Breast cancer and covid-19: reduction in diagnosis and treatment in a Hospital Unit in Pernambuco / Câncer de mama e covid-19: redução no diagnóstico e tratamento em uma Unidade Hospitalar de Pernambuco

Abstract Objectives: to analyze the impact of the covid-19 pandemic on screening, diagnosis and treatment of breast cancer in Pernambuco, Northeastern Brazil. Method: cross-sectional study, based on secondary data from consultations with a mastologist, ultrasound, mammogram, biopsies, new cases, chemotherapy, radiotherapy and surgery, carried out in women for the screening, diagnosis and treatment of breast cancer, from January to December of the years 2019 to 2021. Results: the covid-19 pandemic reduced consultations with mastology (46.3%), ultrasounds (34.8%), mammogram (41.5%), biopsy (49.6%), new cases 45.7 % and surgery 34.6% in 2020 compared to 2019. On the other hand, with the exception of consultations with a mastologist and surgeries, all services where a significant reduction was observed in 2020, increased significantly in 2021 and returned to the same level of production in the pre-pandemic period. The pandemic did not negatively affect the supply of chemotherapy and radiotherapy. Conclusions: the findings of this study indicate negative impacts on breast cancer care, due to covid-19, during the first year of the pandemic, especially in consultations with a mastologist and surgery, which continued with low production in 2021. It is reasonable to assume that the reduction observed in procedures may reflect an increase in late diagnoses and a higher mortality rate in the coming years

Resumo Objetivos: analisar o impacto da pandemia da covid-19 nos atendimentos para rastreamento, diagnóstico e tratamento do câncer de mama em Pernambuco, Nordeste do Brasil. Métodos: estudo transversal, com base em dados secundários de consultas com mastologista, ultrassonografia, mamografia, biópsias, casos novos, quimioterapia, radioterapia e cirurgia, realizadas em mulheres para o rastreamento, diagnóstico e tratamento do câncer de mama, de janeiro a dezembro dos anos 2019 a 2021. Resultados: a pandemia da covid-19 reduziu as consultas com a mastologia (46,3%), ultrassonografias (34,8%), mamografia (41,5%), biópsia (49,6%), casos novos 45,7% e cirurgia 34,6% no ano de 2020 em relação ao ano de 2019. Por outro lado, com exceção das consultas com mastologista e cirurgias, todos os serviços onde se observou redução significativa em 2020, aumentaram significativamente em 2021 e voltaram ao patamar de produção do período pré-pandemia. A pandemia não afetou negativamente a oferta de quimioterapia e radioterapia. Conclusões: os achados deste estudo apontam impactos negativos na atenção ao câncer de mama, em decorrência da covid-19, durante o primeiro ano da pandemia, sobretudo nas consultas com mastologista e cirurgia, que continuaram com baixa produção em 2021. É razoável supor que a redução constatada nos procedimentos poderá refletir em um aumento de diagnósticos tardios e maior taxa de mortalidades nos próximos anos.

Prevalência de amputações e revascularizações por pé diabético e suas características / Prevalence of amputations and revascularization by diabetic foot and its features / Prevalencia de las amputaciones y la revascularización para el pie diabético y sus características

Objetivo: estimar a prevalência de amputações e revascularizações por pé diabético e suas características. Método: estudo transversal de base hospitalar, constituído pelos prontuários de todos os pacientes internados no período de 1990 a 2005 (n=4.633), realizado pela aplicação de um formulário construído a partir das definições do Consenso Internacional sobre pé diabético. As diferenças entre triênios foram analisadas pelo teste Quiquadrado. Resultados: a prevalência de internamentos por pé diabético foi 27,3% e de amputações foram: 66,7%, 73,9% e 67,0% respectivamente para os intervalos considerados. Quanto ao nível de amputação, as prevalências encontradas para amputação maior são superiores àquelas de menor nível de secção. Conclusão: apesar das altas taxas encontradas para os internamentos por pé diabético e amputações, o movimento ao longo do período estudado, sobretudo, no que diz respeito à prática de procedimentos conservadores, aponta para os esforços empreendidos pela atenção básica.(AU)

