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

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

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

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

Hospital costs of immunopreventable diseases in the economically active population in Brazil.

BACKGROUND: Immunopreventable diseases are a public health reality in Brazil and worldwide, a reality that is not exclusive to children, but affects the adult population. OBJECTIVES: Discriminating the total costs of hospitalizations from immunopreventable diseases in the population aged 20 to 59 years. METHODS: A population, observational, descriptive, retrospective study was conducted with secondary information from DATASUS to discriminate the hospitalizations associated with immunopreventable diseases in Brazil and their care costs, within the Scope of the SUS, between 2008 and 2018, in the economically active population (20 to 59 years). RESULTS: It was analyzed 127,746 hospitalizations for immunopreventable diseases, (27.92% of all hospitalizations) were observed in the adult population, totaled R$115,682,097.54 (29.72% of the total costs). Of this population studied, 51.48% were registered as male; 66.74% were associated with influenza disease; 16.05% to chickenpox/herpes zoster infection and 7.55% to acute hepatitis B infections. The trend analysis of the time series of hospitalizations in this population showed a stationary trend. CONCLUSIONS: The 127,746 hospitalizations could be avoided with immunization, and 127,746 workers who could be working and not hospitalized. There were also R$115,682,097.54 that could be invested in other public health needs, which became necessary for the treatment of preventable diseases.

Costs related to immunopreventable diseases: Brazil and its geographic areas (immunopreventable diseases' costs in Brazil).

INTRODUCTION: The occurrence of the immunopreventable diseases in a population global reality. OBJECTIVE: To discriminate the direct costs of the hospitalizations from the immunopreventable diseases in the Unified Health System (SUS), in Brazil and their areas, between 2008 and 2018. METHODS: A population, observational, descriptive and retrospective study, with data from the information supplied by the DATASUS website, these data were collected during the 2019. RESULTS: It was identified 457,479 hospitalizations in the period; with a total of 2,450,870 days of hospital stay, with total costs of R$389,243,264.85. Only the disease mumps presented a growing tendency in whole areas; the chickenpox was decreasing; the illness whooping cough, yellow fever and tetanus were stationary in this period. CONCLUSIONS: The costs related to immunopreventable diseases were relevant in all the Brazil areas, with tendencies different between the geographic areas and between the several illnesses analysed.

Fake news: the impact of the internet on population health

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

Vaccination coverage and adherence to a dengue vaccination program in the state of Paraná, Brazil.

The success of vaccination programs depends on the level of acceptance of the vaccine to achieve high vaccine coverage rates (VCR). Vaccine hesitancy is a challenge, especially concerning new vaccines. Dengue vaccine, Dengvaxia®, was licensed in Brazil in 2015 and implemented, in a pioneering publicly-funded initiative in the state of Paraná, between 2016 and 2018. The vaccination program took place in five phases in the 30 municipalities most affected by dengue in the state, targeting individuals from nine to 44 years-old in two cities and from 15 to 27 years-old in the other 28 municipalities, totaling a target population of 500,000 individuals. A cross-sectional descriptive study was carried out to assess VCR and adherence to the dengue vaccine in this program. VCR, dropout ratio (DR), and compliance with the vaccination schedule (CVS) were analyzed by sex, age group, and municipality size. A total of 302,603 individuals (60.5%) received ≥ 1 dose, 44.2% received ≥ 2 doses, and 28.6% 3 doses. The DR was 52.8%. Among individuals who started vaccination, 40.6% achieved CVS. The highest VCR, highest CVS, and lowest DR occurred in the age group from 9 to 14 years old and from 28 to 44 years old and in smaller municipalities. A greater proportion of men started vaccination (male 64.0%; female 57.1%) however, the DR was higher in men (male 55.4%; female 49.9%), and a higher percentage of women completed the vaccination schedule according to the recommendations (CVS male 37.8%; female 43.6%). Differences were noted in the CVS according to the initial phase of the program (first phase 50.8%; second phase 18.8%). The heterogeneity in vaccine uptake and compliance according to sex, age, and municipality size suggests the need for differentiated strategies to address challenges with new and multiple-dose vaccines.

A prospective cohort study on the challenge to return to work after hospitalisation in Brazil.

After hospital discharge, workers are expected to return to work (RTW). However, the ability to return and any possible limitations after returning are unclear. Will they be able to RTW? Do they face limitations? This is a prospective cohort study with descriptive analysis aimed to investigate the RTW during 1 year following hospital discharge and to identify any limitations faced by the workers. Data collection occurred between February 2017 and July 2018 in an Internal Medicine Unit at a General Hospital. Convenience sampling was used, and participation was voluntary. Participants comprised 170 adults. Participants' RTW and limitations were followed for 1 year after discharge. During hospitalisation, 95.9% of participants planned to RTW. However, only 30% and 34.1% had returned after 1 month and 1 year respectively. Initially, 57.6% did not believe that they would present any limitation after discharge. However, 85.3% experienced restrictions after 1 month, and after 1 year this percentage rose to 88.2%. A correlation was found between young adults and RTW. The presence of limitations increased non-RTW risk. Therefore, it is recommended that the worker role should not be merely replaced by that of a patient, but it deserves attention of the latter in order to RTW activities. The work-return process must focus on understanding, treating and monitoring workers' limitations over time.

