Vaccine effectiveness in preventing deaths in people with severe acute respiratory syndrome due to COVID-19 in Blumenau, Brazil, 2021.

OBJECTIVE: to analyze the vaccine effectiveness in preventing deaths attributed to severe acute respiratory syndrome due to COVID-19 (SARS/COVID-19) in adults and the elderly, in Blumenau, state of Santa Catarina, Brazil, 2021.this was a population-based study conducted among individuals aged 20 years and older hospitalized with SARS/COVID-19; each death due to SARS/COVID-19 was considered a "case", and every survivor was considered a "control"; the association between vaccination status and the outcome of "death" was estimated using logistic regression, and vaccine effectiveness was estimated as (1-OR)*100.The study included 1,756 cases of SARS/COVID-19 (59.2% male, mean age of 56 years, 50.4% with elementary education, 68.4% with comorbidities and 39.1% in intensive care), of whom 398 died (cases) and 1,358 survived (controls); vaccine effectiveness was 74% and 85% (20-59 years old) and 72% and 75% (≥ 60 years old), respectively, for those who were partially vaccinated and fully vaccinated. CONCLUSION: vaccines proved to be effective in reducing case fatality ratio due to SARS/COVID-19 in individuals ≥ 20 years old.

[Meat consumption by adults and the elderly in a city colonized by Germans in the south of Brazil: a population-based study]. / Consumo de carnes por adultos e idosos de uma cidade de colonização alemã do sul do Brasil: estudo de base populacional.

Excessive meat consumption, especially red and processed meats, is associated with increased morbidity and mortality. The pattern of meat consumption varies in Brazil and is influenced by economic and cultural factors in the world. The study aimed to analyze the consumption of meat by adults and the elderly in a city colonized by Germans in the south of Brazil. It involved a cross-sectional population study. Sociodemographic and meat consumption data were collected using a previously validated Food Frequency Questionnaire. Frequencies and amounts were analyzed by type of meat and processing. The association between excessive meat consumption and the study variables was estimated by Prevalence Ratio. Among the 1,941 participants, the average amount of meat consumed was 250 g/day, the most consumed being white unprocessed meat (138 g/day), especially poultry (80 g/day). The prevalence of excessive consumption of red and processed meat (more than 500 g/week) was 63%, mainly among men (PR=1.6; 95%CI 1.5-1.8), aged 20 to 29 years (PR=1.4; 95%CI 1.2-1.5), and higher economic class (PR=1.2; 95%CI 1.0-1.3). Excessive consumption of red and processed meat among young men of upper economic class should be the target of public health actions for the adequacy of food consumption.

O consumo excessivo de carnes, em especial as vermelhas e processadas, está associado ao aumento da morbi-mortalidade. O padrão de consumo de carnes varia no Brasil e no mundo influenciado por fatores econômicos e culturais. O estudo buscou analisar o consumo de carnes por adultos e idosos de uma cidade de colonização alemã do sul do Brasil. Trata-se de estudo populacional seccional. Foram coletados dados sociodemográficas e de consumo de carne por Questionário de Frequência Alimentar previamente validado. Foram analisadas as frequências, e as quantidades por tipo de carne e processamento. A associação entre o consumo excessivo de carne e as variáveis de estudo foi estimada por Razão de Prevalência. Entre os 1.941 participantes, a média de carne consumida foi de 250 g/dia, sendo a carne não processada branca (138 g/dia) a mais consumida, com destaque para as aves (80 g/dia). A prevalência de consumo excessivo de carne vermelha e processada (mais que 500 g/semana) foi de 63%, principalmente entre os homens (RP=1,6; IC95% 1,5-1,8), de 20 a 29 anos (RP=1,4; IC95% 1,2-1,5), e mais alta classe econômica (RP=1,2; IC95% 1,0-1,3). O consumo excessivo de carne vermelha e processada entre homens jovens de classe econômica alta deve ser alvo de ações de saúde pública para a adequação no consumo alimentar.

Beyond access to medication: the role of SUS and the characteristics of HIV care in Brazil.

OBJECTIVE: To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. METHODS: Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015-2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system - no record; follow-up at SUS - two or more records; undefined follow-up - one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents' self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. RESULTS: During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. CONCLUSION: In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.

Association of moderate and vigorous physical activity and relative muscle strength with neck circumference: a cross-sectional analysis of the Study of Health in Pomerode (SHIP-Brazil).