Objective: to estimate the prevalence of amputations and revascularization by diabetic foot and its features. Method: cross-sectional study, hospital-based, consisting of the medical records of all hospitalized patients from 1990 to 2005 (n = 4,633), conducted by applying a form built from the International Consensus definitions of diabetic foot. The differences between the studied periods were analyzed by chi-square test. Results: the prevalence of hospitalizations by diabetic foot was 27.3%, and amputations, 66.7%, 73.9% and 67.0%, respectively for the considered periods. Regarding the level of amputation, the prevalence rates for major amputation are higher than those for lower section level. Conclusion: despite the high rates found for admissions for diabetic foot and amputations, the movement over the period studied, especially regarding the practice of conservative procedures, points to the efforts made by primary care.(AU)

Objetivo: estimar la prevalencia de las amputaciones y la revascularización para el pie diabético y sus características. Método: estudio transversal, hospital-basada, que consiste en las historias clínicas de todos los pacientes admitidas de 1990 y 2005 (n = 4.633) llevadas a cabo mediante la aplicación de una forma construida a partir de las definiciones de consenso internacional de pie diabético. Las diferencias entre los periodos de estudio se analizaron mediante la prueba de chi-cuadrado. Resultados: la prevalencia de hospitalizaciones por pie diabético fue del 27,3% y el 66,7% eran amputaciones, 73,9% y 67,0%, respectivamente, para los intervalos. En cuanto al nivel de amputación, las tasas de prevalencia de amputación mayor son más altas que los de nivel de la sección inferior. Conclusión: a pesar de las altas tasas encontradas para admisiones para el pie diabético y las amputaciones, el movimiento durante el período estudiado, especialmente con respecto a la práctica de los procedimientos conservadores, apunta a los esfuerzos realizados por la atención primaria.(AU)

Factors associated with diabetic foot amputations / Fatores associados a amputações por p¨¦ diab¨¦tico

Diabetes and the problem of the diabetic foot specifically are a severe burden on the public healthcare system. Amputations caused by this condition are still common in our setting (Brazil), although the true magnitude of the problem is not known with certainty. Lower limb amputation rates have come to be seen as an indicator of the quality of preventative care of the diabetic foot. OBJECTIVE: To identify associations between amputations and factors related to people, to morbidities and to primary care received. METHODS: This was a cross-sectional study of a sample of 137 patients with diabetic feet admitted to a large hospital in the city of Recife, Pernambuco, Brazil. Logistic regression analysis was conducted. RESULTS: Associations with amputation were detected for the following variables: age over 60; resident of the Metro zone; income of three minimum salaries or less; presence of gangrene on admission; glycemia ¡Ý 126 mg/dL; smoking; not receiving information about results of glycemia testing; not having feet examined, and not being given guidance on caring for feet at consultations during the previous year. CONCLUSIONS: Factors related to Primary Care, such as time since onset of ulcers, information about results of glycemia testing and lack of guidance on how to care for their feet, were associated with occurrence of lower limb amputations...

O diabetes e especificamente o problema do p¨¦ diab¨¦tico representam grave adversidade ao sistema de sa¨²de p¨²blica. As amputações resultantes deste agravo ainda são frequentes em nosso meio, embora não se conheça ao certo a sua magnitude. A taxa de amputações de membros inferiores tem sido considerada um indicador da qualidade dos cuidados preventivos do p¨¦ diab¨¦tico. OBJETIVO: Identificar a exist¨ºncia de associação entre amputações e fatores relacionados ¨¤s pessoas, ¨¤ morbidade e ¨¤ atenção b¨¢sica recebida. MÉTODOS: Estudo transversal que incluiu uma amostra de 137 portadores de p¨¦ diab¨¦tico internados em hospital de grande porte da cidade do Recife. Realizou-se an¨¢lise de regressão log¨ªstica. RESULTADOS: Verificou-se associação para as vari¨¢veis: idade de 60 anos ou mais; proced¨ºncia da Região metropolitana; renda de at¨¦ tr¨ºs sal¨¢rios m¨ªnimos; presença de gangrena ¨¤ admissão; glicemia de 126 mg/dL ou mais; tabagismo; não receber informação dos resultados da glicemia; não ter os p¨¦s examinados, e não receber orientação sobre cuidados com os p¨¦s nas consultas do ano anterior. CONCLUSÕES: Fatores relacionados ¨¤ Atenção B¨¢sica, tais como o tempo de ocorr¨ºncia da ¨²lcera, a informação dos resultados do exame de glicemia e a falta de orientação sobre cuidados com os p¨¦s, estiveram associados com a ocorr¨ºncia de amputações de membros inferiores...

