Effectiveness of adherence to a renal health program in a health network in Peru / Efectividad de la adherencia a un programa de salud renal en una red sanitaria de Perú

ABSTRACT OBJECTIVE To evaluate the effectiveness of adherence to a multidisciplinary renal health program in reducing mortality and progression to hemodialysis. METHODS We used a database that included patient monitoring (2013-2017), dialysis admissions and all cause of mortality in Peru. Adherence to the program was established by meeting minimum visits during the first year of monitoring. The outcome of interest was hemodialysis admissions or all cause-mortality. Kaplan-Meier curves, Log-Rank test and competing survival analysis methods were used to estimate the differential risk between adherent and non-adherent patients. RESULTS A total of 20,354 participants was evaluated; 54.1% were male, 72.1 years old in average, 2.2 years average follow-up, and 15,279 (75.1%) belonged to the early stages (1 to 3a) of Chronic Kidney Disease. Adherence decreased the risk of renal replacement therapy in 41.0% (HR = 0.59, 95%CI 0.41-0.85) in the low-risk group and mortality in the high-risk group was 31.0% (HR = 0.69, 95%CI 0.57-0.83). CONCLUSIONS The multidisciplinary care strategy with standardized assessments by stage is effective in reducing admission to .0when the patient is identified in early stages and in reducing mortality in advanced stages.

RESUMEN OBJETIVO Evaluar la efectividad de la adherencia a un programa de salud renal en la reducción de mortalidad y progresión a hemodiálisis. MÉTODOS Utilizamos una base de datos que condensaba el seguimiento de los pacientes (2013-2017), los ingresos a diálisis de los mismos y la mortalidad por todas las causas en Perú. La adherencia al programa se estableció con el cumplimiento de visitas mínimas durante su primer año de seguimiento. La efectividad de la adherencia al programa se midió en términos de debut a hemodiálisis o muerte por todas las causas. Se utilizaron curvas de Kaplan-Meier, test de diferencias en la distribución (Log-Rank test) y métodos de análisis de supervivencia. Los análisis se realizaron utilizando R estudio 3.5.0 RESULTADOS Fueron evaluados 20.354 participantes, 54,1% varones, edad media de 72,1 años, con un seguimiento medio de 2,2 años; 15.279 (75.1%) tuvieron ERC en estadios tempranos (estadio 1 al 3a). La adherencia disminuyó en un 41,0% el riesgo de terapia de reemplazo renal (HR = 0,59; IC95% 0,41-0,85) en el grupo de bajo riesgo y en un 31,0% (HR = 0,69; IC95% 0,57-0,83) la mortalidad en el grupo de alto riesgo. CONCLUSIONES La estrategia de cuidado multidisciplinario con evaluaciones estandarizadas según estadio es efectiva en reducir el ingreso a terapia de reemplazo renal cuando se identifica al paciente en estadios tempranos y en reducir la mortalidad en estadios avanzados.

Are laws restricting soft drinks sales in Brazilian schools able to lower their availability?

ABSTRACT OBJECTIVE To describe students protected by laws and exposed to soft drinks sales and assess whether forbidding laws are associated with lower availability of these beverages. METHODS We identified laws forbidding non-government administered cafeterias or sales of soft drinks in schools in the 27 Brazilian state capitals. Data on soft drinks sales were obtained from Pesquisa Nacional de Saúde do Escolar 2015 (PeNSE - National Survey of School Health 2015), for a representative sample of 9th graders from public and private schools. Students were attributed with the status of their school regarding the law and sale of soft drinks. Co-variables were school status (public or private), school size, geographic regions, mother's educational level, score of goods and services. We performed multivariate analyses using Poisson regression. RESULTS The total of 23 laws forbidding sales of soft drinks covered 63.0% of capitals, comprising 56.9% of students. Law coverage was higher among students from more developed regions (67.6%) and in public schools (60.6%), compared with those from less developed regions (38.0%) and private schools (45.8%). Soft drinks were available for 33.9% of students. Students attending public schools in less developed regions had the lowest availability of soft drinks, regardless of law coverage (14.8%; 12.0%); while students attending private schools in these regions had a high availability, regardless of law coverage (82.1%; 73.4%). Restrictive laws were associated with lower sales of soft drinks in more developed regions, and restrictions had a greater association with the availability of soft drinks in public schools (PR = 0.25; 95%CI = 0.15-0.41), compared with private schools (PR = 0.48; 95%CI = 0.35-0.66). CONCLUSION Laws restricting soft drinks in schools were associated with fewer sales in more developed regions. Private schools were less compliant with the law than public schools. A broadly enforced national law could reduce the availability of soft drinks in schools.

Protocolo para prevenção de úlcera por pressão / Protocol for prevention of pressure ulcer

Objetivo: analisar as evidências científicas nacionais e internacionais para estabelecer recomendações na elaboração de protocolo de enfermagem para prevenção de úlcera por pressão. Métodos: revisão integrativa com busca nas bases de dados LILACS, MEDLINE e BDENF, com descritores "úlcera por pressão", "protocolo" e "prevenção secundária", com amostra final de 21 artigos científicos. Resultados: amostra categorizada em dois temas: "Protocolos" que recomenda especificidades sociodemográficas e clínicas com adoção de instrumento e escalas para dimensionar as lesões de pele e úlcera por pressão, além de intervenções de enfermagem; e "Estratégias de implementação do protocolo" que valoriza liderança dos enfermeiros, apoio da gestão, educação permanente, previsão e provisão de recursos humanos e materiais como fundamentais para a implantação. Conclusão: na elaboração de protocolo de prevenção de úlcera por pressão recomenda-se incluir aspectos clínicos e terapêuticos dos pacientes, assim como recursos materiais e humanos para a sua implantação.