OBJECTIVE: Neck circumference is a simple anthropometric measurement that may be linked to chronic diseases, physical activity, and muscle strength. We sought to verify the association of moderate and vigorous physical activity levels and relative muscle strength with neck circumference in a community in southern Brazil. METHODS: We cross-sectionally analyzed data from 2,488 participants (51% women), aged 20-79 years old from the Study of Health in Pomerode (SHIP-Brazil) conducted in Pomerode, Santa Catarina, Brazil. Increased neck circumference was defined with cutoff points of >39cm for men and >35cm for women. The independent variables were the level of moderate and vigorous physical activity using the short International Physical Activity Questionnaire, and relative muscle strength using the handgrip test and body mass. Univariate and multiple Poisson regression models were used to determine the association between variables (p≤0.05). RESULTS: The prevalence of increased neck circumference was 48.2% (60.4% in men, 39.6% in women) and was associated with low relative muscle strength (PR=1.26, 95%CI: 1.17-1.35) in men, insufficient moderate and vigorous physical activity levels (PR=1.23, 95%CI: 1.14-1.32), and relative muscle strength (PR=1.73, 95%CI: 1.61-1.87) in women. After adjusting for covariates, no significant associations were observed between insufficient moderate and vigorous physical activity levels in men (PR=1.02, 95%CI: 0.95-1.07). CONCLUSION: Increased neck circumference seems to be an important predictor of low moderate and vigorous physical activity and relative strength loss in adults, and more pronounced in women.

[Treatment adherence, access and AIDS assistance quality in Brazil. ]. / Adesão ao tratamento, acesso e qualidade da assistência em Aids no Brasil.

The patient adherence to highly active antiretroviral therapy (HAART) is a crucial matter to AIDS treatment effectiveness and its' impact. This article aims to discuss the association between adherence and quality of health service providing care to people living with AIDS (PLWA), highlighting quality of the services as a central point to adherence and access. It is based on results of our previous studies about the health care to PLWA in Brazil. Our studies point out that the groups of patients who are followed-up in health services providing care for less than 100 patients presented greater estimated risk of non-adherence than services following more than 500 patients. Also, smaller health services showed greater estimated risk to be ranged in the worst quality of services groups. This is related to the low complexity of smaller health care services, such as: lack of minimum human resources and material structures, poor organization on work process, medical-centered care and poor technical management. New studies in adherence and quality of services are needed. Nevertheless, the existent findings have already pointed out the need to review the current distribution of AIDS care services as well as to make the quality of services more homogenous thorough the country. These are high priorities in order to keep acceptable levels of adherence to HAART in Brazil.

Vaccine effectiveness in preventing deaths in people with severe acute respiratory syndrome due to COVID-19 in Blumenau, Brazil, 2021 / Efectividad de las vacunas en la prevención de la muerte por síndrome respiratório agudo grave por covid-19 en Blumenau, Brasil, 2021 / Efetividade vacinal na prevenção de óbitos em pessoas com síndrome respiratória aguda grave por covid-19 em Blumenau, 2021

ABSTRACT Objective to analyze the vaccine effectiveness in preventing deaths attributed to severe acute respiratory syndrome due to COVID-19 (SARS/COVID-19) in adults and the elderly, in Blumenau, state of Santa Catarina, Brazil, 2021. this was a population-based study conducted among individuals aged 20 years and older hospitalized with SARS/COVID-19; each death due to SARS/COVID-19 was considered a "case", and every survivor was considered a "control"; the association between vaccination status and the outcome of "death" was estimated using logistic regression, and vaccine effectiveness was estimated as (1-OR)*100. The study included 1,756 cases of SARS/COVID-19 (59.2% male, mean age of 56 years, 50.4% with elementary education, 68.4% with comorbidities and 39.1% in intensive care), of whom 398 died (cases) and 1,358 survived (controls); vaccine effectiveness was 74% and 85% (20-59 years old) and 72% and 75% (≥ 60 years old), respectively, for those who were partially vaccinated and fully vaccinated. Conclusion vaccines proved to be effective in reducing case fatality ratio due to SARS/COVID-19 in individuals ≥ 20 years old.

RESUMEN Objetivo analizar la efectividad de la vacuna para prevención de muertes por SRAG-COVID en adultos y ancianos de Blumenau, Santa Catarina, Brasil, 2021. Método estudio de base poblacional con personas hospitalizadas por SRAG-COVID mayores de 20 años; las muertes por SRAG-COVID se consideraron casos y todos los supervivientes, controles; la asociación entre el estado de vacunación y la muerte se estimó mediante regresión logística; la efectividad de la vacuna se estimó por (1-OR)*100. Resultados participaram do estudo 1.756 casos de SRAG-COVID (59,2% del sexo masculino, edad media de 56 años, 50,4% con estudios primarios, 68,4% con comorbilidades y 39,1% en cuidados intensivos), dos quais 398 foram a óbito (casos) e 1.358 sobreviveram (controles); la efectividad de la vacuna fue del 74% y el 85% (20 a 59 años) y del 72% y el 75% (60 y más años), entre los que tenían vacunación parcial y completa, respectivamente. Conclusión las vacunas fueran efectivas para reducir la letalidad del SRAG-covid.

