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Abstract Objective: To assess the prevalence and factors associated with poor self-rated health according to respondents' sex in Manaus, Brazil. Methods: This was a cross-sectional population-based study with adults in Manaus in 2019. Adjusted prevalence ratios and 95% confidence intervals (95%CI) were calculated using Poisson regression following a hierarchical model. Results: Poor self-rated health occurred in 35.2% (95%CI 33.3;37.2) of the 2,321 participants and was higher in females (PR = 1.27; 95%CI 1.13;1.43). In the general population, among both sexes, poor self-rated health was higher among the oldest, those with moderate and severe food insecurity and with chronic diseases (p-value < 0.05). Among females, poor health was also higher among the evangelical and those with mild food insecurity. Among males, self-rated health was also poorer among the retired and those with education below elementary level (p-value < 0.001). Conclusion: The female sex had the poorest health rating, influenced by morbidity and access to food.
Resumen Objetivo: Analizar la prevalencia y los factores asociados a la mala autoevaluación de salud según sexo en Manaus, Brasil. Métodos: Se trata de un estudio poblacional transversal con adultos residentes en Manaus en 2019. Las razones de prevalencia ajustadas (RP) y los intervalos de confianza del 95% (IC95%) se calcularon mediante regresión jerárquica de Poisson. Resultados: Autoevaluación mala de salud ocurrió en 35,2% (IC95% 33,3;37,2) de los 2.321 participantes y fue mayor en el sexo femenino (RP = 1,27; IC95%1,13;1,43). En la población general, femenina y masculina, la mala autoevaluación de salud fue mayor entre ancianos, con inseguridad alimentaria moderada y grave y con enfermedades crónicas (p-valor < 0,05). En el sexo femenino, la mala salud fue mayor en evangélicas y con inseguridad alimentaria leve. En el sexo masculino, jubilados y con educación inferior al nivel básico también tuvieron una peor autoevaluación (p-valor < 0,001). Conclusión: Personas de sexo femenino tuvieron una peor valoración de salud, influenciada por la morbilidad y el acceso a la alimentación.
Resumo Objetivo: Analisar a prevalência e fatores associados à autoavaliação de saúde ruim segundo o sexo em Manaus. Métodos: Trata-se de estudo transversal de base populacional com adultos residentes em Manaus em 2019. Razões de prevalências (RP) ajustadas e intervalos de confiança de 95% (IC95%) foram calculadas por regressão de Poisson hierarquizada. Resultados: Saúde autoavaliada como ruim ocorreu em 35,2% (IC95% 33,3;37,2) dos 2.321 participantes e foi maior no sexo feminino (RP = 1,27; IC95% 1,13;1,43). Na população geral, em ambos os sexos, saúde autoavaliada como ruim foi maior entre os mais velhos, com insegurança alimentar moderada e grave e com presença de doenças crônicas (p-valor < 0,05). No sexo feminino, saúde ruim foi maior em evangélicas e com insegurança alimentar leve. No masculino, aposentados e com nível de ensino inferior ao fundamental também apresentaram pior autoavaliação (p-valor < 0,001). Conclusão: Pessoas do sexo feminino apresentaram pior avaliação de saúde, influenciada por morbidade e acesso a alimentação.
