uteri cancer the social class patterns were similar to those found in developed countries--a positive relationship for breast and a negative one for cervix uteri cancer. The magnitude of the differences observed between social classes for these cancers was frequently greater in South America than in the United States or western Europe.

The relationships between selected anthropometric and socio-economic data in schoolchildren from different social strata in Rio de Janeiro, Brazil

The nutritional status according to anthropometric data was assessed in 756 schoolchildren from 5 low-income state schools and in one private school in the same part of Rio de Janeiro, Brazil. The prevalence of stunting and wasting (cut-off point: less than 90% ht/age and less than 80% wt/ht) ranged in the public schools from 6.2 to 15.2% and 3.3 to 24.0%, respectively, whereas the figures for the private school were 2.3 and 3.5%, respectively. Much more obesity was found in the private school (18.0%) than in the state schools (0.8-6.2%). Nutritional problems seem to develop more severely in accordance with the increasing age of the children. Therefore it appears advisable to assess schoolchildren within the context of nutritional surveillance system.

Nursing diagnoses in trauma victims with fatal outcomes in the emergency scenario

The objective of this study was to identify and analyze the nursing diagnoses that constitute risk factors for death in trauma victims in the first 6 hours post-event. This is a cross-sectional, descriptive and exploratory study using quantitative analysis. A total of 406 patients were evaluated over six months of data collection in a tertiary hospital in the municipality of São Paulo, according to an instrument created for this purpose. Of the total, 44 (10.7%) suffered death. Multivariate analysis indicated the nursing diagnoses ineffective respiratory pattern, impaired spontaneous ventilation, risk of bleeding and risk of ineffective gastrointestinal tissue perfusion as risk factors for death and ineffective airway clearance, impaired comfort, and acute pain as protective factors, data that can direct health teams for different interventionist actions faced with the complexity of the trauma.El objetivo de este estudio fue identificar y analizar diagnosticos de enfermeria que constituyen factores de riesgo para muerte en victimas de trauma en las primeras 6 horas despues del evento. Se trata de un estudio transversal, descriptivo y exploratorio con analisis cuantitativo. Se evaluo 406 pacientes durante seis meses de recoleccion en un hospital terciario del Municipio de Sao Paulo, segun instrumento creado para esa finalidad. Del total, 44 (10,7%) evolucionaron para muerte. El analisis multivariado apunto los diagnosticos de enfermeria: patron respiratorio ineficaz, ventilacion espontanea perjudicada, riesgo de sangramiento y riesgo de perfusion tisular gastrointestinal ineficaz, como factores de riesgo para muerte; la desobstruccion ineficaz de vias aereas, confort perjudicado y dolor agudo como factores de proteccion, datos que pueden orientar a los equipos de salud para realizar acciones intervencionistas diferenciadas frente a la complejidad del trauma.O objetivo deste estudo foi identificar e analisar diagnosticos de enfermagem que constituem fatores de risco para obito, em vitimas de trauma, nas primeiras 6 horas apos o evento. Trata-se de estudo transversal, descritivo e exploratorio, com analise quantitativa. Avaliaram-se 406 pacientes durante seis meses de coleta em um hospital terciario do municipio de Sao Paulo, segundo instrumento criado para essa finalidade. Do total, 44 (10,7%) evoluiram para obito. Analise multivariada apontou os diagnosticos de enfermagem padrao respiratorio ineficaz, ventilacao espontânea prejudicada, risco de sangramento e risco de perfusao tissular gastrintestinal ineficaz como fatores de risco para obito e desobstrucao ineficaz de vias aereas, conforto prejudicado e dor aguda como fatores de protecao, dados que podem direcionar as equipes de saude para acoes intervencionistas diferenciadas frente a complexidade do trauma.

Lentas mudanças: o voto e a política tradicional

The goal of the present work is to analyze the relationship between development and political power, as well as to evaluate political changes in municipalities in Brazil. The study is based on a data bank from municipal elections (Tribunal Superior Eleitoral, 1996, 2000 and 2004) applying a procedure which takes structural variables into account, such as size and quality of life in municipalities (IBGE/IPEA/PNUD), and ideology of political parties. The question is whether favorable geographic- political configurations exist for left or right wing parties. Our conclusion is that traditional political parties (right wing) find larger support in micro municipalities with bad quality of life.

Diagnósticos de enfermagem em vítimas fatais decorrentes de trauma no cenário da emergência

