Thaynã Ramos Flores

Multimorbidity and mortality in older adults: A systematic review and meta-analysis.

OBJECTIVE To review literature and provide a pooled effect for the association between multimorbidity and mortality in older adults. METHODS A systematic review was performed of articles held on the PUBMED database published up until January 2015. Studies which used different diseases and other conditions to define frailty, evaluated multimorbidity related only to mental health or which presented disease homogeneity were not included. A meta-analysis using random effect to obtain a pooled effect of multimorbidity on mortality in older adults was conducted only with studies which reported hazard ratio (HR). Stratified analysis and univariate meta-regression were performed to evaluate sources of heterogeneity. RESULTS Out of 5806 identified articles, 26 were included in meta-analysis. Overall, positive association between multimorbidity and mortality [HR: 1.44 (95%CI: 1.34; 1.55)] was detected. The number of morbidities was positively related to risk of death [HR: 1.20 (95%CI: 1.10; 1.30)]. Compared to individuals without multimorbidity, the risk of death was 1.73 (95%CI: 1.41; 2.13) and 2.72 (95%CI: 1.81; 4.08) for people with 2 or more and 3 or more morbidities, respectively. Heterogeneity between studies was high (96.5%). The sample, adjustment and follow-up modified the associations. Only nine estimates performed adjustment which included demographic, socioeconomic and behaviour variables. Disabilities appear to mediate the effect of multimorbidity on mortality. CONCLUSIONS Multimorbidity was associated with an increase in risk of death. Multimorbidity measurement standardization is needed to produce more comparable estimates. Adjusted analysis which includes potential confounders might contribute to better understanding of causal relationships between multimorbidity and mortality.

Consumo de refrigerantes entre escolares de séries iniciais da cidade de Pelotas, Rio Grande do Sul

Objective: To describe the daily consumption of soft drinks among students from the 1st to the 4th year from public primary schools in the city of Pelotas, Rio Grande do Sul. Materials and Methods: We conducted a cross-sectional study, with a quantitative approach, including 356 students from the 1st to the 4th year in the urban area of the city, in 2011. The outcome of this study was the daily consumption of soft drinks as was evaluated trough the Form Labels Food Consumption System proposed by the Food and Nutrition Surveillance. The frequency of consumption was described according to gender, age, maternal education, socio-economic level and students’ nutritional state. We analyzed the prevalence and its 95% confidence intervals, adopting the significance level of 5%. Results: Of the 411 students eligible for the study, 356 were evaluated, with 13.4% of losses and refusals. The prevalence of daily consumption of soft drinks was 21.6%. There were no statistically significant differences in daily consumption of soft drinks between sexes, age, classes of consumer goods and nutritional state. Conclusion: The students of the public primary schools of Pelotas showed a high prevalence of daily consumption of soft drinks. Therefore, we emphasize the importance of nutritional education in schools.

Prepregnancy weight excess and cessation of exclusive breastfeeding: a systematic review and meta-analysis

Recent studies have identified a relationship between maternal body mass index during prepregnancy (BMI) and exclusive breastfeeding (EBF), which is less common among mothers with higher BMI. The purpose of this literature review is to provide a pooled effect for the association between maternal excess weight during prepregnancy and cessation of exclusive breastfeeding. A systematic review was performed using articles present in six databases (PubMed, Scopus, Web off Science, Science direct, CINAHL and LILACS) published till February 2017. Studies investigating the association between excess maternal weight during prepregnancy and cessation of exclusive breastfeeding were included in the review. A meta-analysis using random effects to obtain a pooled effect of the studied association was conducted only with studies reporting odds ratio (OR) or available data for the calculation. Univariate meta-regression was performed to evaluate possible sources of heterogeneity. Eggers tests were also performed to verify possible publication bias. From the 6889 studies identified, 102 were read in full and 17 were included in the meta-analysis, providing 28 estimates for the association. Overall, a positive association was observed between maternal excess weight during prepregnancy and cessation of exclusive breastfeeding (ES: 1.60 (95% CI: 1.47, 1.74), I2: 93.2%). According to the used independent variables, no sources of heterogeneity were identified between studies Bias in publication was found. Maternal excess weight during prepregnancy was associated with cessation of exclusive breastfeeding. A standardized measure for exclusive breastfeeding is still needed for estimating its duration, in addition to further studies in developing countries to understand what could explain the heterogeneity of the findings.