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Objectives: To estimate the prevalence of antidepressant use in Brazil. Methods: We conducted a systematic review with searches in MEDLINE, Embase, Scopus, LILACS, and SciELO up to May 2023. Two researchers independently selected studies, extracted data, and assessed the methodological quality. We pooled the prevalence of antidepressant use using meta-analyses of proportions (Freeman-Tukey transformation) and estimated heterogeneity by the I2 statistic. OR meta-analyses of antidepressant use by sex were calculated (men as reference) and between-study variation was explored by meta-regressions. Results: Out of 3,299 records retrieved, 23 studies published in 28 reports were included, with a total of 75,061 participants. The overall prevalence of antidepressant use was 4.0% (95%CI 2.7-5.6%; I2 = 98.5%). Use of antidepressants in the previous 3 days was higher in women (12.0%; 95%CI 9.5-15.1%; I2 = 0%) than men (4.6%; 95%CI 3.1-6.8%; I2 = 0%) (p < 0.001; OR = 2.82; 95%CI 1.72-4.62). Gender differences were particularly higher for antidepressant use in the previous year (women: 2.3%; 95%CI 1.6-3.1; I2 = 37.6% vs. men: 0.5%; 95%CI 0.2-1.0%; I2 = 0%, p < 0.001; OR = 4.18; 95%CI 2.10-8.30). Between-study variation in the overall prevalence of antidepressant use significantly increased with mean participant age (p = 0.035; residual I2 = 0%; regression coefficient = 0.003). Conclusion: Four out of every 100 Brazilians used antidepressants in this 3-decade assessment. Use increased with age and was more prevalent in women compared to men. Registration number: PROSPERO CRD42022345332.
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ABSTRACT Objective: To assess the incidence of tuberculosis in Brazil between 2001 and 2022 and estimate the monthly incidence forecast until 2030. Methods: This is a time-series study based on monthly tuberculosis records from the Notifiable Diseases Information System and official projections of the Brazilian population. The monthly incidence of tuberculosis from 2001 to 2022 was evaluated using segmented linear regression to identify trend breaks. Seasonal autoregressive integrated moving average (Sarima) was used to predict the monthly incidence from 2023 to 2030, deadline for achieving the sustainable development goals (SDGs). Results: There was a decrease in incidence between January/2001 and December/2014 (4.60 to 3.19 cases-month/100,000 inhabitants; β=-0.005; p<0.001), followed by an increase between January/2015 and March /2020 (β=0.013; p<0.001). There was a sharp drop in cases in April/2020, with the onset of the pandemic, and acceleration of the increase in cases since then (β=0.025; p<0.001). A projection of 124,245 cases in 2030 was made, with an estimated incidence of 4.64 cases-month/100,000 inhabitants, levels similar to those in the 2000s. The Sarima model proved to be robust, with error of 4.1% when removing the pandemic period. Conclusion: The decreasing trend in tuberculosis cases was reversed from 2015 onwards, a period of economic crisis, and was also impacted by the pandemic when there was a reduction in records. The Sarima model can be a useful forecasting tool for epidemiological surveillance. Greater investments in prevention and control need to be made to reduce the occurrence of tuberculosis, in line with the SDGs.
RESUMO Objetivo: Avaliar a incidência de tuberculose no Brasil entre 2001 e 2022 e estimar a previsão de incidência mensal até 2030. Métodos: Trata-se de estudo de série temporal que partiu de registros mensais de tuberculose do Sistema de Informação de Agravos de Notificação e projeções oficiais da população brasileira. Avaliou-se a incidência mensal de tuberculose entre 2001 e 2022 por meio de regressão linear segmentada para identificar quebras de tendências. Utilizou-se o modelo autorregressivo integrado de médias móveis sazonais (Sarima) para prever a incidência mensal de 2023 a 2030, prazo para alcançar os objetivos de desenvolvimento sustentável (ODS). Resultados: Observou-se diminuição da incidência entre janeiro/2001 e dezembro/2014 (de 4,60 para 3,19 casos-mês/100 mil habitantes; β=-0,005; p<0,001), seguida de aumento entre janeiro/2015 e março/2020 (β=0,013; p<0,001). Houve queda abrupta de casos em abril/2020, com início da pandemia e aceleração do aumento de casos desde então (β=0,025; p<0,001). Projetaram-se 124.245 casos de tuberculose em 2030, com incidência estimada em 4,64 casos-mês/100 mil habitantes, patamares da década de 2000. O modelo Sarima mostrou-se robusto, com erro de 4,1% ao remover o período pandêmico. Conclusão: A tendência decrescente nos casos de tuberculose foi revertida a partir de 2015, período de crises econômicas, e foi também impactada pela pandemia quando houve redução nos registros. O modelo Sarima pode ser uma ferramenta de previsão útil para a vigilância epidemiológica. Maiores investimentos na prevenção e controle precisam ser aportados para reduzir a ocorrência de tuberculose, em linha com os ODS.
