Association between vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling Brazilian older adults: results from ELSI-Brazil study.

Low serum 25(OH)D levels (< 30 nmol/L) have been associated with increased depressive symptom scores over time, and it is believed that functionality may play a mediating role in the relationship between 25(OH)D and depressive symptoms. To comprehend the association between these factors could have significant implications for public health policy. The aim of this study was to verify the association between simultaneous vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling older adults. This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), collected between 2015 and 2016. The outcomes were functional disability assessed through basic activities of daily living (ADL) and instrumental activities of daily living (IADL). The exposures were vitamin D insufficiency (< 30 nmol/L) and depressive symptoms (≥ 4 points in 8-item version of the Center for Epidemiological Studies-Depression). Crude and adjusted Poisson regression was performed to estimate associations. A total of 1781 community-dwelling older adults included in this study, 14.6% had disability in ADL and 47.9% in IADL; 59.7% had vitamin D insufficient levels, and 33.2% depressive symptoms. The concomitant presence of vitamin D insufficient and depressive symptoms increased the prevalence of ADL by 2.20 (95% CI: 1.25; 3.86) and IADL by 1.54 (95% CI: 1.24; 1.91), respectively. Therefore, preventive strategies to keep older adults physically and socially active, with a good level of vitamin D, are essential to avoid depression and functional disability.

Socioemotional Factors and Cardiovascular Risk: What Is the Relationship in Brazilian Older Adults?

Background and Objectives: Cardiovascular risk is composed of several modifiable factors that cannot be explained only at the individual level. The aim of this study was to investigate the association between socioemotional factors and cardiovascular risk in older adults. Research Design and Methods: A cross-sectional study with data from The Brazilian Longitudinal Study of Aging (Estudo Longitudinal de Saúde dos Idosos Brasileiros, ELSI-Brazil), population based with data collected between 2015 and 2016. Cardiovascular risk-the study outcome-was assessed using the WHO/ISH Cardiovascular Risk Prediction Charts. The exposure variables were perceived social support from those who would receive help in situations and productive and leisurely social participation carried out in the last 12 months. We used crude and adjusted logistic regression for socioeconomic conditions, health conditions, and lifestyle habits to estimate odds ratio (OR) and 95% confidence intervals (CIs) for the occurrence of the outcome. Results: There were 6,005 participants between 50 and 74 years old with complete data. Of these, 18.7% (95% CI: 16.9-20.6) had high cardiovascular risk. Being in the highest tertile of greater social participation is associated with a lower prevalence of high cardiovascular risk (OR: 0.69; 95% CI: 0.50-0.95), adjusted for all variables, when compared to the lowest tertile. Furthermore, the absence of perceived social support is associated with a higher prevalence in different models. Perceived social support from close family members (son/daughter, son-in-law, and daughter-in-law) for material issues is associated with a higher prevalence, whereas having support from friends for affective resources is associated with a lower prevalence of high cardiovascular risk. Discussion and Implications: Socioemotional factors such as lack of perceived social support and social participation were significantly associated with cardiovascular risk. This suggested that the development of strategies aimed at reducing cardiovascular risk during aging needs to consider socioemotional factors and social relationships.

Is the combination of depression symptoms and multimorbidity associated with the increase of the prevalence of functional disabilities in Brazilian older adults? A cross-sectional study.

Introduction: Functional disabilities are more prevalent in older adults with multimorbidity and depression. However, few studies have investigated the combination of multimorbidity and depression with functional disability. This study aims to verify whether symptoms of depression and multimorbidity combined increase the prevalence of functional disability in Brazilian older adults. Material and methods: This is a cross-sectional study conducted with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline examination in 2015-2016 in adults aged 50 years and older. The variables included were basic (BADL) and instrumental activities of daily living (IADL), depressive symptoms, multimorbidity (≥2 chronic diseases), sociodemographic variables, and lifestyle. Logistic regression was performed to estimate crude and adjusted odds ratios. Results: A total of 7,842 participants over 50 years of age were included. Of these, 53.5% were women and 50.5% were between 50 and 59 years old, 33.5% reported ≥4 depressive symptoms, 51.4% had multimorbidity, 13.5% reported difficulty in performing at least one BADL, and 45.1% reported difficulty in performing the IADL. In the adjusted analysis, the prevalence of difficulty on BADL was 6.52 (95% CI: 5.14; 8.27) and on IADL was 2.34 (95% CI: 2.15; 2.55), higher for those with depression and multimorbidity combined when compared with those without these conditions. Conclusion: The combination of symptoms of depression and multimorbidity may increase functional impairments in the BADL and IADL of Brazilian older adults, impairing self-efficacy, independence, and autonomy. Early detection of these factors benefits the person, their family, and the healthcare system for health promotion and disease prevention.