RESUMO Objetivo Analisar a efetividade vacinal na prevenção de óbitos atribuídos a síndrome respiratória aguda grave por covid-19 (SRAG-covid) em adultos e idosos, em Blumenau, Santa Catarina, Brasil, 2021. Métodos Estudo populacional, entre maiores de 20 anos de idade internados por SRAG-covid; considerou-se "caso" cada óbito por SRAG-covid, e "controle", todo sobrevivente; estimou-se a associação entre a condição vacinal e o desfecho "óbito" por regressão logística, e a efetividade vacinal, por (1-OR)*100. Resultados Participaram do estudo 1.756 casos de SRAG-covid (59,2% do sexo masculino, idade média de 56 anos, 50,4% com ensino fundamental, 68,4% com comorbidades e 39,1% em cuidado intensivo), dos quais 398 foram a óbito (casos) e 1.358 sobreviveram (controles); a efetividade vacinal foi de 74% e 85% (20-59 anos) e de 72% e 75% (≥ 60 anos), respectivamente, para quem possuía vacinação parcial e vacinação completa. Conclusão Vacinas mostraram-se efetivas na redução da letalidade por SRAG-covid em indivíduos com idade ≥ 20 anos.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions.

INTRODUCTION: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

Consumo de carnes por adultos e idosos de uma cidade de colonização alemã do sul do Brasil: estudo de base populacional / Meat consumption by adults and the elderly in a city colonized by Germans in the south of Brazil: a population-based study

Resumo O consumo excessivo de carnes, em especial as vermelhas e processadas, está associado ao aumento da morbi-mortalidade. O padrão de consumo de carnes varia no Brasil e no mundo influenciado por fatores econômicos e culturais. O estudo buscou analisar o consumo de carnes por adultos e idosos de uma cidade de colonização alemã do sul do Brasil. Trata-se de estudo populacional seccional. Foram coletados dados sociodemográficas e de consumo de carne por Questionário de Frequência Alimentar previamente validado. Foram analisadas as frequências, e as quantidades por tipo de carne e processamento. A associação entre o consumo excessivo de carne e as variáveis de estudo foi estimada por Razão de Prevalência. Entre os 1.941 participantes, a média de carne consumida foi de 250 g/dia, sendo a carne não processada branca (138 g/dia) a mais consumida, com destaque para as aves (80 g/dia). A prevalência de consumo excessivo de carne vermelha e processada (mais que 500 g/semana) foi de 63%, principalmente entre os homens (RP=1,6; IC95% 1,5-1,8), de 20 a 29 anos (RP=1,4; IC95% 1,2-1,5), e mais alta classe econômica (RP=1,2; IC95% 1,0-1,3). O consumo excessivo de carne vermelha e processada entre homens jovens de classe econômica alta deve ser alvo de ações de saúde pública para a adequação no consumo alimentar.

Abstract Excessive meat consumption, especially red and processed meats, is associated with increased morbidity and mortality. The pattern of meat consumption varies in Brazil and is influenced by economic and cultural factors in the world. The study aimed to analyze the consumption of meat by adults and the elderly in a city colonized by Germans in the south of Brazil. It involved a cross-sectional population study. Sociodemographic and meat consumption data were collected using a previously validated Food Frequency Questionnaire. Frequencies and amounts were analyzed by type of meat and processing. The association between excessive meat consumption and the study variables was estimated by Prevalence Ratio. Among the 1,941 participants, the average amount of meat consumed was 250 g/day, the most consumed being white unprocessed meat (138 g/day), especially poultry (80 g/day). The prevalence of excessive consumption of red and processed meat (more than 500 g/week) was 63%, mainly among men (PR=1.6; 95%CI 1.5-1.8), aged 20 to 29 years (PR=1.4; 95%CI 1.2-1.5), and higher economic class (PR=1.2; 95%CI 1.0-1.3). Excessive consumption of red and processed meat among young men of upper economic class should be the target of public health actions for the adequacy of food consumption.

Beyond access to medication: the role of SUS and the characteristics of HIV care in Brazil / Para além do acesso ao medicamento: papel do SUS e perfil da assistência em HIV no Brasil

ABSTRACT OBJECTIVE To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. METHODS Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015-2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system - no record; follow-up at SUS - two or more records; undefined follow-up - one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents' self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. RESULTS During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. CONCLUSION In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.