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PURPOSE: We aimed to rate the importance of outcomes from a systematic review about biosimilars in oncology from patients' perspective. METHODS: This is a qualitative research with nominal group technique. Patients with cancer were selected by convenience sampling and invited for two mediated virtual meetings in 2022. Twelve outcomes from a systematic review on biosimilars for oncology developed following a protocol were explained in plain language to participants who classified them as critical, important, or not important according to the Grading of Recommendations Assessment, Development and Evaluation approach. We employed Iramuteq software for lexical categorization of the meeting transcripts, and content analysis for interpretation. RESULTS: Five women participated (three had metastatic cancer, one non-metastatic, one recurrent). Six outcomes were classified as critical: duration of response, progression-free survival, pathological complete response, overall survival, severe adverse events, and quality of life; three as important: mortality, event-free survival, and objective response; and three as non-important: neutralizing anti-drug antibody, any adverse event, and non-neutralizing anti-drug antibody. Duration of response, pathological complete response, severe adverse events, and quality of life were considered secondary in the review protocol, but critical by the patients. The main themes influencing the importance classification were related to the disease (progression and control) and treatment (recognition and healthcare setting). CONCLUSION: Patients rated most outcomes as critical or important, some of them previously regarded as secondary by the researchers, which reinforces the need to include stakeholders' perspectives in oncology research. Aspects of the disease progression and treatment effects influenced participants' judgment on outcomes' relevance.
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Medicamentos Biossimilares , Neoplasias , Humanos , Feminino , Medicamentos Biossimilares/uso terapêutico , Qualidade de Vida , Neoplasias/tratamento farmacológico , Pesquisa Qualitativa , PacientesRESUMO
Abstract This article aims to assess the prevalence of psychotropic and antidepressant use and associated factors in a Brazilian Amazon city. Two cross-sectional studies conducted in Manaus in 2015 and 2019 with adults selected by probabilistic sampling. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression with robust variance. 3,479 participants were included in 2015 and 2,321 in 2019; 2.0% used psychotropics in 2015 and 2.7% in 2019. Antidepressants were used by 0.4% (2015) and 1.4% (2019). Psychotropic use was lower in younger (PR = 0.41; 95%CI: 0.19-0.90), partnerless (PR = 0.64; 95%CI: 0.44-0.93), and informal workers (PR=0.47; 95%CI: 0.25-0.86), but higher in people with poor health (PR=2.86; 95%CI: 1.71-4.80), multimorbidity (PR = 3.24; 95%CI: 1.87-5.60), and who visited doctors (PR = 3.04; 95%CI: 1.45-6.38) or dentists (PR = 1.50; 95%CI: 1.08-2.10). Antidepressant use was higher in 2019 (PR = 2.90; 95%CI: 1.52-5.54), people with poor health (PR = 2.77; 95%CI: 1.16-6.62), and multimorbidity (PR = 8.72; 95%CI: 2.71-28.00), while lower in informal workers (PR = 0.33; 95%CI: 0.12-0.87) and unemployed (PR = 0.26; 95%CI: 0.08-0.81). Use of psychotropics remained stable in Manaus from 2015 to 2019, while antidepressant use more than tripled, which was marked by social inequalities.