Perfil do absenteísmo dos servidores públicos de um município do Extremo Sul Catarinense

O objetivo do presente estudo foi verificar o perfil do absenteísmo dos servidores públicos de um município do extremo sul catarinense. A pesquisa é de natureza observacional e transversal, utilizando-se de dados fornecidos pela prefeitura municipal estudada. Foram analisados 578 servidores públicos municipais que afastaram-se entre 2015 e 2020. Dentre os servidores em afastamento, aponta-se que 77,3% eram do sexo feminino, 31,5% tinham entre os 29 aos 38 anos de idade, 53,3% eram servidores estatutários, e 65,1% ocorreram nos primeiros 5 anos de trabalho. Os Auxiliares de Ensino de Educação, foram os profissionais que mais se afastaram, e entre as secretarias, foi a Secretaria de Educação. Como principais causas de afastamento foram identificadas as doenças causadas por transtornos mentais e comportamentais, doenças do sistema osteomuscular, doenças do sistema respiratório e fatores que influenciam o estado de saúde e o contato com os serviços de saúde. Conclui-se que as causas de afastamentos são preocupantes, e provocam alterações nos processos de trabalho. Dessa forma, é importante compreender essa dinâmica, contribui para planejar medidas para reduzir os índices de absenteísmo no município.

Centrais de Regulação e Consórcios Intermunicipais de Saúde: a Percepção de Gestores Catarinenses

Objetivo: Analisar a percepção dos gestores dos consórcios intermunicipais de saúde e das comissões intergestores regionais do sul de Santa Catarina sobre a incorporação das centrais de regulação nos procedimentos eletivos de média e alta complexidade, inseridos nos consórcios intermunicipais de saúde do estado. Métodos: Trata-se de um estudo descritivo como abordagem mista, realizado com representantes legais de consórcios intermunicipais de saúde e gestores municipais representantes da Comissão Intergestores Regional do sul de Santa Catarina, totalizando 6 participantes. A coleta de dados se deu através de entrevista semiestruturada. A análise ocorreu por método de condensação de significados com auxílio do programa SPSS versão 23.0. Resultados: Foi possível obter a percepção dos representantes legais e gestores acerca dos mecanismos de regulação, legislação vigente, sua eficácia e seu conhecimento prévio a respeito dos mesmos. Além disso, conseguiu-se traçar as características do perfil profissional dos respectivos indivíduos. Conclusões: Os resultados obtidos apontam uma percepção positiva dos gestores acercada regulação e o auxílio que a mesma trouxe aos municípios em relação à continuidade na linha de cuidado e a garantia do acesso aos pacientes com critérios clínicos mais graves. Evidenciou-se também a necessidade de melhorias na eficiência e fiscalização das legislações vigentes, além da necessidade dos gestores receberem capacitações acerca de características pontuais dos mecanismos legais.

The combined effect of anemia and dynapenia on mortality risk in older adults: 10-Year evidence from the ELSA cohort study.

