Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil.

BACKGROUND: Because postlicensure surveillance determined that a previous rotavirus vaccine, RotaShield, caused intussusception in 1 of every 10,000 recipients, we assessed the association of the new monovalent rotavirus vaccine (RV1) with intussusception after routine immunization of infants in Mexico and Brazil. METHODS: We used case-series and case-control methods to assess the association between RV1 and intussusception. Infants with intussusception were identified through active surveillance at 69 hospitals (16 in Mexico and 53 in Brazil), and age-matched infants from the same neighborhood were enrolled as controls. Vaccination dates were verified by a review of vaccination cards or clinic records. RESULTS: We enrolled 615 case patients (285 in Mexico and 330 in Brazil) and 2050 controls. An increased risk of intussusception 1 to 7 days after the first dose of RV1 was identified among infants in Mexico with the use of both the case-series method (incidence ratio, 5.3; 95% confidence interval [CI], 3.0 to 9.3) and the case-control method (odds ratio, 5.8; 95% CI, 2.6 to 13.0). No significant risk was found after the first dose among infants in Brazil, but an increased risk, albeit smaller than that seen after the first dose in Mexico--an increase by a factor of 1.9 to 2.6 - was seen 1 to 7 days after the second dose. A combined annual excess of 96 cases of intussusception in Mexico (approximately 1 per 51,000 infants) and in Brazil (approximately 1 per 68,000 infants) and of 5 deaths due to intussusception was attributable to RV1. However, RV1 prevented approximately 80,000 hospitalizations and 1300 deaths from diarrhea each year in these two countries. CONCLUSIONS: RV1 was associated with a short-term risk of intussusception in approximately 1 of every 51,000 to 68,000 vaccinated infants. The absolute number of deaths and hospitalizations averted because of vaccination far exceeded the number of intussusception cases that may have been associated with vaccination. (Funded in part by the GAVI Alliance and the U.S. Department of Health and Human Services.).

Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life.

PURPOSE: Fatigue is a phenomenon that may persist for years after completion of adjuvant therapy, and is one of the most frequent symptoms associated with breast cancer survivors. The purposes of this study were to investigate the occurrence of fatigue in disease-free breast cancer survivors after treatment, to identify variables associated with fatigue, and to evaluate the impact of fatigue on health-related quality of life. METHODS: A cross-sectional study was conducted on 202 consecutive women diagnosed with in-situ to Stage III breast cancer attending in outpatient facilities of two large hospitals, one year or more after diagnosis. They completed the Piper Fatigue Scale-Revised and the European Organization for Research and Treatment of Cancer QLQ-C30. Multiple logistic regression models were used to identify predictive factors associated with fatigue. EORTC QLQC-30 scores for fatigued survivors were compared to non-fatigued survivors. RESULTS: The prevalence of fatigue reported by the breast cancer survivors was 37.6%. Multiple logistic regression analysis revealed that predictive factors for fatigue included younger age (odds ratio [OR]=2.23, 95% confidence interval [CI]=1.11-4.45, p = 0.024); presence of pain (OR = 3.87, 95% CI = 1.88-7.98, p = 0.000); dyspnea (OR = 3.72, 95% CI = 1.46-9.50, p = 0.006); insomnia (OR = 2.40, 95% CI = 1.19-4.86, p = 0.015); and nausea and vomiting (OR = 12.25, 95% CI = 1.18-126.75, p = 0.036). Fatigued women had poorer health-related quality of life than non-fatigued women in all domains. CONCLUSION: Our results suggest that many disease-free breast cancer survivors after treatment experienced fatigue that compromises their health-related quality of life.

Incidence of hip fractures during the COVID-19 pandemic in the Brazilian public health care system.

This study compared the incidence of hip fractures before and during the COVID-19 pandemic in Brazil, aged ≥ 60 years excluding all fractures related to any trauma. There was a significant reduction in the number of hip fractures and the length of hospital stay during the period of social isolation. PURPOSE: To compare the incidence of hip fractures before and during the COVID-19 pandemic in Brazil and in the main regions of the country in patients covered by the Brazilian public health care system (SUS). As far as we are aware, no studies have evaluated the impact of COVID-19 pandemic on hip fractures in Brazil. METHODS: Descriptive, cross-sectional study in individuals aged ≥ 60 years who presented with a hip fracture before and during the COVID-19 pandemic and received treatment covered by the SUS. The data were collected from the DATASUS electronic database. We calculated the incidence, mortality, lethality, duration of hospitalization, and average reimbursement associated with the treatment of the fractures. RESULTS: There was a significant reduction in the incidence of hip fractures among individuals aged ≥ 60 years in Brazil during the period of social isolation due to COVID-19. The observed incidence was 15.58/10,000 inhabitants between March and December 2020 and 16.07/10,000 inhabitants in the same period of 2019 (p < 0.005; main decline observed in the age groups > 70 years). The average length of hospital stay reduced from 8.35 days in 2019 to 7.33 days in 2020, following a similar pattern of reduction across all regions. The Southeast was the only region with a significant reduction in mortality during the pandemic (relative risk 0.90, 95% confidence interval 0.84-0.97, p < 0.005). CONCLUSION: During the COVID-19 pandemic in Brazil, the incidence rate of hip fractures and the associated duration of hospital stay decreased among patients aged ≥ 60 years.