Resumo O objetivo deste artigo é avaliar a prevalência do uso de psicotrópicos e antidepressivos e fatores associados em uma cidade da Amazônia. Dois estudos transversais foram realizados em Manaus, em 2015 e 2019, com adultos selecionados por amostragem probabilística. Razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) foram calculados por regressão de Poisson. Foram incluídos 3.479 participantes em 2015 e 2.321 em 2019; 2,0% usaram psicotrópicos em 2015 e 2,7% em 2019. Antidepressivos foram usados por 0,4% (2015) e 1,4% (2019). O uso de psicotrópicos foi menor em jovens (RP = 0,41; IC95%: 0,19-0,90), sem companheiros (RP = 0,64; IC95%: 0,44-0,93) e trabalhadores informais (RP = 0,47; IC95%: 0,25-0,86), mas maior em pessoas com saúde ruim (RP = 2,86; IC95%: 1,71-4,80), multimorbidade (RP = 3,24; IC95%: 1,87-5,60) e que visitaram médico (RP = 3,04; IC95%: 1,45-6,38) ou dentista (RP = 1,50; IC95%: 1,08-2,10). O uso de antidepressivos foi maior em 2019 (RP = 2,90; IC95%: 1,52-5,54), e pessoas com saúde ruim (RP = 2,77; IC95%: 1,16-6,62) e multimorbidade (RP = 8,72; IC95%: 2,71-28,00), mas menor em trabalhadores informais (RP = 0,33; IC95%: 0,12-0,87) e desempregados (RP = 0,26; IC95%: 0,08-0,81). O uso de psicotrópicos permaneceu estável em Manaus de 2015 a 2019, enquanto o de antidepressivos triplicou, sendo marcados por desigualdades sociais.
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OBJECTIVE: To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions in Manaus, Amazonas state, Brazil, in 2019. METHODS: This was a population-based cross-sectional study conducted with adults aged ≥ 18 years. The presence of drug interactions among people on a polypharmacy regimen (≥ 5 drugs) was investigated on the Micromedex database. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson regression model with robust variance, following hierarchical analysis and considering the complex sample design. RESULTS: Of the 2,321 participants, 2.8% (95%CI 2.1;3.6) were on polypharmacy regimen, of whom, 74.0% presented drug interactions, usually with four or more drug interactions per person (40.4%) and high severity (59.5%). Polypharmacy was higher among older adults (PR = 3.24; 95%CI 1.25;8.42), people with poor health (PR = 2.54; 95%CI 1.14;5.67), previous hospitalization (PR = 1.90; 95%CI 1.09;3.32) and multimorbidity (PR = 3.20; 95%CI 1.53;6.67). CONCLUSION: Polypharmacy was more frequent among older adults and people with medical problems, who presented more drug interactions.
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Polimedicação , Idoso , Brasil/epidemiologia , Estudos Transversais , Interações Medicamentosas , Humanos , PrevalênciaRESUMO
ABSTRACT BACKGROUND: Workplaces can be sources of mental distress. In healthcare services, this can also affect patients. OBJECTIVE: To assess the prevalence of and factors associated with depressive symptoms, burnout, job satisfaction and patient safety culture and the relationships between these constructs, among healthcare workers. DESIGN AND SETTING: Cross-sectional study in a university hospital in Manaus, Brazil. METHODS: Randomly selected workers were interviewed based on Brazilian-validated tools. We calculated the prevalence ratio (PR) and 95% confidence interval (CI) of depressive symptoms and burnout using Poisson regression with robust variance; and the β-coefficient of safety culture and job satisfaction using linear regression. Outcome relationships were assessed using partial least-squares structural equation modeling. RESULTS: 300 professionals were included; 67.3% were women. The prevalence of depressive symptom was 19.0% (95% CI: 14.5; 23.5%) and burnout, 8.7% (95% CI: 5.2; 12.3%). Lack of work stability increased depression (PR = 1.88; 95% CI: 1.17; 3.01) and burnout (PR = 2.17; 95% CI: 1.03; 4.57); and reduced job satisfaction (β = -11.93; 95% CI: -18.79; -5.07). Depressive symptoms and burnout were positively correlated, as also were job satisfaction and safety culture (P < 0.001); job satisfaction was negatively correlated with burnout (P < 0.001) and depression (P = 0.035). CONCLUSION: Impermanent employment contracts increased depression and burnout and reduced job satisfaction. Job satisfaction reduced poor mental health outcomes and increased safety culture. Job satisfaction and safety culture were directly proportional (one construct increased the other and vice versa), as also were depression and burnout. Better working conditions can provide a virtuous cycle of patient safety and occupational health.