BACKGROUND/OBJECTIVE: Anemia and dynapenia can occur simultaneously. Separately, both conditions increase the mortality risk with advancing age. However, there is no epidemiological evidence on the combined effect of these conditions on mortality in older adults. We investigated whether combined anemia and dynapenia increase the mortality risk, and whether there are gender differences. METHODS: A 10-year follow-up study was conducted involving 5,310 older adults from the English Longitudinal Study of Ageing (ELSA). According to the diagnosis of anemia (hemoglobin concentration < 13.0 g/dL in men and < 12.0 g/dL in women) and dynapenia (grip strength < 26 kg for men and < 16 kg for women), individuals at baseline were categorized as "non-anemic/non-dynapenic", "dynapenic", "anemic" and "anemic/dynapenic". The outcome was all-cause mortality during the follow-up period. RESULTS: A total of 984 deaths were computed during the follow-up (63.7% in non-anemic/non-dynapenic, 22.8% in dynapenic, 7.5% in anemic and 6.0% in anemic/dynapenic). Adjusted Cox proportional hazard models stratified by sex showed that anemia and dynapenia combined was associated with an increased mortality risk in men (HR: 1.64; 95% IC 1.08 - 2.50) and women (HR: 2.17; 95% CI 1.44 - 3.26). Anemia in men (HR: 1.68; 95% CI 1.22 - 2.32) and dynapenia in women (HR: 1.37; 95% CI 1.09 - 1.72) were also risk factors for mortality. CONCLUSIONS: The coexistence of anemia and dynapenia increases the mortality risk, highlighting the need for early identification, prevention, and treatment of these conditions to reduce their complications and the mortality risk.

Tobacco-related neoplasms: survival analysis and risk of death of population data from Florianópolis, SC.

OBJECTIVE: To estimate the probability of survival and prognostic factors for tobacco-related neoplasms in a population-based cohort. METHODS: This is a cohort with data from the Population-Based Cancer Registry of Florianópolis, southern Brazil, from 2008 to 2012. The Stata 16.0 software was used to estimate the probabilities of survival in five years after diagnosis, by the Kaplan Meier method, and the risk of death, by the Cox regression. RESULTS: A total of 2,829 cancer records related to smoking were included, more prevalent among males, over 70 years of age, nine years or more of schooling, white, with a partner and metastatic diagnosis. The most frequent groupings were colon and rectum (28.7%), trachea, bronchi and lungs (18.6%) and stomach (11.8%). At follow-up, 1,450 died. Pancreatic cancer had the worst probability of survival (14.3%), followed by liver cancer (19.4%). CONCLUSION: Risk factors for death and survival rates differ across the 13 types of tobacco-related cancers. Early diagnosis and primary prevention are strategies that must be improved to improve survival and decrease the burden related to these types of cancer.

Overall survival analyses of female malignancies in Southern Brazil during 2008-2017: A closer look at breast, cervical and ovarian cancer.

Background: The aim of this study was to report the overall survival and baseline factors associated with OS for breast, cervical and ovarian cancer in Florianópolis, Southern Brazil, a region with quality-of-life indicators comparable to high-income countries. Methods: Cohort study was performed from probabilistic record linkage of the Mortality Information System and the Population-based cancer registry of Florianópolis. It was included breasts, cervical and ovarian cancer diagnosis during the period of 2008-2012 with a follow up of 60 months. Cox regression and Kaplan-Meier method were used for associations with overall survival and risk factors. Findings: 1857 cases of the three malignancies were included in the analysis. We identified 202 deaths in breast cancer subjects, 53 for cervical cancer and 51 for ovarian cancer. Metastatic disease at diagnosis was present in 31%, 9.6%, and 55% of the cases, respectively. Overall survival was statistically correlated with age, educational level and stage for breast cancer; age and stage for cervical cancer; age and stage for ovarian cancer. Interpretation: Metastatic disease and age are the main prognostic factors for the malignancies studied, as they were associated with both overall survival and risk of death. Better screening and preventive tests for early diagnosis are needed. Funding: Support of Research and Innovation in the State of Santa Catarina, Research Program for the Unified Health System (FAPESC/MS-DECIT/CNPQ/SES-SC-PPSUS); the Brazilian National Research Council (CNPq); and the Coordination for the Improvement of Higher Education Personnel (CAPES).