RESUMO OBJETIVO Estimar a composição público-privada da assistência em HIV no Brasil e o perfil organizacional da extensa rede de serviços públicos. MÉTODOS Foram utilizados dados da Coorte Qualiaids-BR, que reúne dados dos sistemas nacionais de informações clínicas e laboratoriais de pessoas com 15 anos ou mais com primeira dispensação de terapia antirretroviral, entre 2015-2018, e informações dos serviços do SUS de acompanhamento clínico-laboratorial do HIV, produzidas pelo inquérito Qualiaids. O sistema de acompanhamento foi definido pelo número de exames de carga viral solicitados por algum serviço do SUS: acompanhamento no sistema privado - nenhum registro; acompanhamento no SUS - dois ou mais registros; acompanhamento indefinido - um registro. Os serviços do SUS foram caracterizados como ambulatórios, atenção básica e sistema prisional, segundo autoclassificação dos respondentes ao inquérito Qualiaids (72,9%); para os não respondentes (27,1%) a classificação baseou-se nos termos presentes nos nomes dos serviços. RESULTADOS No período, 238.599 pessoas com 15 anos ou mais iniciaram a terapia antirretroviral no Brasil, das quais, 69% receberam acompanhamento no SUS, 21,7% no sistema privado e 9,3% tiveram o sistema indefinido. Entre os acompanhados no SUS, 93,4% foram atendidos em serviços do tipo ambulatório, 5% em serviços de atenção básica e 1% no sistema prisional. CONCLUSÃO No Brasil o tratamento antirretroviral é fornecido exclusivamente pelo SUS, que também é responsável pelo acompanhamento clínico-laboratorial da terapia da maior parte das pessoas em serviços ambulatoriais. O estudo só foi possível porque o SUS mantêm registros e informações públicas acerca do acompanhamento em HIV. Não há nenhum dado disponível para o sistema privado.

Association of moderate and vigorous physical activity and relative muscle strength with neck circumference: a cross-sectional analysis of the Study of Health in Pomerode (SHIP-Brazil)

ABSTRACT Objective Neck circumference is a simple anthropometric measurement that may be linked to chronic diseases, physical activity, and muscle strength. We sought to verify the association of moderate and vigorous physical activity levels and relative muscle strength with neck circumference in a community in southern Brazil. Methods We cross-sectionally analyzed data from 2,488 participants (51% women), aged 20-79 years old from the Study of Health in Pomerode (SHIP-Brazil) conducted in Pomerode, Santa Catarina, Brazil. Increased neck circumference was defined with cutoff points of >39cm for men and >35cm for women. The independent variables were the level of moderate and vigorous physical activity using the short International Physical Activity Questionnaire, and relative muscle strength using the handgrip test and body mass. Univariate and multiple Poisson regression models were used to determine the association between variables (p≤0.05). Results The prevalence of increased neck circumference was 48.2% (60.4% in men, 39.6% in women) and was associated with low relative muscle strength (PR=1.26, 95%CI: 1.17-1.35) in men, insufficient moderate and vigorous physical activity levels (PR=1.23, 95%CI: 1.14-1.32), and relative muscle strength (PR=1.73, 95%CI: 1.61-1.87) in women. After adjusting for covariates, no significant associations were observed between insufficient moderate and vigorous physical activity levels in men (PR=1.02, 95%CI: 0.95-1.07). Conclusion Increased neck circumference seems to be an important predictor of low moderate and vigorous physical activity and relative strength loss in adults, and more pronounced in women.

Adequacy of sphygmomanometer cuff to brachial circumference of people attended in Primary Health Care Centers. / Adequação do manguito do esfigmomanômetro às medidas de circunferência braquial em pessoas atendidas na Atenção Primária.

OBJECTIVE:: To evaluate the adequacy of sphygmomanometer cuff to brachial circumference (BC) of individuals treated at Primary Health Care Centers. METHODS:: Epidemiological, observational, and quantitative cross-sectional study. A total of 381 blood pressure (BP) readings conducted by nursing professionals were observed at 18 service units selected by drawing, considering two modalities of care centers. The correct use of the cuff was the main outcome variable. The BC was measured using inelastic measuring tape. The tests used for statistical analysis were Student's t-test, χ2, or Fisher's exact test. RESULTS:: The measurement of BC ranged from 19.5 to 45.0 cm (mean = 30.4; standard deviation - SD = 4.3). Among the BP measurements, 218 (57.2%) of them were conducted with the appropriately sized cuff, being more frequent in the units with Family Health Teams (59.6 versus 40.4; p < 0.001). Ninety-three (24.2%) BC measurements were < 27 cm and 63 (16.5%) were > 34 cm. The adult cuff was used correctly 209 (59.4%) times and the large adult cuff was used correctly 9 (31.0%) times. CONCLUSION:: The study found an inadequacy in the use of the cuff in 42.8% of blood pressure readings in the Primary Health Care Centers. Similar studies should be performed in other cities and areas to estimate the effect of this problem in the diagnosis and monitoring of systemic arterial hypertension (SAH).

[Use of medicinal plants as home remedies in Primary Health Care in Blumenau - State of Santa Catarina, Brazil]. / Utilização de plantas medicinais como remédio caseiro na Atenção Primária em Blumenau, Santa Catarina, Brasil.