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Humanos , Masculino , Feminino , Esgotamento Profissional/epidemiologia , Satisfação no Emprego , Brasil/epidemiologia , Estudos Transversais , Inquéritos e Questionários , Satisfação do Paciente , Gestão da Segurança , Depressão/epidemiologia , Segurança do Paciente , Análise de Classes Latentes , Hospitais UniversitáriosRESUMO
OBJECTIVE: To investigate the use of health services among adults living in Manaus, Amazonas. METHODS: This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS: The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals - sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06-1.12), health insurance (PR = 1.13; 95%CI 1.09-1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84-0.90) and informal workers (PR = 0.89; 95%CI 0.84-0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05-1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33-2.12) but lower in men (PR = 0.55; 95%CI 0.44-0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51-0.89), and unemployed (PR = 0.72; 95%CI 0.53-0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01-1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65-0.86). CONCLUSIONS: From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.
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Utilização de Instalações e Serviços , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Idoso , Brasil/epidemiologia , Estudos Transversais , Humanos , Seguro Saúde , Masculino , PrevalênciaRESUMO
BACKGROUND: The burden of mental health disorders is high and may be particularly alarming in developing countries. We assessed the prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence, and hazardous alcohol drinking in the Brazilian Amazon. METHODS: Cross-sectional population-based study conducted in Manaus in 2019 with adults selected by probabilistic sampling. Depressive symptoms were measured by the PHQ-9 instrument (cut-off ≥9) and anxiety symptoms by the GAD-7 scale (cut-off ≥10). Prevalence ratios (PRs) of depressive and anxiety symptoms were calculated by Poisson regression with robust variance with 95% confidence intervals (CI) following a hierarchical model. Partial least squares structural equation modeling was used to investigate the relationship between the outcomes and risk behaviors. RESULTS: Out of the 2,321 participants, 24.3% (95%CI 22.2-26.5%) had depressive and 21.6% (95%CI 19.6-23.7%) had anxiety symptoms. Depressive symptoms were more frequent in women (PR=1.32; 95%CI 1.08-1.61), lower social class (PR=1.59; 95%CI 1.11-2.27), life-threatening events (PR=2.66; 95%CI 2.00-3.54), tobacco dependence (PR=1.84; 95%CI 1.37-2.47), worse health statuses (p<0.001), and chronic diseases (PR=1.63; 95%CI 1.33-2.00), but were lower in older adults (p=0.014). Anxiety symptoms were higher in women (PR=1.74; 95%CI 1.42-2.14), lower educational levels (PR=2.19; 95%CI 1.38-3.47), evangelical individuals (PR=1.28; 95%CI 1.05-1.57), having no religion (PR=1.72; 95%CI 1.24-2.38), life-threatening events (PR=3.26; 95%CI 2.41-4.41), tobacco dependence (PR=1.53; 95%CI 1.09-2.16), worse health statuses (p<0.001), and chronic diseases (PR=1.77; 95%CI 1.40-2.25). Depressive symptoms, anxiety symptoms, and life-threatening events were directly correlated with one another, while tobacco dependence and hazardous alcohol drinking were significantly intercorrelated (p<0.05). LIMITATIONS: Cross-sectional design limits the assessment of causality. Recall bias was possible as responses were self-reported. GAD-7 scale was not validated in the Brazilian population. CONCLUSION: Nearly a quarter of the population had depressive symptoms and one-fifth presented anxiety symptoms, which were associated with socioeconomic, behavioral, and health-related factors. Implementation of social well-being policies is required to minimize the burden of mental health disorders in the Amazonian population.