Fake news: the impact of the internet on population health.

OBJECTIVE: The aim of this study was to evaluate the search for health information on the Internet and to determine the frequency and main means of spreading fake health news. METHODS: A descriptive cross-sectional study was conducted through the virtual distribution of questionnaires on social media platforms in 2019 by using the snowball technique. The questionnaire collected information regarding sociodemographics, means used to clarify doubts about health, implementation of information obtained through the Internet, receipt of fake news, and means of transmission of fake news. Quantitative variables are described as means and standard deviations, and categorical variables are described as frequencies and percentages. The chi-square and Fisher's exact tests were used. RESULTS: Out of 1,195 respondents, 53% had followed Internet guidance without consulting a health professional, especially young people and individuals with low education levels (p<0.05). The resources most used to answer questions about health were a physician (78%) and Google (51%), and searches using the latter were more predominant among younger age groups (p<0.05). A large part of the sample (89.4%) had received fake news, and the main means of receipt were Facebook and WhatsApp. CONCLUSIONS: The Internet was the second most commonly used means to search for health information. A significant portion of the population adopts actions based on this information. The frequency of broadcasting fake news through this digital medium is high.

[Large-scale contamination by Bisphenol A: are we aware of the risk and forms of exposure?] / Contaminação em larga escala por Bisfenol-A: estamos conscientes do risco e formas de exposição?

Bisphenol A (BPA) is a substance extensively used in daily life, mainly in plastic materials. This study assessed the exposure of university students to endocrine disruptor BPA, their knowledge about this substance and the damage it causes to human health. This is a cross-sectional descriptive study carried out with 500 students from a University in Curitiba. The sample was selected proportionally to the three major areas of knowledge, and the courses interviewed were drawn at random. Students were asked to fill out an objective questionnaire consisting of three parts: socioeconomic, assessment of exposure and knowledge tests. Of the respondents, 91.3% consume food stored in plastic packaging, 90.06% use drinks in this type of container and 84.8% consume canned food/drinks. However, only 19.8% have heard of BPA and 97.2% do not know about the relationship between exposure to BPA and endocrine changes. A high rate of exposure to BPA and a low level of knowledge on the subject was detected. This disproportion highlights the need for more in-depth research on the topic among the Brazilian population, in addition to broadening dissemination of information measures on the issue.

O Bisfenol-A (BFA) é uma substância amplamente empregada no cotidiano, principalmente nos materiais plásticos. Este estudo avaliou a exposição de universitários ao disruptor endócrino BFA, o conhecimento dos mesmos acerca dessa substância e dos seus danos à saúde humana. Trata-se de um estudo transversal descritivo realizado com 500 estudantes de uma Universidade de Curitiba. A amostra foi selecionada de forma proporcional as três grandes áreas do conhecimento, sendo que os cursos entrevistados foram sorteados. Aos estudantes aplicou-se um questionário objetivo composto por três partes: socioeconômica, avaliação da exposição e testes de conhecimento. Dos respondentes, 91,3% consomem alimentos armazenados em embalagens plásticas, 90,06% utilizam bebidas nesse tipo de recipiente e 84,8% consomem bebidas/alimentos enlatados. Entretanto, apenas 19,8% já ouviram falar em BFA e 97,2% não sabem sobre a relação entre a exposição ao BFA e alterações endócrinas. Observou-se uma alta taxa de exposição ao BFA e um baixo nível de conhecimento sobre o assunto. Essa desproporção evidencia a necessidade de pesquisas mais aprofundadas sobre o tema na população brasileira, além da ampliação de medidas informativas.

Dental Caries Investigation in Children Controlled for an Educative and Preventive Oral Health Programme.