Impact of chronic kidney disease on quality of life, lung function, and functional capacity / Repercussão da doença renal crônica na qualidade de vida, função pulmonar e capacidade funcional

OBJECTIVES: To evaluate the impact of the chronic kidney disease (CKD) on quality of life, from the children's and their parents' perspective, respiratory muscle strength, lung function, and functional capacity in children and adolescents. METHOD: Cross-sectional study of children with CKD aged 8 to 17 years. Those incapable of taking the tests were excluded. After an interview, quality of life by Pediatric Quality of Life Inventory) (PedsQLTM), muscular strength, pulmonary function tests, and the 6-minute walking test (6MWT) were applied. Student's t-test, ANOVA (difference in means), and Pearson's coefficient of correlation were used. The level of significance was set at 5%. RESULTS: Of the 40 patients, the mean distance walked at the 6MWT was 396 meters, and the mean final score at the quality of life test as perceived by the children and parents was 50.9 and 51, respectively. From the children's perspective, the transplanted patients had a higher quality of life score when compared to those undergoing hemodialysis (p < 0.001); those who practiced physical activity had better quality of life when compared to the sedentary children (p < 0.001). From the children's and the parents' perspectives, the male gender had a higher quality of life score (p < 0.05). There was a positive correlation between the distance walked at the 6MWT and age, height, final PedsQLTM, forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), as well as a negative correlation between FEV1/FVC and the distance walked. CONCLUSION: A significant reduction in the quality of life and the functional capacity was observed in children with CKD, influenced by the type of treatment, gender, and sedentary life style. .

OBJETIVOS: Avaliar repercussões da doença renal crônica (DRC) sobre a qualidade de vida na percepção das crianças e dos pais, força muscular respiratória, função pulmonar e capacidade funcional em crianças e adolescentes. MÉTODO: Estudo transversal de crianças e adolescentes com DRC de oito a 17 anos. Excluídas as incapazes de realizar os testes. Após entrevista, aplicou-se questionário de qualidade de vida (PedsQLTM), testes de força muscular, função pulmonar e teste de caminhada de 6 minutos (TC6 min). Foi utilizado o teste t de Student e ANOVA (diferenças de médias) e o coeficiente de correlação de Pearson. Considerou-se nível de significância de 5%. RESULTADOS: Dentre os 40 pacientes, a média da distância percorrida no TC6 min foi de 396 ± 71 metros, e a média do escore final de qualidade de vida percebida pelas crianças e pelos pais de 50,9 e 51, respectivamente. Na percepção das crianças, os transplantados apresentaram maior escore de qualidade de vida, comparados aos em hemodiálise (p < 0,001), e aos com atividade física e melhor qualidade de vida, comparadas às sedentárias (p < 0,001). Na percepção das crianças e dos pais, o sexo masculino apresentou maior escore de qualidade de vida (p < 0,05). Houve correlação positiva entre a distância percorrida no TC6 min e as variáveis idade, altura, PedsQLTM final da criança, capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1) e negativa entre VEF1/CVF e a distância percorrida. CONCLUSÃO: Observou-se redução significativa na qualidade de vida e na capacidade funcional em crianças com DRC influenciadas pelo tipo de tratamento, sexo e sedentarismo. .