Esperança e desespero: reflexões sobre o acesso na Atenção Primaria à Saúde / Hope and despair: reflections on access in Primary Health Care / Esperanza y desesperación: reflexiones sobre el acceso en la Atención Primaria de Salud

Objetivo: refletir sobre o acesso na Atenção Primária à Saúde (APS) através de analogias entre dois programas televisivos brasileiros. Método: trata-se de uma reflexão teórica sustentada em elementos da cultura televisiva popular brasileira, a partir dos programas: a porta da esperança e a porta dos desesperados. Resultados: o acesso à saúde no âmbito da APS pode ser analisado na perspectiva de três portas: esperança, na solução de suas necessidades; desespero, voltada aqueles que não conseguem encontrar soluções as suas demandas; e a prioritária, pautada nas atribuições que lhe constitui e no direito à saúde. Conclusão: a APS precisa superar a tipologia de porta da esperança e dos desesperados para efetivação da sua atribuição ordenadora da rede de atenção à saúde.

Objective: to reflect on access in Primary Health Care (PHC) through analogies of two Brazilian television shows. Method: this is a theoretical reflection based on elements of Brazilian popular television culture, based on the shows: the door of hope and the door of the desperate. Results: the access to health within the scope of PHC can be analyzed from the perspective of three doors: hope, in the solution of their needs; despair, aimed at those who cannot find solutions to their demands; and the priority, based on the attributions that constitute it and the right to health. Conclusion: PHC needs to overcome the typology of the door of hope and of the desperate for the achievement of its ordering attribution of the health care network.

Objetivo: reflexionar sobre el acceso en la Atención Primaria de Salud (APS) a través de analogías entre dos programas de televisión brasileños. Método: se trata de una reflexión teórica a partir de elementos de la cultura popular televisiva brasileña, a partir de los programas: la puerta de la esperanza y la puerta de los desesperados. Resultados: el acceso a la salud en el ámbito de la APS puede analizarse desde la perspectiva de tres puertas: la esperanza, en la solución de sus necesidades; la desesperación, dirigida a quienes no encuentran solución a sus demandas; y la prelación, con base en las atribuciones que la constituyen y el derecho a la salud. Conclusión: la APS necesita superar la tipología de la puerta de la esperanza y del desesperado para cumplir su tarea de organización de la red de atención a la salud.

Percepção dos usuários sobre a atenção primária em saúde: estudo transversal em um município de grande porte / Users' perception about primary health care: a cross-sectional study in a large municipality

O objetivo deste estudo foi avaliar o nível de satisfação dos usuários da Atenção Primária em Saúde de um município de grande porte. Trata-se de um estudo transversal, do tipo censitário e com amostra por conveniência, visto que foram incluídas todas as unidades de saúde e entrevistados os usuários que estavam na sala de espera no dia da coleta e aceitaram participar da pesquisa. Toda a coleta de dados foi realizada por meio de questionários, e,posteriormente,tabulada e analisada no software Stata 14.0. Os usuários relataram satisfação com a unidade e equipe, e com serviços assistenciais. Entretanto, usuários que manifestaram que trocariam de unidade caso isto fosse possível, tinham razões atribuídas à organização do cuidado e agendamento de consultas. Concluímos que a satisfação com os cuidados exercidos pelos profissionais e com o acolhimento de informações de cunho afetivo foram evidentemente altas, ao passo que a insatisfação com a organização do cuidado é aparente.

This study aimed to assess the level of satisfaction of users of PrimaryHealth Care in a large city. This is a cross-sectional, census-type study with a convenience sample, as all health units were included and users who were in the waiting room on the day of collection and who agreed to participate in the survey were interviewed. All data collection was performed through questionnaires, and later tabulated and analyzed using the Stata 14.0 software. Users reported satisfaction with the unit and team, and with care services. However, users who stated that they would change units if this was possible had reasons attributed to the organization of care and appointment scheduling. We conclude that satisfaction with the care provided by professionals and with the reception of information of an affective nature were evidently high, while dissatisfaction with the organization of care is apparent.

Racial inequities in tooth loss among older Brazilian adults: A decomposition analysis.

OBJECTIVE: To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services. METHODS: Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities. RESULTS: The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years. CONCLUSIONS: Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.