Prevalence and clinical characteristics of X-linked hypophosphatemia in Paraná, southern Brazil.

OBJECTIVE: The aim of this cross-sectional study was to estimate the prevalence of XLH in Paraná, a state in southern Brazil, and report the clinical features and complications of the disease. METHODS: We invited all endocrinologists (n = 205), nephrologists (n = 221), orthopedic surgeons (n = 1020), and pediatricians (n = 1000) in Paraná to fill out an electronic survey with information on patients with X-linked hypophosphatemia (XLH), and searched the records of the state's health department for all calcitriol prescriptions in 2018. RESULTS: In all, 244 (10%) specialists responded to the email, of whom 18 (7.4%) reported to be taking care of patients with XLH and answered the online survey. A total of 57 patients with XLH were identified (prevalence 5 per million inhabitants). The median age at diagnosis was 22 years, and 42.2% were children and adolescents. Fifteen patients had genetic testing showing a PHEX mutation. Overall, 91.2% had bone deformities, 30.8% had a history of fragility fractures, and 22.4% had renal complications. CONCLUSION: This study demonstrated a prevalence of XLH of 5 cases per million inhabitants in the state of Paraná, a rate lower than the one reported in other countries. Manifestations of renal calcification and bone fragility were frequent among the patients. This is the first epidemiological study evaluating the prevalence and clinical presentation of XLH in Latin America.

Prevalence and clinical characteristics of X-linked hypophosphatemia in Paraná, southern Brazil

ABSTRACT Objective: The aim of this cross-sectional study was to estimate the prevalence of XLH in Paraná, a state in southern Brazil, and report the clinical features and complications of the disease. Materials and methods: We invited all endocrinologists (n = 205), nephrologists (n = 221), orthopedic surgeons (n = 1020), and pediatricians (n = 1000) in Paraná to fill out an electronic survey with information on patients with X-linked hypophosphatemia (XLH), and searched the records of the state's health department for all calcitriol prescriptions in 2018. Results: In all, 244 (10%) specialists responded to the email, of whom 18 (7.4%) reported to be taking care of patients with XLH and answered the online survey. A total of 57 patients with XLH were identified (prevalence 5 per million inhabitants). The median age at diagnosis was 22 years, and 42.2% were children and adolescents. Fifteen patients had genetic testing showing a PHEX mutation. Overall, 91.2% had bone deformities, 30.8% had a history of fragility fractures, and 22.4% had renal complications. Conclusion: This study demonstrated a prevalence of XLH of 5 cases per million inhabitants in the state of Paraná, a rate lower than the one reported in other countries. Manifestations of renal calcification and bone fragility were frequent among the patients. This is the first epidemiological study evaluating the prevalence and clinical presentation of XLH in Latin America.

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

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

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

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

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

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

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

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

Complicações referentes à correção videolaparoscópica de hérnia inguinal: um estudo comparativo entre as técnicas TEP e TAPP realizado em um hospital terciário / Complications related to inguinal hernia videolaparoscopic repair: a comparative study between TEP and TAPP techniques in a terciary hospital

Hérnias de parede abdominal estão entre as enfermidades mais comuns na prática cirúrgica. Atualmente, duas técnicas videolaparoscópicas são utilizadas: totalmente extraperitoneal (TEP) e transabdominal pré-peritoneal (TAPP). Este estudo busca descrever e comparar as características clínico-epidemiológicas dos pacientes submetidos a herniorrafia videolaparoscópica por essas técnicas Para tal, foram analisados prontuários de pacientes atendidos no serviço de cirurgia geral do Hospital Cruz Vermelha Brasileira - Curitiba, entre novembro de 2009 e dezembro de 2018. Trata-se de um estudo transversal analítico com coleta de dados retrospectiva. Os dados evidenciaram uma prevalência em homens, idade média de 50 anos e hérnia inguinal à direita. Quando comparadas, não houve associação entre frequência de complicações e técnica utilizada. Hérnias que acometem o lado esquerdo, tendem a recidivar com maior frequência. O estudo reforça a recomendação da literatura: a técnica preferencial deve ser escolhida conforme experiência do cirurgião.

Abdominal wall hernias are among the most common diseases in surgical practice. Currently, two videolaparoscopic techniques are used: totally extraperitoneal (TEP) and pre-peritoneal transabdominal (TAPP). This study aims to describe and quantify the clinical and epidemiological characteristics of patients submitted to videolaparoscopic herniorrhaphy by these techniques, in order to identify which is the preferred one. For that, charts from patients who underwent treatment in the general surgery service of the Brazilian Red Cross Hospital - Curitiba, during November 2009 and February 2018, were analyzed. This is a cross-sectional analytical study with retrospective data collection. The data showed a prevalence of men, mean age of 50 years and right inguinal hernia. When compared, there was no association between the frequency of complications and the technique used. Hernias that affect the left side tend to recur more frequently. The study reinforces the recommendation of the literature: the preferred technique should be chosen according to the experience of the surgeon.

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

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

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

Home enteral nutrition: clinical-nutritional analysis and outcomes of 10 years of public policy / Nutrición enteral domiciliaria: análisis clínico-nutricional de los 10 años de política pública

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

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

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

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

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

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

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

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

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