Hábitos saudáveis: que tipo de orientação a população idosa está recebendo dos profissionais de saúde?

OBJECTIVE To describe the prevalence of guidance on healthy habits received from health professionals by elderly and its relation to socioeconomic demographic, behavioral and health indicators, and the type of services. METHODS Cross sectional population based study including individuals aged 60 years or more in the urban area of Pelotas, Rio Grande do Sul, Brazil. Seven guidance on healthy habits were evaluated: weight control, reduction in salt, sugar and fat intake, physical activity practice, not smoking and not drinking alcohol. RESULTS Among the 1,451 elderly interviewed, 1,281 (88.3%) consulted in the last year. The orientations more refereed were to fat (61.7%) and salt (61.5%) intake reduction and physical activity (58.2%). Elderly who consulted three times or more and in services financed by the Unified Health System received more guidance. Those elderly from the socioeconomic classes A/B were more likely to receive guidance for weight control (RP = 1.27; 95%CI 1.06 - 1.70) and physical activity (RP = 1.34; 95%CI 1.06 - 1.69). CONCLUSION The orientation from health professionals were uncommon and, in some cases, unfocused.

Tendência da incidência de dengue no Brasil, 2002-2012

Resumo OBJETIVO: analisar a tendencia da incidencia de dengue no Brasil, no periodo de 2002 a 2012. METODOS: estudo ecologico com dados do Sistema de Informacao de Agravos e Notificacao (Sinan); a taxa de incidencia de dengue foi calculada segundo grupos etarios, unidades da federacao (UF) e grandes regioes do pais, utilizando-se a regressao de Prais-Winsten. RESULTADOS: as taxas de incidencia de dengue no Brasil, em 2002 e 2012, foram de 401,6 e 301,5 por 100 mil habitantes, respectivamente; as taxas de incremento anual revelaram-se estaveis (21,4%; IC95% -19,8;83,7) na maioria das UF, a excecao de Alagoas (38,9%; IC95% 5,1;83,5) e Tocantins (50,4%; IC95% 12,6;100,7); a regiao Norte foi a unica a apresentar tendencia de crescimento da incidencia de dengue. CONCLUSAO: embora as taxas tenham permanecido estaveis na maioria das UF, ainda sao altas no pais; politicas mais amplas com foco em novas estrategias de combate a dengue mostram-se necessarias.OBJECTIVE to analyze dengue incidence trend in Brazil from 2002 to 2012. METHODS this was an ecological study with data of the Information System for Notifiable Diseases (Sinan); the incidence rate was calculated by age groups, states and macroregions, through Prais-Winsten regression. RESULTS dengue incidence rates in Brazil, in 2002 and 2012, were of 401.6 and 301.5 per 100,000 inhabitants, respectively; annual increment rates were stable (21.4%; 95%CI -19.8;83.7) in most of the states, except for Alagoas (38.9%; 95%CI 5.1;83.5) and Tocantins (50.4%; 95%CI 12.6;100.7); the North Region was the only region to present increase trend in the incidence of dengue. CONCLUSION although rates have remained stable in most of the states, they are still high in Brazil; broader public policies focusing on new dengue control strategies are necessary.

Utilização dos serviços de saúde por adolescentes: estudo transversal de base populacional, Pelotas-RS, 2012

OBJECTIVE: to describe the prevalence and characteristics of health service use by adolescents in the urban area of Pelotas-RS, Brazil. METHODS: a population-based cross-sectional study was conducted with 743 adolescents aged 10 to 19 years; the outcome was health service use in the thirty days preceding the interview. RESULTS: of the total sample, 23.0% (95%CI: 19.4;26.6) used health services; of these, 38% used private or health plan services and 32.2% used public health services; the SUS financed more than half (52.1%) of care; the main reasons for health service use was health problems (69.0%) and follow-up appointments (18.7%); the reasons for choosing the service were nearness to home (23.4%), preference for commonly used services (22.8%) and choice made by parents or guardians (21.1%). CONCLUSION: health service use was high and its characteristics can contribute to the planning of adolescent health care.

Social inequalities in care for the elderly with diabetes in Brazil

ABSTRACT Objective. To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services. Methods. This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles. Results. A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0). Conclusion. There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level.