Perfil das internações por condições sensíveis à atenção primária em Pernambuco, 2008 a 2012 / Profile of hospital admissions for primary care sensitive conditions in Pernambuco State, Brazil, 2008-2012 / Perfil de las internaciones por condiciones sensibles a la atención primaria en Pernambuco, 2008 a 2012

Objetivo: descrever o perfil das internações por condições sensíveis à atenção primária (ICSAP) no estado de Pernambuco, no período de 2008 a 2012. Métodos: estudo descritivo com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), referentes a residentes no estado; foram calculados a proporção, o coeficiente e a variação percentual das ICSAP por região de saúde. Resultados: 20,0 por cento das internações ocorridas em Pernambuco (n=559.975) foram por ICSAP, com redução no período estudado (de 13,01 para 12,11 internações/1000 habitantes); as regiões de saúde de Recife (48,6 por cento) e Salgueiro (1,9 por cento) apresentaram a maior e a menor frequência desses eventos; os principais grupos de causas foram gastroenterites infecciosas e complicações (19,7 por cento), pneumonias bacterianas (18,7 por cento), asma (7,9 por cento), insuficiência cardíaca (7,7 por cento) e infecção no rim e trato urinário (7,2 por cento). Conclusões: observou-se redução das ICSAP entre as regiões de Pernambuco de forma heterogênea, embora com potencial para continuidade desse declínio.

Objective: to describe the profile of Primary Care Sensitive Conditions Hospitalizations (PCSCH) in Pernambuco State, 2008-2012. Methods: a descriptive study using data from the Health Service Hospital Information System, related to state residents. PCSCH proportion, rate and percentage variation were calculated by health region. Results: 20.0 percent of hospital admissions in Pernambuco (n= 559,975) were PCSCH. A reduction occurred during the study period (from 13.01 to 12.11 admissions /1,000 inhabitants). Recife and Salgueiro health regions had the highest and lowest frequency of these events, 48.6 percent and 1.9 percent, respectively. The main groups of causes were infectious gastroenteritis and complications (19.7 percent), bacterial pneumonia (18.7 percent), asthma (7.9 percent), heart failure (7.7 percent) and kidney and urinary tract infection (7.2 percent). Conclusions: we found a heterogeneous reduction in PCSCH among Pernambuco's health regions, although there was potential for the decrease to continue.

Objective: to describe the profile of Primary Care Sensitive Conditions Hospitalizations (PCSCH) in Pernambuco State, 2008-2012.Methods: a descriptive study using data from the Health Service Hospital Information System, related to state residents. PCSCH proportion, rate and percentage variation were calculated by health region.Results: 20.0% of hospital admissions in Pernambuco (n = 559,975) were PCSCH. A reduction occurred during the study period (from 13.01 to 12.11 admissions /1,000 inhabitants). Recife and Salgueiro health regions had the highest and lowest frequency of these events, 48.6% and 1.9%, respectively. The main groups of causes were infectious gastroenteritis and complications (19.7%), bacterial pneumonia (18.7%), asthma (7.9%), heart failure (7.7%) and kidney and urinary tract infection (7.2%).Conclusions: we found a heterogeneous reduction in PCSCH among Pernambuco's health regions, although there was potential for the decrease to continue.

Impact of chronic kidney disease on quality of life, lung function, and functional capacity.

OBJECTIVES: To evaluate the impact of the chronic kidney disease (CKD) on quality of life, from the children's and their parents' perspective, respiratory muscle strength, lung function, and functional capacity in children and adolescents. METHOD: Cross-sectional study of children with CKD aged 8 to 17 years. Those incapable of taking the tests were excluded. After an interview, quality of life by Pediatric Quality of Life Inventory) (PedsQL(TM)), muscular strength, pulmonary function tests, and the 6-minute walking test (6MWT) were applied. Student's t-test, ANOVA (difference in means), and Pearson's coefficient of correlation were used. The level of significance was set at 5%. RESULTS: Of the 40 patients, the mean distance walked at the 6MWT was 396 meters, and the mean final score at the quality of life test as perceived by the children and parents was 50.9 and 51, respectively. From the children's perspective, the transplanted patients had a higher quality of life score when compared to those undergoing hemodialysis (p<0.001); those who practiced physical activity had better quality of life when compared to the sedentary children (p<0.001). From the children's and the parents' perspectives, the male gender had a higher quality of life score (p<0.05). There was a positive correlation between the distance walked at the 6MWT and age, height, final PedsQL(TM), forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), as well as a negative correlation between FEV1/FVC and the distance walked. CONCLUSION: A significant reduction in the quality of life and the functional capacity was observed in children with CKD, influenced by the type of treatment, gender, and sedentary life style.