PURPOSE: To evaluate the association of dental caries with behavioural, socioeconomic and cultural factors; and Streptococcus mutans (SM) levels in the saliva and oral hygiene index of children aged 4 and 6 years old placed in an oral health programme. MATERIALS AND METHODS: This study was an analytic cross-sectional oral health survey conducted over a 9-month period. A total of 466 children aged 4 and 6 years old were included for evaluation of SM levels in saliva, simplified oral hygiene index and dental caries activity. RESULTS: High SM levels were associated with dmft index, toothbrushing without parental assistance, deficient oral hygiene and ingestion of sweet foods. Deficient oral hygiene was found in children aged 4 years old and with three or more siblings. Dental caries was associated with low family income, deficient oral hygiene, sucrose ingestion by children younger than three years old, bottle-feeding habit and low parental compliance. CONCLUSIONS: High SM levels in saliva, deficient oral hygiene and high frequency of sucrose ingestion had association with dental caries in children. Cultural, socioeconomic and behaviour factors indirectly influenced the onset of dental caries.

Home enteral nutrition: clinical-nutritional analysis and outcomes of 10 years of public policy.

INTRODUCTION: Background and aims: home enteral nutrition (HEN) is an established treatment for clinically stable patients. The objective of this study was to determine the frequency and the situation of patients in HEN, in the capital city in the south of Brazil. Methods: in this retrospective study, we recorded all new cases of HEN in adults in Curitiba, Brazil, from January 2006 to December 2015. Data were collected by a dietitian from medical records of patients attending public health settings. The following data were analyzed: clinical diagnosis, diet prescribed during hospitalization and at discharge, and feeding access types. Kaplan-Meier and Cox regression analyses were used to calculate survival. Results: a total of 1,231 patients were included. There was a 425% increase in the frequency of HEN over the years studied. The mean age was 66.7 years, and 54.4% were men. Neurological diseases were the most prevalent (46.4%), followed by cancer (33.6%). Eight hundred and one patients (65.1%) died during this period. Mean HEN duration was 180 days (95% CI 163.6-193.4), with a significant difference between neurological diseases (median: 180 days) and cancer (median: 210 days) (p < 0.05). Neurological disease was an independent risk factor for mortality in patients on HEN (HR: 1.17; CI: 1.08-1.27). Conclusions: the study shows an increase in HEN. Neurological diseases prevailed and presented a risk of mortality, and more than half of the patients with NED died in this period.

INTRODUCCIÓN: Introducción y objetivos: la nutrición enteral domiciliaria (NED) es un tratamiento establecido para pacientes clínicamente estables. El objetivo de este estudio fue determinar la frecuencia y la situación de los pacientes con NED en la capital del sur de Brasil. Métodos: en este estudio retrospectivo se registraron todos los nuevos casos de NED en adultos en Curitiba, Brasil, de enero de 2006 a diciembre de 2015. Los datos fueron recolectados por un nutricionista de historiales clínicos de pacientes que frecuentan establecimientos de salud pública. Se analizaron los siguientes datos: diagnóstico clínico, dieta prescrita durante la estancia hospitalaria y en el momento del alta y acceso alimenticio. Se utilizaron los análisis de Kaplan-Meier y regresión de Cox para calcular la supervivencia. Resultados: fueron incluidos 1.231 pacientes. Hubo un aumento del 425% en la frecuencia de NED a lo largo de los años estudiados. La edad media fue de 66,7 años y el 54,4% eran hombres. Las enfermedades neurológicas fueron las más prevalentes (46,4%), seguidas de las neoplasias (33,6%). Durante este periodo murieron 801 pacientes (65,1%). La duración media de la NED fue de 180 días (IC 95%, 163,6-193,4), con una diferencia significativa entre enfermedades neurológicas (mediana: 180 días) y cáncer (mediana: 210 días) (p < 0,05). La enfermedad neurológica fue un factor de riesgo independiente para la mortalidad en pacientes en NED (HR: 1,17; IC: 1,08-1,27). Conclusiones: el estudio muestra un aumento en la NED. Las enfermedades neurológicas prevalecieron y presentaron riesgo de mortalidad y más de la mitad de los pacientes murieron durante la NED.

COLORECTAL CANCER: factors related to late diagnosis in users of the public health system treated at an Universitary Hospital in Curitiba, Paraná State, Brazil.