Aconselhamento por profissionais de saúde e comportamentos saudáveis entre idosos: estudo de base populacional em Pelotas, sul do Brasil, 2014

OBJECTIVE to analyze the association between counseling by health care professionals and healthy behaviors among the elderly. METHODS population-based, cross-sectional study with elderly individuals (≥60 years) interviewed in 2014; Poisson regression was used to estimate crude and adjusted prevalence ratios (PR) of associations between counseling by health professionals on the reduction of salt, sugar and fat and on the practice of physical activity during the year previous to the interview and healthy behaviors. RESULTS 1,281 elderly individuals were interviewed; after adjustments, the elderly who mentioned receiving counseling by health professionals reported reduction in the intake of salt (PR 1.64; 95%CI 1.41;1.91), sugar and sweets (PR 1.21; 95%CI 1.08;1.36) and greater practice of physical activity (PR 1.21; 95%CI 1.06;1.39), when compared to the elderly who had not received any counseling. CONCLUSION the counseling carried out by health professionals seems to favor the practice of healthy habits among elderly individuals.

Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study

Objectives The study aims to evaluate the magnitude of multimorbidity in Brazilian adults, as well to measure their association with individual and contextual factors stratified by Brazilian states and regions. Methods A national-based cross-sectional study was carried out in 2013 with Brazilian adults. Multimorbidity was evaluated by a list of 22 physical and mental morbidities (based on self-reported medical diagnosis and Patient Health Questionnaire-9 for depression). The outcome was analysed taking ≥2 and ≥3 diseases as cut-off points. Factor analysis (FA) was used to identify disease patterns and multilevel models were used to test association with individual and contextual variables. Results The sample comprised 60 202 individuals. Multimorbidity frequency was 22.2% (95% CI 21.5 to 22.9) for ≥2 morbidities and 10.2% (95% CI 9.7 to 10.7) for ≥3 morbidities. In the multilevel adjusted models, females, older people, those living with a partner and having less schooling presented more multiple diseases. No linear association was found according to wealth index but greater outcome frequency was found in individuals with midrange wealth index. Living in states with higher levels of education and wealthier states was associated with greater multimorbidity. Two patterns of morbidities (cardiometabolic problems and respiratory/mental/muscle–skeletal disorders) explained 92% of total variance. The relationship of disease patterns with individual and contextual variables was similar to the overall multimorbidity, with differences among Brazilian regions. Conclusions In Brazil, at least 19 million adults had multimorbidity. Frequency is similar to that found in other Low and and Middle Income Countries. Contextual and individual social inequalities were observed.

Tendência temporal da falta de acesso aos serviços de saúde no Brasil, 1998-2013

OBJECTIVE to analyze the time trend on the demand and lack of access to public health services in Brazil. METHODS this is a panel of cross-sectional studies with data of the National Household Sample Survey (1998, 2003, 2008) and the National Health Survey (2013); the prevalence of demand and lack of access within the fifteen days prior to the survey was estimated; Poisson regression was used for trend analysis. RESULTS the demand for health services increased from 13.0% (95%CI 12.3;13.7), in 1998, to 15.0% (95%CI 14.5;15.4), in 2013; the lack of access remained stable, being of 3.7% (95%CI 3.2;4.2) in 1998 and 4.5% (95%CI 4.0;5.0) in 2013. CONCLUSIONS the increase in demand for health services and the stability in the lack of access indicate improvements in the Brazilian public health system performance; additional efforts are required to ensure universal access to public health services in Brazil.Resumo OBJETIVO: analisar a tendencia temporal da procura e da falta de acesso aos servicos de saude no Brasil. METODOS: trata-se de um painel de estudos transversais com dados das Pesquisas Nacionais por Amostra de Domicilios (1998, 2003, 2008) e da Pesquisa Nacional de Saude (2013) que estimou a prevalencia da demanda e da falta de acesso nos quinze dias anteriores a entrevista; empregou-se regressao de Poisson para analise da tendencia. RESULTADOS: a procura por servicos aumentou, de 13,0% (IC95% 12,3;13,7) em 1998 para 15,0% (IC95% 14,5;15,4) em 2013; a falta de acesso foi estavel, equivalente a 3,7% (IC95% 3,2;4,2) em 1998 e 4,5% (IC95% 4,0;5,0) em 2013. CONCLUSAO: o aumento na procura e a estabilidade na falta de acesso indicam avancos no desempenho do sistema publico de saude; esforcos adicionais sao necessarios para garantir o acesso universal aos servicos de saude no Brasil.