Magnitude, tendência temporal e fatores associados à anemia em crianças do Estado da Paraíba / Magnitude, time trends and factors associate with anemia in children in the state of Paraíba, Brazil

OBJETIVO: Estimar a prevalência da anemia em crianças, sua tendência temporal e identificar fatores associados. MÉTODOS: Estudo de corte transversal, de base populacional, envolvendo 1.108 crianças, com idade entre seis e 59 meses, de ambos os sexos, do Estado da Paraíba, em 2007. A hemoglobina foi analisada em sangue venoso com contador automático. Foram considerados para anemia valores < 11,0 g/dL, forma leve 9-11g/dL, moderada 7-9 g/dL e grave < 7,0 g/dL. As condições socioeconômicas e demográficas das crianças foram obtidas por meio de questionário aos pais ou responsáveis. As proporções foram comparadas pelo teste do qui-quadrado de Pearson, e a associação entre as concentrações de hemoglobina e potenciais fatores de riscos foi testada pelo modelo de regressão de Poisson. A tendência temporal da anemia foi avaliada pelo incremento/redução na prevalência de anemia nos anos de 1982, 1992 e 2007. RESULTADOS: A prevalência de anemia foi de 36,5% (IC95% 33,7;39,3). Observa-se que 1,3% (IC95% 0,7;1,8) foi na forma grave, 11,1% (IC95% 9,4;13,5) na forma moderada e 87,6% (IC95% 79,1;91,2) na forma leve. Houve um incremento de 88,5% nos casos de anemia no período entre 1982 e1992 e uma estabilização na prevalência entre 1992 e 2007. A análise ajustada no modelo de Poisson mostrou maior suscetibilidade à anemia nas crianças de seis a 24 meses de idade, naquelas amamentadas por seis meses ou mais, que co-habitavam com mais de quatro pessoas no mesmo domicílio e moravam em casas com menos de cinco cômodos. CONCLUSÕES: A alta prevalência de anemia mostra que continua sendo um importante problema de saúde pública no Estado da Paraíba. Apesar da estabilização na prevalência entre 1992 e 2007, a anemia apresenta-se em elevado patamar, o que impõe medidas mais efetivas de prevenção e controle.

OBJECTIVE: To estimate the magnitude of the anemia, to analyze the time trends and investigate the factors associated with this disturbance in children in the state of Paraíba, Brazil. METHODS: A cross-sectional survey, of population-based, with 1108 children, aged 6 to 59 months, both sexes in the state of Paraíba. Hemoglobin (Hb) in venous blood was analyzed with an automatic counter. The social-economic and demographic characteristics of children were obtained by questionnaire. Proportions were compared by Pearson's chi-squared test, and the association between hemoglobin concentrations and potential risk factors was tested by regression model Poisson. The time trend of anemia was assessed by the increase/decreased in the prevalence of anemia, using as comparison the prevalence observed in the years 1982, 1992 and 2007. RESULTS: The prevalence of anemia (Hb < 11.0 g/dl) in the state of Paraíba was 36.5% (CI95% 33.7 to 39.3). It was observed that 1.3% (CI95% 0.7 to 1.8) were in severe form (Hb <7.0 g/dl), 11% (CI95% 9.4 to 13.5) in a moderate form and 87.6% (CI95% 79.1 to 91.2) in the mild form. There was an increase 88.5% in cases of anemia between the years 1982-1992 and stabilization in the prevalence between the years 1992-2007. The analysis adjusted Poisson model showed a greater susceptibility to anemia in children 6 to 24 months of age, those breastfed for six months or more, who co-inhabited with more than 04 people in the same household and lived in houses with less than 05 rooms. CONCLUSIONS: The results revealed that anemia remains an important public health problem in the state of Paraíba and despite having been shown an stabilization in the prevalence of anemia between 1992-2007, differently the prevalence observed between 1982-1992, this deficiency presents in high level, witch requires more effective measures of prevention and control.