BACKGROUND: - The fourth most frequent tumor in the world, colorectal cancer is commonly diagnosed at an advanced stage. OBJECTIVE: - To analyze factors that interfere in the diagnosis of colorectal cancer in users of the Public Health System treated at an universitary hospital in Curitiba, Paraná State, Brazil. METHODS: - Cross-sectional, quantitative and descriptive study with 120 patients treated at the institution between 2012 and 2013. Data collection, carried out by means of medical record appointments and patients' interviews, addressed sociodemographic variables; clinical profile; timespan between symptoms, examination, diagnosis, treatment onset and difficulties encountered. Statistical analyses were performed by means of Stata 8.0. RESULTS: - Abdominal pain was the most frequent complaint and rectal bleeding presented the highest chance of advanced colorectal cancer diagnosis. From 52.5% of patients with late diagnosis of colorectal cancer, 81% reported difficulties in the health system. CONCLUSION: - Results suggest that late diagnosis is due to symptom absence in the early stage of the disease, patients' lack of perception about the severity of the symptoms, need of better of health teams to search early diagnosis. Educational interventions are deemed necessary to the population and health teams, besides actions prioritizing the access to diagnostic testing for serious illnesses.

Fake news: the impact of the internet on population health

SUMMARY OBJECTIVE: The aim of this study was to evaluate the search for health information on the Internet and to determine the frequency and main means of spreading fake health news. METHODS: A descriptive cross-sectional study was conducted through the virtual distribution of questionnaires on social media platforms in 2019 by using the snowball technique. The questionnaire collected information regarding sociodemographics, means used to clarify doubts about health, implementation of information obtained through the Internet, receipt of fake news, and means of transmission of fake news. Quantitative variables are described as means and standard deviations, and categorical variables are described as frequencies and percentages. The chi-square and Fisher's exact tests were used. RESULTS: Out of 1,195 respondents, 53% had followed Internet guidance without consulting a health professional, especially young people and individuals with low education levels (p<0.05). The resources most used to answer questions about health were a physician (78%) and Google (51%), and searches using the latter were more predominant among younger age groups (p<0.05). A large part of the sample (89.4%) had received fake news, and the main means of receipt were Facebook and WhatsApp. CONCLUSIONS: The Internet was the second most commonly used means to search for health information. A significant portion of the population adopts actions based on this information. The frequency of broadcasting fake news through this digital medium is high.

Contaminação em larga escala por Bisfenol-A: estamos conscientes do risco e formas de exposição? / Large-scale contamination by Bisphenol A: are we aware of the risk and forms of exposure?

Resumo O Bisfenol-A (BFA) é uma substância amplamente empregada no cotidiano, principalmente nos materiais plásticos. Este estudo avaliou a exposição de universitários ao disruptor endócrino BFA, o conhecimento dos mesmos acerca dessa substância e dos seus danos à saúde humana. Trata-se de um estudo transversal descritivo realizado com 500 estudantes de uma Universidade de Curitiba. A amostra foi selecionada de forma proporcional as três grandes áreas do conhecimento, sendo que os cursos entrevistados foram sorteados. Aos estudantes aplicou-se um questionário objetivo composto por três partes: socioeconômica, avaliação da exposição e testes de conhecimento. Dos respondentes, 91,3% consomem alimentos armazenados em embalagens plásticas, 90,06% utilizam bebidas nesse tipo de recipiente e 84,8% consomem bebidas/alimentos enlatados. Entretanto, apenas 19,8% já ouviram falar em BFA e 97,2% não sabem sobre a relação entre a exposição ao BFA e alterações endócrinas. Observou-se uma alta taxa de exposição ao BFA e um baixo nível de conhecimento sobre o assunto. Essa desproporção evidencia a necessidade de pesquisas mais aprofundadas sobre o tema na população brasileira, além da ampliação de medidas informativas.

Abstract Bisphenol A (BPA) is a substance extensively used in daily life, mainly in plastic materials. This study assessed the exposure of university students to endocrine disruptor BPA, their knowledge about this substance and the damage it causes to human health. This is a cross-sectional descriptive study carried out with 500 students from a University in Curitiba. The sample was selected proportionally to the three major areas of knowledge, and the courses interviewed were drawn at random. Students were asked to fill out an objective questionnaire consisting of three parts: socioeconomic, assessment of exposure and knowledge tests. Of the respondents, 91.3% consume food stored in plastic packaging, 90.06% use drinks in this type of container and 84.8% consume canned food/drinks. However, only 19.8% have heard of BPA and 97.2% do not know about the relationship between exposure to BPA and endocrine changes. A high rate of exposure to BPA and a low level of knowledge on the subject was detected. This disproportion highlights the need for more in-depth research on the topic among the Brazilian population, in addition to broadening dissemination of information measures on the issue.