An increase in the use of alternative therapeutic practices has been observed in the past decade, especially in medicinal plants, herbal and home remedies, which has been supported by policies within the scope of the Unified Health System (SUS). This study investigated the use of home remedies by users of Primary Health Care in Blumenau, State of Santa Catarina. It is a cross-sectional, observational and epidemiological study, the data for which were obtained via a questionnaire applied to 701 individuals. An unconditional logistic regression model was used to estimate the association between the use of home remedies and socio-demographic and medical care variables. It was observed that 21.9% of the sample use home remedies and medicinal plants grown in the back yard are the remedies of choice. Lemon balm, chamomile, peppermint and lime were the remedies most frequently mentioned. The use of home remedies was associated with the female gender, older age and the Family Health Strategy care model. The results supported that medicinal plants are used by the population as a therapeutic alternative option. However, it is necessary that primary care services ensure both access to natural products and supply qualified professionals to give instructions regarding the correct usage of home remedies.

Insufficient physical activity and multimorbidity was associated with low physical functional performance in older adults: a cross-sectional study / Atividade física insuficiente e multimorbidade foram associadas ao baixo desempenho físico funcional em idosos: um estudo transversal

Aging, physical inactivity, and chronic disease can decrease strength and muscle mass and affect mobility and autonomy in older adults. This study aimed to analyze the prevalence and associated factors of low physical functional performance among older adults in the city of Pomerode, in southern Brazil. Methods: This is a cross-sectional population-based study with data on 733 older adults from the Study of Health in Pomerode ­ SHIP-Brazil. Low functional physical performance was defined as handgrip strength ≤ 32 kg for men or ≤ 20 kg for women and/or a Timed Up and Go test ≥ 11 seconds for men or ≥ 13 seconds for women. Associations were analyzed by multiple logistic regression. Results: The prevalence of low physical functional performance was 43.7% (42.2% among women and 45.5% among men). Low physical functional performance was associated with the 70­79 years age group (odds ratio [OR] = 2.07) and insufficient physical activity (OR = 2.73) in men, and with the 70­79 years age group (OR = 2.09) and multimorbidity (OR = 1.87) in women. In general, older age, insufficient physical activity, and multimorbidity were associated with low physical functional performance in older adults.

O envelhecimento, o sedentarismo e as doenças crônicas podem diminuir a força e a massa muscular e afetar a mobilidade e a autonomia do idoso. O objetivo deste estudo foi analisar a prevalência e os fatores associados ao baixo desempenho funcional em idosos de uma cidade de origem pomerana no sul do Brasil. Metodologia: Estudo transversal de base populacional com dados de 733 idosos do Estudo Vida e Saúde em Pomerode ­ ShipBrazil. O baixo desempenho físico funcional foi definido como a força de preensão palmar ≤ 32 kg para os homens ou ≤ 20 kg para as mulheres e(ou) timed up and go ≥ 11 segundos para os homens ou ≥ 13 segundos para as mulheres. As associações foram analisadas por regressão logística múltipla. Resultados: A prevalência de baixo desempenho físico funcional foi de 43,7% (42,2% idosas e 45,5% idosos). O baixo desempenho físico funcional foi associado à idade, 70-79 anos (OR = 2,07), e à atividade física insuficiente (OR = 2,73) nos homens; e à idade, 70­79 anos (OR = 2,09), e à presença de multimorbidade (OR = 1,87) nas mulheres. Em geral, maior idade, atividade física insuficiente e multimorbidade foram associadas ao baixo desempenho físico funcional entre os idosos.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions / A intervenção QualiRede: melhoria do desempenho do contínuo do cuidado em HIV, sífilis congênita e hepatite C em regiões de saúde

ABSTRACT Introduction: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). Methods: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. Results: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. Conclusion: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

RESUMO Introdução: Modelos de cuidado contínuo baseiam recentes estratégias em HIV, infecções sexualmente transmissíveis e hepatite C (HCV). Métodos: Desenvolveram-se modelos de contínuo do cuidado em HIV, HCV e sífilis congênita incluindo todas as etapas da atenção, desde a promoção e a prevenção até o controle clínico/cura. O modelo baseou a intervenção QualiRede, desenvolvida em parceria entre universidade e Sistema Único de Saúde (SUS), direcionada a gestores e demais profissionais de 6 regiões de saúde prioritárias em São Paulo e Santa Catarina. Selecionaram-se indicadores para cada etapa do contínuo do cuidado, provenientes dos sistemas de informação do SUS e dos questionários de avaliação de processo Qualiaids e QualiAB. Os indicadores formaram a base técnica de duas oficinas com profissionais e gestores de cada região: a primeira para identificar problemas e formar um Grupo Técnico Regional; e a segunda para construir planos de ação e metas a fim de melhorar o desempenho regional. Resultados: Os indicadores estão disponíveis no website www.qualirede.org. As oficinas ocorreram em quatro regiões de São Paulo (Alto Tietê, Baixada Santista, Grande ABC e Registro) e uma região de Santa Catarina (Foz do Rio Itajaí), resultando em planos regionais em São Paulo, mas não em Santa Catarina. Observou-se domínio limitado dos novos protocolos para HIV e HCV e uso incipiente de indicadores na rotina dos serviços. Conclusão: Melhorar o desempenho do contínuo do cuidado exige apropriação dos indicadores de desempenho e coordenação integrada dos fluxos de atenção em todos os níveis de gestão.