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Tabagismo , Idoso , Consumo de Bebidas Alcoólicas , Ansiedade/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Prevalência , Tabagismo/epidemiologiaRESUMO
Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections affect around 95% of the world's population. In Brazil, there are few epidemiological reports related to EBV and CMV infection, especially in the western Amazon region. This study aimed to estimate the seroprevalence of EBV and CMV infection in individuals residents in Presidente Figueiredo, Amazonas, Brazil. Blood samples of 443 individuals were tested for the presence of anti-EBV and anti-CMV IgG antibodies through an enzyme-linked immunosorbent assay. EBV (95.9%; 95% CI: 0.94;0.98), CMV (96.8%; 95% CI: 0.95;0.98) and CMV/EBV (93%;95% CI: 0.91-0.95) coinfection were highly prevalent in the study population. Children (1 to 5 years) not attending school were less susceptible to EBV (OR 0.15; 95% CI: 0.05-0.52; p = 0.017) and CMV infections (OR 0.05; 95% CI: 0.02 - 0.17; p < 0.0001). Teenagers at high school showed increased susceptibility to CMV infection (OR 4.65; 95%CI: 1.43-15.08; p = .013) and EBV/CMV co-infection (OR 3.04; 95%CI: 1.44-6.45; p = 0.005). The seroprevalence of CMV and EBV infections were preeminent and tend to increase with age in the study population. Either attendance to a daycare facility or primary school before the age of 5 years may increase the susceptibility to EBV or CMV infection.
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Infecções por Citomegalovirus , Infecções por Vírus Epstein-Barr , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Infecções por Citomegalovirus/epidemiologia , Infecções por Vírus Epstein-Barr/epidemiologia , Herpesvirus Humano 4 , Humanos , Estudos SoroepidemiológicosRESUMO
Objetivo: Analisar a prevalência e fatores associados à polifarmácia e a presença de potenciais interações medicamentosas em Manaus, estado do Amazonas, Brasil, em 2019. Métodos: Estudo transversal de base populacional, com adultos de ≥ 18 anos. Entre pessoas em polifarmácia (≥ 5 medicamentos), pesquisou-se a presença de interações medicamentosas na base Micromedex. Razões de prevalências (RP) com intervalos de confiança de 95% (IC95%) foram calculadas por regressão de Poisson com variância robusta, seguindo análise hierárquica e considerando o delineamento amostral complexo. Resultados: Dos 2.321 participantes, 2,8% (IC95% 2,1;3,6) estavam em polifarmácia e, destes, 74,0% apresentaram interações, sendo mais frequentes quatro ou mais interações por pessoa (40,4%) e gravidade alta (59,5%). Polifarmácia foi maior entre idosos (RP = 3,24; IC95% 1,25;8,42), pessoas com saúde ruim (RP = 2,54; IC95% 1,14;5,67), hospitalização prévia (RP = 1,90; IC95% 1,09;3,32) e multimorbidade (RP = 3,20; IC95% 1,53;6,67). Conclusão: A polifarmácia foi mais frequente entre idosos e pessoas com problemas de saúde, que tiveram mais interações medicamentosas.
Objetivo: Analizar la prevalencia y factores asociados a la polifarmacia y la presencia de posibles interacciones farmacológicas en Manaus, estado de Amazonas, Brasil, en 2019. Métodos: Estudio poblacional transversal realizado con adultos con edad ≥ 18 años. Entre personas en polifarmacia (≥ 5 medicamentos), se investigó la presencia de interacciones farmacológicas en Micromedex. Las razones de prevalencia (RP) con intervalos de confianza de 95% (IC95%) se calcularon mediante la regresión de Poisson con varianza robusta, siguiendo análisis jerárquico y considerando el diseño de muestra complejo. Resultados: De los 2.321 participantes, 2,8% (IC95% 2,1;3,6) se encontraban en polifarmacia, de los cuales 74,0% presentaban interacciones, siendo más frecuentes cuatro o más interacciones por persona (40,4%) y de alta gravedad (59,5%). La polifarmacia fue mayor entre los ancianos (RP = 3,24; IC95% 1,25;8,42), personas con mala salud (RP = 2,54; IC95% 1,14;5,67), hospitalización previa (RP = 1,90; IC95% 1,09;3,32) y multimorbilidade (RP = 3,20; IC95% 1,53;6,67). Conclusión: La polifarmacia fue más frecuente entre los ancianos y personas con problemas de salud, que potencialmente tenían más interacciones farmacológicas.