[Evaluation of surgical training in medical school]. / Avaliação de treinamento cirúrgico na graduação de medicina.

OBJECTIVE: To evaluate the effectiveness of training in surgical techniques in pig feet during medical school. METHODS: We conducted a cross-sectional study with 87 volunteer medical students from different graduation semesters, who attended a basic workshop for incisions, sutures, biopsies, flaps, grafts, under direct supervision. Pre and post-training self-administered questionnaires were used. RESULTS: The teaching of sutures, biopsies and ear correction was effective for learning of the minimal skills required for the proposed techniques (p <0.005), as well as excisions and flaps, except grafting (p> 0 97). CONCLUSION: The methodological approach and monitoring of techniques' reproduction were adequate. The training offered complemented cutaneous surgical skills of undergraduate medicine students.

Uso de rastreadores para a identificação de eventos adversos a medicamentos* / The use of trigger toolsin the identification of adverse drug events / Uso de rastreadores para identificación de eventos adversos a medicamentos

É um desafio verificar se as estratégias voltadas para aumento da segurança no uso dos medicamentos são efetivas. Dessa maneira, mostra-se clara a necessidade de mecanismos para acompanhar estes resultados. A ferramenta "Global Trigger Tool for Measuring Adverse Events" do Institute for Healthcare Improvement foi desenvolvida para vencer este desafio. O uso de rastreadores para seleção de prontuários, com maior probabilidade de apresentarem eventos adversos, tem sido um método adotado por várias instituições de saúde, em vários países. O objetivo deste relato é descrever a experiência obtida na aplicação do módulo "Medicamento" desta ferramenta em um hospital público brasileiro no estado do Paraná. Realizada no período de novembro de 2012 a janeiro de 2015. A aplicação do método foi de baixo custo e viável para aplicação regular na Instituição (AU).

Checking whether the strategies aimed to improve the safety of drug use are effective is a major challenge. Therefore, the use of mechanisms to monitor these results is clearly necessary. The tool "Global Trigger Tool for Measuring Adverse Events" of the Institute for Healthcare Improvement has been developed to meet this challenge. The use of triggers in the selection of medical records with higher probability of showing adverse drug events (ADE) is adopted by health organizations in several countries. The present experience report aimed to describe the experience of application of the "Medication" module of this tool in a Brazilian public hospital in the state of Paraná. The experience was conducted from November 2012 to January 2015. It is a low-cost method that could be routinely used in the hospital (AU).

Verificar la efectividad de las estrategias para mejorar la seguridad en el uso de los medicamentos es un gran desafío. Así, hay una evidente necesidad de establecer modos de acompañar eses resultados. La herramienta "Global Trigger Tool for Measuring Adverse Events" del Institute for Healthcare Improvement fue desarrollada para vencer ese desafío. El uso de rastreadores para selección de prontuarios, con más probabilidad de presentar eventos adversos, viene siendo un método utilizado por variadas instituciones de salud, en distintos países. El objetivo de este relato es describir la experiencia obtenida en la aplicación del módulo "Medicamento" de esta herramienta en un hospital público brasileño en el estado de Paraná. El estudio fue realizado en el periodo de noviembre de 2012 a enero de 2015. La aplicación del método fue de bajo custo y viable para uso regular en la Institución (AU).

A relação entre o suporte organizacional no trabalho e o risco para doenças crônicas não transmissíveis em um serviço de saúde / Relationship between organizational support at work and risk of non-communicable chronic diseases in a health service

Contexto: Conhecer a relação entre o suporte organizacional e as doenças crônicas e seus fatores de risco pode contribuir no planejamento ações de prevenção e promoção à saúde integral dos trabalhadores. Objetivo: Avaliar a relação entre o suporte organizacional percebido (SOP) e os fatores de risco para as doenças crônicas não transmissíveis (DCNT) em um serviço de saúde. Métodos: Estudo transversal, observacional e descritivo, com delineamento correlacional e abordagem quantitativa, através de dados de um questionário de autopreenchimento. Resultados: A taxa de participação da pesquisa foi de 80,24%, com média etária de 36,9 anos, 52,3% com contrato de trabalho por tempo determinado, 38,5% em turno noturno e 69,3% com trabalho exclusivo no serviço. Os riscos mais prevalentes para as DCNT foram hipertensão arterial sistêmica (29,2%), tabagismo (13,8%), sedentarismo (73,8%), dislipidemia (29,2%) e mais de um fator de risco associado (61,6%). O SOP na população estudada foi favorável, principalmente devido ao salário e às relações sociais no trabalho. Não houve relação significativa do SOP, mais de um emprego, turno noturno ou contratação temporária com os riscos para DCNT. Conclusão: O suporte organizacional percebido não aumentou ou reduziu o risco para as DCNT na população estudada.