[Magnitude, time trends and factors associate with anemia in children in the state of Paraíba, Brazil]. / Magnitude, tendência temporal e fatores associados à anemia em crianças do Estado da Paraíba.

OBJECTIVE: To estimate the magnitude of the anemia, to analyze the time trends and investigate the factors associated with this disturbance in children in the state of Paraíba, Brazil. METHODS: A cross-sectional survey, of population-based, with 1108 children, aged 6 to 59 months, both sexes in the state of Paraíba. Hemoglobin (Hb) in venous blood was analyzed with an automatic counter. The social-economic and demographic characteristics of children were obtained by questionnaire. Proportions were compared by Pearson's chi-squared test, and the association between hemoglobin concentrations and potential risk factors was tested by regression model Poisson. The time trend of anemia was assessed by the increase/decreased in the prevalence of anemia, using as comparison the prevalence observed in the years 1982, 1992 and 2007. RESULTS: The prevalence of anemia (Hb < 11.0 g/dl) in the state of Paraíba was 36.5% (CI95% 33.7 to 39.3). It was observed that 1.3% (CI95% 0.7 to 1.8) were in severe form (Hb <7.0 g/dl), 11% (CI95% 9.4 to 13.5) in a moderate form and 87.6% (CI95% 79.1 to 91.2) in the mild form. There was an increase 88.5% in cases of anemia between the years 1982-1992 and stabilization in the prevalence between the years 1992-2007. The analysis adjusted Poisson model showed a greater susceptibility to anemia in children 6 to 24 months of age, those breastfed for six months or more, who co-inhabited with more than 04 people in the same household and lived in houses with less than 05 rooms. CONCLUSIONS: The results revealed that anemia remains an important public health problem in the state of Paraíba and despite having been shown an stabilization in the prevalence of anemia between 1992-2007, differently the prevalence observed between 1982-1992, this deficiency presents in high level, witch requires more effective measures of prevention and control.

Comorbidities in patients with osteoarthritis: frequency and impact on pain and physical function.

INTRODUCTION: As the prevalence of osteoarthritis (OA) increases with age, the coexistence of other chronic diseases is common. OBJECTIVES: To evaluate the frequency of comorbidities in OA patients and to measure their impact on pain and physical function of those patients. METHODS: Cross-sectional study in OA patients of a public rheumatology clinic. Pain was measured by use of the Visual Analogue Scale (VAS) and physical function by use of the Lequesne's and SACRAH indices. A screening for depression was performed, as were the following measurements: anthropometric data; blood pressure; fasting glycemia; and lipid profile. RESULTS: The study assessed 91 patients (mean age 59.3 years; 91.4% female). The metabolic syndrome frequency was 54.9%. Hypertension occurred in 75.8% of the patients, dyslipidemia in 52.6%, and obesity in 57.1%. The screening for depression was positive in 61.3% of patients. When comparing the metabolic syndrome components individually, patients with hypertension had higher SACRAH scores, with statistically significant differences (P = 0.035). For the other variables, no differences among the Lequesne's, SACRAH and VAS scores were observed. CONCLUSION: This group of OA patients showed a high frequency of depression, metabolic syndrome and its components in isolation, which can impact the pain and physical function of those patients. Such results showed the need for investigating and treating those comorbidities in OA patients.