The objective of this study was to identify and analyze the nursing diagnoses that constitute risk factors for death in trauma victims in the first 6 hours post-event. This is a cross-sectional, descriptive and exploratory study using quantitative analysis. A total of 406 patients were evaluated over six months of data collection in a tertiary hospital in the municipality of São Paulo, according to an instrument created for this purpose. Of the total, 44 (10.7%) suffered death. Multivariate analysis indicated the nursing diagnoses ineffective respiratory pattern, impaired spontaneous ventilation, risk of bleeding and risk of ineffective gastrointestinal tissue perfusion as risk factors for death and ineffective airway clearance, impaired comfort, and acute pain as protective factors, data that can direct health teams for different interventionist actions faced with the complexity of the trauma.El objetivo de este estudio fue identificar y analizar diagnosticos de enfermeria que constituyen factores de riesgo para muerte en victimas de trauma en las primeras 6 horas despues del evento. Se trata de un estudio transversal, descriptivo y exploratorio con analisis cuantitativo. Se evaluo 406 pacientes durante seis meses de recoleccion en un hospital terciario del Municipio de Sao Paulo, segun instrumento creado para esa finalidad. Del total, 44 (10,7%) evolucionaron para muerte. El analisis multivariado apunto los diagnosticos de enfermeria: patron respiratorio ineficaz, ventilacion espontanea perjudicada, riesgo de sangramiento y riesgo de perfusion tisular gastrointestinal ineficaz, como factores de riesgo para muerte; la desobstruccion ineficaz de vias aereas, confort perjudicado y dolor agudo como factores de proteccion, datos que pueden orientar a los equipos de salud para realizar acciones intervencionistas diferenciadas frente a la complejidad del trauma.O objetivo deste estudo foi identificar e analisar diagnosticos de enfermagem que constituem fatores de risco para obito, em vitimas de trauma, nas primeiras 6 horas apos o evento. Trata-se de estudo transversal, descritivo e exploratorio, com analise quantitativa. Avaliaram-se 406 pacientes durante seis meses de coleta em um hospital terciario do municipio de Sao Paulo, segundo instrumento criado para essa finalidade. Do total, 44 (10,7%) evoluiram para obito. Analise multivariada apontou os diagnosticos de enfermagem padrao respiratorio ineficaz, ventilacao espontânea prejudicada, risco de sangramento e risco de perfusao tissular gastrintestinal ineficaz como fatores de risco para obito e desobstrucao ineficaz de vias aereas, conforto prejudicado e dor aguda como fatores de protecao, dados que podem direcionar as equipes de saude para acoes intervencionistas diferenciadas frente a complexidade do trauma.

Estado nutricional dos pré-escolares ingressantes nos Centros de Educação e Alimentação do Pré-escolar

Descreve-se o estado nutricional da populacao de pre-escolares ingressantes nos Centros de Educacao e Alimentacao do Pre-escolar (CEAPE) por intermedio de medidas antropometricas. A prevalencia da desnutricao proteico calorica encontrada foi igual a 46,8% com graus moderados e graves em 5,8% dos casos, situacao esta, intermediaria entre a descrita em duas outras populacoes desfavorecidas economicamente no Estado de Sao Paulo, Brasil.

Diagnósticos de enfermería en víctimas fatales provenientes de trauma en el escenario de la atención de emergencia

The objective of this study was to identify and analyze the nursing diagnoses that constitute risk factors for death in trauma victims in the first 6 hours post-event. This is a cross-sectional, descriptive and exploratory study using quantitative analysis. A total of 406 patients were evaluated over six months of data collection in a tertiary hospital in the municipality of São Paulo, according to an instrument created for this purpose. Of the total, 44 (10.7%) suffered death. Multivariate analysis indicated the nursing diagnoses ineffective respiratory pattern, impaired spontaneous ventilation, risk of bleeding and risk of ineffective gastrointestinal tissue perfusion as risk factors for death and ineffective airway clearance, impaired comfort, and acute pain as protective factors, data that can direct health teams for different interventionist actions faced with the complexity of the trauma.El objetivo de este estudio fue identificar y analizar diagnosticos de enfermeria que constituyen factores de riesgo para muerte en victimas de trauma en las primeras 6 horas despues del evento. Se trata de un estudio transversal, descriptivo y exploratorio con analisis cuantitativo. Se evaluo 406 pacientes durante seis meses de recoleccion en un hospital terciario del Municipio de Sao Paulo, segun instrumento creado para esa finalidad. Del total, 44 (10,7%) evolucionaron para muerte. El analisis multivariado apunto los diagnosticos de enfermeria: patron respiratorio ineficaz, ventilacion espontanea perjudicada, riesgo de sangramiento y riesgo de perfusion tisular gastrointestinal ineficaz, como factores de riesgo para muerte; la desobstruccion ineficaz de vias aereas, confort perjudicado y dolor agudo como factores de proteccion, datos que pueden orientar a los equipos de salud para realizar acciones intervencionistas diferenciadas frente a la complejidad del trauma.O objetivo deste estudo foi identificar e analisar diagnosticos de enfermagem que constituem fatores de risco para obito, em vitimas de trauma, nas primeiras 6 horas apos o evento. Trata-se de estudo transversal, descritivo e exploratorio, com analise quantitativa. Avaliaram-se 406 pacientes durante seis meses de coleta em um hospital terciario do municipio de Sao Paulo, segundo instrumento criado para essa finalidade. Do total, 44 (10,7%) evoluiram para obito. Analise multivariada apontou os diagnosticos de enfermagem padrao respiratorio ineficaz, ventilacao espontânea prejudicada, risco de sangramento e risco de perfusao tissular gastrintestinal ineficaz como fatores de risco para obito e desobstrucao ineficaz de vias aereas, conforto prejudicado e dor aguda como fatores de protecao, dados que podem direcionar as equipes de saude para acoes intervencionistas diferenciadas frente a complexidade do trauma.

Avaliação antropométrica da eficácia da suplementação alimentar dos Centros de Educação e Alimentação do Pré-Escolar

Alimentary supplementation efficiency was assessed by follow-up of two groups of preschool age children of similar socio-economic status both attending and not attending CEAPE programs. The results showed that in the interior of the State of S. Paulo, Brazil, the program, notwithstanding low calorie supplementation and far-from-ideal operating conditions, produced nutritional effects detectable by means of the usual anthropometric indices.