Background: Accurate knowledge on the relationship between organizational support and chronic diseases and their risk factors might contribute to the planning of prevention and promotion actions focusing on the integral health of workers. Objective: To investigate the relationship between perceived organizational support (POS) and risk factors for chronic noncommunicable diseases (NCD) in a health service. Methods: The present was a cross-sectional, observational and descriptive study, with correlational design and quantitative approach that data collected by means of a self-report questionnaire. Results: The participation rate was 80.24%; the average age of the participants was 36.9 years old; 52.3% of the sample had temporary jobs, 38.5% worked the night shift and for 69.3% this was their only job. The most prevalent risks for NCD were systemic hypertension (29.2%), smoking (13.8%), sedentary lifestyle (73.8%), dyslipidemia (29.2%) and more than one associated risk factor (61.6%). The POS score was favorable, mainly due to the salary and social relationships at the workplace. There was no significant relation between risk for NCD and POS score, more than one job, night shift or temporary job. Conclusion: The perceived organizational support did not increase or reduced the risk for chronic noncommunicable diseases in the study sample.

Nutritional problems in older adults with Alzheimer's disease: Risk of malnutrition and sarcopenia / Alterações nutricionais em idosos com doença de Alzheimer: risco nutricional e sarcopenia

ABSTRACT Objective Understand the nutritional problems and detect the presence of sarcopenia in older adults with Alzheimer's disease. Methods Descriptive cross-sectional study carried out among elderly patients with Alzheimer's disease receiving care at the Unidade de Saúde de Atenção ao Idoso (Elderly Care Unit) in a capital city in Southern Brazil between November 2010 and July 2011. The Clinical Dementia Rating scale was used for the evaluation of staging severity of dementia. Participants' nutritional status was classified using The Mini Nutritional Assessment. The following tests were used to diagnose sarcopenia: bioelectrical impedance, hand grip strength, and the Timed Up and Go test. Anthropometric measurements and laboratory tests (hemoglobin, lymphocytes, serum albumin, and total cholesterol) were performed. Results Ninety-six older adults (mean age of 78 years) were evaluated. It was observed prevalence of mild Alzheimer's disease in 54.2% of the participants; 55.2% were at risk of malnutrition; unintentional weight loss was observed in 64.6%, 55.3% had lower number of lymphocytes, and 43.7% had severe sarcopenia. Conclusion The prevalence of risk of malnutrition and sarcopenia is high among older adults with Alzheimer's disease. Future studies should focus on the evaluation of nutritional interventions aimed at maintaining the nutritional status and muscle mass in these individuals.

RESUMO Objetivo Conhecer as alterações nutricionais e a presença de sarcopenia em idosos com doença de Alzheimer. Métodos Trata-se de estudo transversal descritivo, no qual foram incluídos idosos com diagnóstico de doença de Alzheimer acompanhados na Unidade de Saúde de Atenção ao Idoso em uma capital do Sul do Brasil, entre novembro/2010 a julho/2011. A escala Clinical Dementia Rating foi utilizada para definição do estágio da demência. Para classificação do estado nutricional aplicou-se a Mini Avaliação Nutricional. Para o diagnóstico de sarcopenia, foram utilizados os testes: impedância bioelétrica, força de preensão manual e teste Timed Get Up and Go. Foram realizadas medidas antropométricas e exames laboratoriais (hemoglobina, linfócitos, albumina e colesterol total). Resultados Foram avaliados 96 idosos com idade média de 78 anos, prevalecendo doença de Alzheimer na fase leve (54,2%), sendo que 55,2% apresentavam risco de desnutrição, 64,6% perda de peso involuntária, 55,3% redução de linfócitos e 43,7% sarcopenia grave. Conclusão Os idosos com doença de Alzheimer apresentam alta prevalência de risco de desnutrição e sarcopenia. Estudos futuros devem ser direcionados a avaliar intervenções nutricionais que visem a manutenção do estado nutricional e da massa muscular desses indivíduos.