Assessment of adherence in elderly patients in primary care.

OBJECTIVE: To identify the prevalence of non-adherence to drug therapy for elderly patients in primary care in Blumenau, SC, Brazil. METHODS: This is a cross-sectional, population-based epidemiological study. A randomly selected sample of users who attended the pharmacies of 14 units of primary healthcare answered the questionnaire's study variables. The prevalence of non-adherence was measured using a self-reported questionnaire. A logistic regression model to calculate odds ratio was performed to estimate the association between risk factors and non-adherence. RESULTS: Of the 151 elderly individuals interviewed, 84.1% reported continuous use of their medicines. The average age of the participants was 69.04 years. Regarding the characteristics of the medications, an average of 4.3 medicines were used by the elderly, and diseases of the circulatory system were the most prominent (43.3%). The prevalence of non-adherence was 35.4%. Logistic regression showed an association between non-adherence and "prior stopping treatment because of lack of medication" and "inappropriately prescribed medication use" (p < 0.005). CONCLUSION: The results reinforce the need to improve public policy and management processes aimed at ensuring people's access to essential medicines and qualify the process of prescribing health professionals as a way to improve treatment adherence in the elderly.

Utilização de plantas medicinais como remédio caseiro na Atenção Primária em Blumenau, Santa Catarina, Brasil / Use of medicinal plants as home remedies in Primary Health Care in Blumenau - State of Santa Catarina, Brazil

Resumo Na última década foi observado um aumento no uso de práticas terapêuticas alternativas apoiadas por políticas no âmbito do Sistema Único de Saúde (SUS), em particular o uso de plantas medicinais e de fitoterápicos. Este estudo investigou o uso de remédios caseiros pelos usuários da Atenção Primária da Saúde do município de Blumenau, em Santa Catarina. Estudo epidemiológico observacional seccional, cujos dados foram obtidos através de questionário aplicado a 701 indivíduos. Utilizou-se um modelo de regressão logística não condicional para estimar a associação entre uso de remédios caseiros e variáveis sociodemográficas e médicoassistenciais. Observou-se que 21,9% dos entrevistados utilizaram remédios caseiros, sendo as plantas medicinais obtidas no quintal das casas a principal escolha. Como as mais citadas destacaram-se erva-cidreira, camomila, hortelã e limão. O uso de remédios caseiros se mostrou associado ao sexo feminino, à idade mais avançada e à modalidade de serviço, Estratégia Saúde da Família. Os resultados mostraram que as plantas medicinais são utilizadas como alternativa terapêutica. Entretanto, é necessário que os serviços de atenção primária garantam o acesso aos produtos naturais, bem como profissionais qualificados capazes de fornecer orientações sobre sua utilização.

Abstract An increase in the use of alternative therapeutic practices has been observed in the past decade, especially in medicinal plants, herbal and home remedies, which has been supported by policies within the scope of the Unified Health System (SUS). This study investigated the use of home remedies by users of Primary Health Care in Blumenau, State of Santa Catarina. It is a cross-sectional, observational and epidemiological study, the data for which were obtained via a questionnaire applied to 701 individuals. An unconditional logistic regression model was used to estimate the association between the use of home remedies and socio-demographic and medical care variables. It was observed that 21.9% of the sample use home remedies and medicinal plants grown in the back yard are the remedies of choice. Lemon balm, chamomile, peppermint and lime were the remedies most frequently mentioned. The use of home remedies was associated with the female gender, older age and the Family Health Strategy care model. The results supported that medicinal plants are used by the population as a therapeutic alternative option. However, it is necessary that primary care services ensure both access to natural products and supply qualified professionals to give instructions regarding the correct usage of home remedies.