Objective: To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions in Manaus, Amazonas state, Brazil, in 2019. Methods: This was a population-based cross-sectional study conducted with adults aged ≥ 18 years. The presence of drug interactions among people on a polypharmacy regimen (≥ 5 drugs) was investigated on the Micromedex database. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson regression model with robust variance, following hierarchical analysis and considering the complex sample design. Results: Of the 2,321 participants, 2.8% (95%CI 2.1;3.6) were on polypharmacy regimen, of whom, 74.0% presented drug interactions, usually with four or more drug interactions per person (40.4%) and high severity (59.5%). Polypharmacy was higher among older adults (PR = 3.24; 95%CI 1.25;8.42), people with poor health (PR = 2.54; 95%CI 1.14;5.67), previous hospitalization (PR = 1.90; 95%CI 1.09;3.32) and multimorbidity (PR = 3.20; 95%CI 1.53;6.67). Conclusion: Polypharmacy was more frequent among older adults and people with medical problems, who presented more drug interactions.
Assuntos
Humanos , Farmacoepidemiologia/estatística & dados numéricos , Polimedicação , Interações Medicamentosas , Brasil/epidemiologia , Prevalência , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricosRESUMO
ABSTRACT OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals - sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06-1.12), health insurance (PR = 1.13; 95%CI 1.09-1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84-0.90) and informal workers (PR = 0.89; 95%CI 0.84-0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05-1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33-2.12) but lower in men (PR = 0.55; 95%CI 0.44-0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51-0.89), and unemployed (PR = 0.72; 95%CI 0.53-0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01-1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65-0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.
Assuntos
Humanos , Masculino , Adolescente , Idoso , Aceitação pelo Paciente de Cuidados de Saúde , Utilização de Instalações e Serviços , Brasil/epidemiologia , Prevalência , Estudos Transversais , Seguro SaúdeRESUMO
Abstract Objective: To estimate the prevalence of childhood obesity in Brazil by means of a systematic review of representative studies. Sources: We searched for population-based studies that assessed obesity in Brazilian children aged < 10 years in MEDLINE, EMBASE, Scopus and other sources up to September, 2019. Paired researchers selected studies, extracted data and assessed the quality of these studies. Meta-analysis of prevalence and confidence interval (95% CI) was calculated, weighted by the population sizes using Freeman-Tukey double-arccosine transformation. Heterogeneity (I2) and publication bias were investigated by meta-regression and Egger's test, respectively. Summary of the findings: 53 studies were included (n = 122,395), which were held from 1986 to 2015 and limited mainly due to inadequate response rates. Prevalence of obesity in the threedecade period was of 8.2% ([95% CI]: 8.1-8.4%, I2 = 98.5%). Higher prevalence was observed in boys (9.7% [9.4-9.9%], I2 = 97.4%) than girls (7.3% [7.1 7.5%], I2 = 96.1%). Prevalence increased according to the decade (1990: 6.5% [6.0-7.0 %], I2 = 96.8%; 2000: 7.9% [7.7-8.0 %], I2 = 98.8%; 2010: 12.0% [11.5-12.6 %], I2 = 95.8%), and Brazilian region (Northeast: 6.4% [6.2−6.7%], I2 = 98.1%; North: 6.7% [6.3−7.2%], I2 = 98.8%; Southeast:10.6% [10.2−11.0%], I2 = 98.2%; South: 10.1 [9.7−10.4%], I2 = 97.7%). Heterogeneity was affected by age and region (p < 0.05) and publication bias was discarded (p = 0.746). Conclusion: For every 100 Brazilian children, over eight had obesity in the three-decade period and 12 in each 100 had childhood obesity in more recent estimates. Higher prevalence occurred in boys, recent decades and more developed Brazilian regions.