Estudo comparativo entre colecistectomia por laparoscopia convencional e minilaparoscopia realizadas em hospital escola / Comparative trial between conventional laparoscopic and minilaparoscopic cholecystectomy proceeded at school hospital

O advento de procedimentos como a minilaparoscopia (MLC) tem feito com que a laparoscopia convencional (LC) seja reconsiderada. Contudo, ainda não está claro se a MLC adiciona benefícios aos já gerados pela LC. Objetivo: Este estudo busca comparar tempo cirúrgico, complicações peri e pós-operatórias, marcadores inflamatórios e dor referida das colecistectomias por LC e MLC. Métodos: Foi realizado um ensaio clínico randomizado no Hospital da Cruz Vermelha-PR, sendo analisados os dados de 37 pacientes, 18 submetidos à LC e 19, à MLC. Desses, 24,32% foram homens e 75,77%, mulheres. Resultados: Dentre os resultados, a LC apresentou menor tempo cirúrgico e a MLC menor dor no sétimo pós-operatório, ambos com significância estatística. Conclusão: Conclui-se que ambas as técnicas se mostraram seguras e efetivas, cabendo cirurgião a escolha da técnica que apresenta maior habilidade e que seja mais adequada para o paciente

The advent of procedures as minilaparoscopy (MLC) has made conventional laparoscopy (LC) be reconsidered. However, it's still unclear whether MLC adds benefits to those already generated by LC. Objective: This study aims to compare surgical time, peri and postoperative complications, inflammatory markers and referred pain of LC and MLC cholecystectomies. Methods: A randomized clinical trial was conducted at the Hospital da Cruz Vermelha-PR, where the data of 37 patients were analyzed, 18 submitted to LC and 19, to MLC. Of these, 24.32% were men and 75.77% were women. Results: Among the results, LC presented shorter surgical time and MLC had lower pain at the seventh postoperative day, both with statistical significance. Conclusion: It was concluded that both techniques proved to be safe and effective and it's the surgeon's choice to opt for the technique that he has more dexterity with and is more appropriate for the patient

Colorectal cancer: factors related to late diagnosis in users of the public health system treated at an Universitary Hospital in Curitiba, Paraná State, Brazil

ABSTRACT Background - The fourth most frequent tumor in the world, colorectal cancer is commonly diagnosed at an advanced stage. Objective - To analyze factors that interfere in the diagnosis of colorectal cancer in users of the Public Health System treated at an universitary hospital in Curitiba, Paraná State, Brazil. Methods - Cross-sectional, quantitative and descriptive study with 120 patients treated at the institution between 2012 and 2013. Data collection, carried out by means of medical record appointments and patients' interviews, addressed sociodemographic variables; clinical profile; timespan between symptoms, examination, diagnosis, treatment onset and difficulties encountered. Statistical analyses were performed by means of Stata 8.0. Results - Abdominal pain was the most frequent complaint and rectal bleeding presented the highest chance of advanced colorectal cancer diagnosis. From 52.5% of patients with late diagnosis of colorectal cancer, 81% reported difficulties in the health system. Conclusion - Results suggest that late diagnosis is due to symptom absence in the early stage of the disease, patients' lack of perception about the severity of the symptoms, need of better of health teams to search early diagnosis. Educational interventions are deemed necessary to the population and health teams, besides actions prioritizing the access to diagnostic testing for serious illnesses.

RESUMO Contexto - Quarto tumor mais frequente no mundo, o câncer colorretal comumente é diagnosticado em estádio avançado. Objetivo - Analisar fatores que interferem no diagnóstico do câncer colorretal de usuários do Sistema Único de Saúde, atendidos em hospital universitário de Curitiba. Métodos - Estudo transversal, quantitativo e descritivo com 120 pacientes atendidos na instituição em 2012 e 2013. A coleta de dados, realizada por meio de consulta ao prontuário e entrevista aos pacientes, abordou variáveis sociodemográficas; perfil clínico; tempo decorrido entre sintomas, atendimento, diagnóstico e início do tratamento e dificuldades encontradas. As análises estatísticas foram feita com pelo Stata 8.0. Resultados - Dor abdominal foi a queixa mais frequente e sangramento retal representou maior chance de diagnóstico avançado de câncer colorretal. Dos 52,5% dos pacientes que diagnosticaram a doença tardiamente, 81% relataram dificuldades com o serviço de saúde. Conclusão - Os resultados sugerem que o diagnóstico tardio é devido à ausência de sintomas na fase inicial da doença, falta de percepção dos pacientes sobre a gravidade dos sintomas, necessidade de maior preparo das equipes de saúde para o diagnóstico precoce. São necessárias intervenções educativas junto à população e equipes de saúde, além de ações que priorizem o acesso a exames diagnósticos de doenças graves.