Adequação do manguito do esfigmomanômetro às medidas de circunferência braquial em pessoas atendidas na Atenção Primária / Adequacy of sphygmomanometer cuff to brachial circumference of people attended in Primary Health Care Centers

RESUMO: Objetivo: Avaliar a adequação do manguito às medidas de circunferência braquial (CB) em pessoas atendidas na Atenção Primária. Métodos: Estudo epidemiológico do tipo transversal observacional e quantitativo. Foram observadas 381 medidas de pressão arterial (PA), realizadas por profissionais de enfermagem, em 18 serviços de Atenção Primária selecionados por sorteio, considerando 2 modalidades de atenção. O uso correto do manguito foi a principal variável de desfecho. A CB foi medida com fita métrica inelástica. Para análise estatística das variáveis foram utilizados os testes t de Student, χ2 ou exato de Fisher. Resultados: A medida de CB variou de 19,5 a 45,0 cm (média = 30,4; desvio padrão - DP = 4,3). Observou-se que 218 (57,2%) das medidas foram executadas com o manguito adequado, com maior frequência nas unidades com Equipes de Saúde da Família (59,6 versus 40,4; p < 0,001). Constatou-se 93 (24,2%) medidas de CB < 27 cm e 63 (16,5%) medidas de CB > 34 cm. O manguito adulto foi usado corretamente 209 (59,4%) vezes e o manguito adulto grande, 9 (31,0%) vezes. Conclusão: O estudo constatou uma inadequação no uso do manguito em 42,8% das medidas de PA na Atenção Primária à Saúde (APS). Estudos semelhantes em serviços de outras cidades e regiões devem ser realizados para estimar a magnitude do problema para o diagnóstico e monitoramento de hipertensão arterial sistêmica (HAS).

ABSTRACT: Objective: To evaluate the adequacy of sphygmomanometer cuff to brachial circumference (BC) of individuals treated at Primary Health Care Centers. Methods: Epidemiological, observational, and quantitative cross-sectional study. A total of 381 blood pressure (BP) readings conducted by nursing professionals were observed at 18 service units selected by drawing, considering two modalities of care centers. The correct use of the cuff was the main outcome variable. The BC was measured using inelastic measuring tape. The tests used for statistical analysis were Student’s t-test, χ2, or Fisher’s exact test. Results: The measurement of BC ranged from 19.5 to 45.0 cm (mean = 30.4; standard deviation - SD = 4.3). Among the BP measurements, 218 (57.2%) of them were conducted with the appropriately sized cuff, being more frequent in the units with Family Health Teams (59.6 versus 40.4; p < 0.001). Ninety-three (24.2%) BC measurements were < 27 cm and 63 (16.5%) were > 34 cm. The adult cuff was used correctly 209 (59.4%) times and the large adult cuff was used correctly 9 (31.0%) times. Conclusion: The study found an inadequacy in the use of the cuff in 42.8% of blood pressure readings in the Primary Health Care Centers. Similar studies should be performed in other cities and areas to estimate the effect of this problem in the diagnosis and monitoring of systemic arterial hypertension (SAH).

Não comparecimento às consultas especializadas é um resultado indesejado do processo de regulação / Non-attendance to specialized appointments is an unintentional outcome of the regulation process

O acesso à assistência especializada tem problemas recorrentes no Sistema Único de Saúde que se manifestam por falta de profissionais e fluxos regulatórios pouco efetivos, que culminam no aumento do tempo de espera e não comparecimento dos usuários às consultas. Esse estudo buscou identificar o perfil dos usuários que não compareceram às consultas e seus motivos alegados. Trata-se de estudo avaliativo seccional com dados coletados em prontuário eletrônico e por entrevista telefônica com 496 usuários. A taxa de absenteísmo foi de 12,2%, com maior número de ausências em Ginecologia e Obstetrícia (25,2%). As pessoas que faltaram eram majoritariamente mulheres, com nível fundamental de escolaridade e idade mediana de 41,4 anos. Ao final de 3 tentativas, foram entrevistadas 273(55%) pessoas. A principal categoria de motivos alegados para não comparecimento foi da gestão do processo regulatório (47%), e, dentro dessa, não ter sido informado sobre a data da consulta (30,7%). A gestão do processo de regulação pode melhorar o acesso ao reorganizar os fluxos e melhorar a comunicação entre profissionais e usuários dos serviços de saúde. Os usuários devem ser valorizados como parte do processo e não objetos da atenção à saúde, cujas voz e ações têm consequências para si e demais cidadãos.

The access to specialized care presents recurring problems in the Unified Health System. These manifests by lack of professionals and ineffective regulatory flows, which culminate in an increase in the waiting time and non-attendance of the users to the consultations. This study aimed to identify the profile of users whom did not attend the consultations and their alleged motives. This is a cross-sectional evaluative study with data collected in an electronic medical record and by telephone interview with 496 users. The non-attendance rate was 12.2%, with a greater number of absences in Gynecology and Obstetrics (25.2%). The absence persons were mostly women, with a fundamental level of education and a median age of 41.4 years. After 3 trials, 273 (55%) people were interviewed. The main category of alleged reasons for non-attendance was 'the management of the regulatory process' (47%), and within that, 'to had not been informed about the date of the consultation' (30.7%). Managing the regulatory process can improve access by reorganizing flows and improving communication between professionals and clientes of health services. Clients must be valued as part of the process and not as objects in health care, whose voice and actions have consequences for themselves and other citizens.