Prevalência de Anemia em Pacientes com Insuficiência Cardíaca / Prevalence of Anemia in Patients with Heart Failure

A prevalência de anemia bem como a morfologia das hemácias em pacientes internados porinsuficiência cardíaca (IC) não são totalmente conhecidos. Objetivo: Verificar a prevalência de anemia em pacientes diagnosticados com IC, caracterizar o seu padrão morfológico e verificar a sua associação com a classe funcional da NYHA. Métodos: Estudo transversal, retrospectivo, com 144 pacientes do Sistema Único de Saúde, internados por IC no Hospital da Cruz Vermelha, Curitiba, PR de janeiro de 2010 a julho de 2014. Dados sócio demográficos e informações do hemograma admissional foram obtidos nos prontuários dos pacientes. A análise do hemograma incluiu: níveis de hemoglobina, volume corpuscular médio (VCM), concentração de hemoglobina corpuscular média (CHCM) e índice de anisocitose (RDW). Os valores de referência para caracterizar a anemia seguiram orientação da Organização Mundial da Saúde. Resultados: População estudada com distribuição semelhante de sexo (52,8% homens), média de idade 67,8±13,8 anos e quase a totalidade (95,8%) se declarou de etnia branca. A prevalência de anemia nessa população foi 41,0%, a maioria (38,2%) correspondendo a graus leves e moderados. A classe funcional III (CF III) foi a mais prevalente (63,2%) seguida da CF IV (31,3%). A principal característica morfológica encontrada foi normocítica e hipocrômica com 49,1%. Encontrou-se correlação da anemia com o aumento da faixa etária (>60anos), com p=0,008. Conclusões: A prevalência da anemia em pacientes com IC foi maior nas faixas etárias mais avançadas, em CF III e IV, e a principal característica morfológica foi a normocítica e hipocrômica...

Background: The prevalence of anemia and the morphology of red blood cells in patients hospitalized with heart failure (HF) are not totally known. Objective: To check the prevalence of anemia in patients diagnosed with HF, characterize the morphology and check its associationwith NYHA functional class. Methods: Cross-sectional retrospective study with 144 patients from the Brazilian Public Health System hospitalized for HF atHospital da Cruz Vermelha, Curitiba, PR, January 2010 to July 2014. Sociodemographic data and admission blood count information were taken from the patients’ medical records. The blood count analysis included: hemoglobin levels, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and anisocytosis index (RDW). The reference values to characterize anemia followed the World Health Organization’s guidelines.Results: Population studied with similar distribution of sex (52.8% men), mean age 67.8±13.8 years and nearly all of them (95.8%) self-reported white ethnicity. Anemia prevalence in this population was 41.0%, the majority (38.2%) corresponding to mild to moderate degrees. Functional class III (FC III) was the most prevalent one (63.2%), followed by FC IV (31.3%). The main morphological characteristicfound was normocytic and hypochromic with 49.1%. Correlation of anemia with increasing age (>60 years) was found with p=0.008. Conclusions: Prevalence of anemia in patients with HF was higher in older age groups, in FC III and IV, and the main morphological characteristic was normocytic and hypochromic...

[Evaluation of physicians' compliance with the hypertension protocol of the Municipal Health Department of the city of Curitiba]. / Avaliação da adesão de médicos ao protocolo de hipertensão arterial da secretaria municipal de saúde de Curitiba.

BACKGROUND: In Curitiba, systemic hypertension (SH) is the second leading cause of hospitalization and the leading cause of death from cardiovascular diseases. The protocols for the treatment of hypertension provide a systematic approach to patient management, aiming at improving the efficiency and quality of health services. OBJECTIVE: To evaluate medical professionals' compliance with the protocol of hypertension of the Municipal Health Department (MHD) of the city of Curitiba. METHODS: This was a cross-sectional observational study. The data collection for the study was conducted in four health units in Curitiba. The sample consisted of 200 hypertensive patients enrolled in the hypertension program. The collected data refers to the first two consultations. The data source was the electronic records of the health units. The protocol used for comparative analysis was the protocol of the Municipal Health Department of Curitiba. RESULTS: The non-conformity percentage between clinical practice and the protocol in the first consultation was 56.8% on hypertension grade classification, 63.8% on cardiovascular risk evaluation, and 54% on treatment. In the second consultation, the non-conformity percentage was 67% on risk evaluation, and 51.3% on treatment. CONCLUSION: The non-conformity between clinical practice and the protocol of the MHD of Curitiba was evident on hypertension grade classification, cardiovascular risk evaluation, and treatment of hypertensive patients. This non-conformity may result in low efficiency of the health service, which hinders the efforts to reduce morbidity and mortality from cardiovascular disease in the population.