Estoque domiciliar de medicamentos de pessoas assistidas por uma equipe de profissionais da Estratégia de Saúde da Família / Medications stored at home by patients cared for by Family Health Strategy professionals / Almacenamiento medicamentos de los pacients atendidos por profesionales de atención primaria de la salud

O estoque domiciliar de medicamentos é uma prática comum a muitas famílias, mas pode representar um risco à saúde. Foi realizado um estudo transversal em 100 domicílios em uma área de abrangência da Estratégia Saúde da Família (ESF) em Blumenau, SC, entre fevereiro e março de 2012. Nos domicílios visitados, 91% tinham medicamentos, sendo encontrados 737 medicamentos (média de 7,6 por domicílio). O grupo terapêutico de medicamentos mais frequente foi o dos que atuam no sistema digestivo 148 (20,1%) e o medicamento mais encontrado foi o paracetamol (48,7%). Dentre os entrevistados, 29 (31,9%) relataram descartar medicamentos no lixo comum, 12 (13,2%) não observavam o aspecto físico antes de utilizar e 74 (81,3%) tiveram acesso a medicamentos em farmácias comunitárias e ESFs. Observou-se associação entre número de medicamentos e número de pessoas no domicílio (p<0,01) e com presença de doenças crônicas (p<0,05). Pessoas com mais escolaridade armazenam mais medicamentos (p<0,001). Contudo, pessoas com baixa escolaridade utilizam mais medicamentos prescritos por médicos (p<0,001).

Many families commonly store medications at home, a practice that may pose a health risk to these individuals. A cross-sectional study of 100 households in an area covered under the Family Health Strategy (FHS) was conducted in Blumenau, SC, between February and March 2012. Among the households visited, 91% had stored drugs; 737 different medications were found (with a mean of 7.6 medications per household). The most commonly stored drugs were the ones that act on the digestive system (148 drugs, or 20.1%), and the most commonly found medication was paracetamol (48.7%). Among the respondents, 29 (31.9%) reported often having disposed of medications in the trash; 12 (13.2%) did not particularly note the drug's appearance before ingesting it; and 74 (81.3%) had access to drugs in publicly funded (community) pharmacies and primary healthcare centers. The number of drugs was associated with the number of people in the household (p < 0.01) and the presence of chronic diseases (p < 0.05). People with higher levels of education stored more drugs (p < 0.001). However, people with lower levels of education used more drugs prescribed by doctors (p < 0.001).

El almacenamiento de los medicamentos en los hogares es una práctica común para muchas familias, pero puede representar un riesgo a la salud. Un estudio transversal se llevó a cabo en 100 hogares en un área de cobertura de la Estrategia de la Salud de la Familia (ESF) en Blumenau, SC, entre febrero y marzo del 2012. En el 91% de los hogares visitados había medicinas, donde fueron encontrados 737 medicamentos (promedio de 7,6 por hogar). Los medicamentos que actúan sobre el sistema digestivo fue el grupo terapéutico más frecuente 148 (20,1%) y la medicina más encontrada fue el Paracetamol (48,7%). Entre los encuestados, 29 (31,9 %) relataron que decartaan sus medicamentos en la basura comun, 12 (13,2 %) no observaban el aspecto físico antes del uso y 74 (81,3%) tuvieron acceso a los medicamentos en las farmacias comunitarias y en la ESF. Se observó una asociación entre el número de medicamentos y el número de personas en el hogar (p<0,01) y la presencia de enfermedades crónicas (p<0,05). Las personas con más educación almacenan más drogas (p<0,001). Sin embargo las personas con bajo nivel de estudios útilizan nás medicamentos prescritos por los médicos (p<0,001).

Assessing patient adherence to chronic diseases treatment: differentiating between epidemiological and clinical approaches.

This review discusses the concepts and methods for assessing patient adherence to treatment, as applied to both epidemiological and clinical approaches within real health care practices. For the epidemiological approach, the assessment must be as accurate as possible. Self-reported questionnaires are the most feasible option in most circumstances, but most demonstrate low sensitivity combined with high specificity. We suggest that self-reported outcomes, where feasible, can increase the sensitivity for non-adherence of these questionnaires. In the clinical approach an accurate distinction between adherents and non-adherents is less useful. For the health provider, it is more important to be aware of the particular situation that each patient is currently experiencing with his/her treatment. Self-reported questionnaires applied in clinical settings can help the health provider to form an objective opinion. In any event, the patient-provider dialogue is still the best approach to assess patient adherence as well as to deliver good care.