Comorbidades em pacientes com osteoartrite: frequência e impacto na dor e na função física / Comorbidities in patients with osteoarthritis: frequency and impact on pain and physical function

INTRODUÇÃO: Uma vez que a prevalência da osteoartrite (OA) aumenta com o envelhecimento, é comum a coexistência de outras doenças crônicas. OBJETIVOS: Avaliar a frequência de comorbidades em pacientes com OA e mensurar o impacto destas na dor e a função física nesses pacientes. MÉTODOS: Estudo transversal em pacientes portadores de OA do ambulatório de reumatologia do IMIP. A dor foi mensurada pela Escala Visual Analógica (EVA) e a função física pelos índices de Lequesne e SACRAH. Foi realizado um screening para depressão, além de aferição de medidas antropométricas, pressão arterial, dosagem da glicemia de jejum e perfil lipídico. RESULTADOS: Foram estudados 91 pacientes, com média de idade de 59,3 anos, sendo 91,4 por cento do sexo feminino. A frequência de síndrome metabólica foi de 54,9 por cento. Hipertensão arterial sistêmica ocorreu em 75,8 por cento dos casos, dislipidemia em 52,6 por cento e obesidade em 57,1 por cento. O screening para depressão foi positivo em 61,3 por cento dos pacientes. Quando comparamos individualmente os componentes da síndrome metabólica, observamos que pacientes com hipertensão apresentavam maiores escores no SACRAH com diferença estatisticamente significante (P = 0,035). Para as outras variáveis, não foram demonstradas diferenças entre os escores Lequesne, SACRAH e EVA. CONCLUSÃO: Foi observada uma alta frequência de depressão, síndrome metabólica e de seus componentes isoladamente nesse grupo de pacientes com OA, podendo haver impacto da presença destes na dor e na função física desses pacientes. Tais resultados demonstraram a necessidade de investigação e tratamento dessas comorbidades em pacientes com OA.

INTRODUCTION: As the prevalence of osteoarthritis (OA) increases with age, the coexistence of other chronic diseases is common. OBJECTIVES: To evaluate the frequency of comorbidities in OA patients and to measure their impact on pain and physical function of those patients. METHODS: Cross-sectional study in OA patients of a public rheumatology clinic. Pain was measured by use of the Visual Analogue Scale (VAS) and physical function by use of the Lequesne's and SACRAH indices. A screening for depression was performed, as were the following measurements: anthropometric data; blood pressure; fasting glycemia; and lipid profile. RESULTS: The study assessed 91 patients (mean age 59.3 years; 91.4 percent female). The metabolic syndrome frequency was 54.9 percent. Hypertension occurred in 75.8 percent of the patients, dyslipidemia in 52.6 percent, and obesity in 57.1 percent. The screening for depression was positive in 61.3 percent of patients. When comparing the metabolic syndrome components individually, patients with hypertension had higher SACRAH scores, with statistically significant differences (P = 0.035). For the other variables, no differences among the Lequesne's, SACRAH and VAS scores were observed. CONCLUSION: This group of OA patients showed a high frequency of depression, metabolic syndrome and its components in isolation, which can impact the pain and physical function of those patients. Such results showed the need for investigating and treating those comorbidities in OA patients.

Prevalence of anemia in under five-year-old children in a children's hospital in Recife, Brazil

INTRODUCTION: Anemia is a nutritional problem of global importance. It is estimated that at least one-third of the population has been at one time anemic. OBJECTIVE: To evaluate the prevalence of anemia and associated factors in patients of a children's hospital in Recife. METHODS: A cross-sectional study was developed involving 595 male and female children aged from 6 to 59 months old, who were hospitalized in 2007. RESULTS: Children with a hemoglobin concentration less than 11 g/dL were considered anemic. The relationship between studied variables and anemia was evaluated by Poisson regression analysis. There was a 56.6 percent prevalence of anemia (95 percent CI: 46.6-54.6). Anemia was significantly correlated with low weight (Prevalence ratio - PR = 1.39; 95 percent CI: 1.18-1.64), young age (PR = 2.01; 95 percent CI: 1.57-2.56) and a diagnosis of acute lower respiratory disease (PR = 1.57; 95 percent CI: 1.27-1.96). CONCLUSION: The high prevalence of anemia suggests that it may contribute as a causal factor for hospitalization, especially because the period of hospitalization was short and the patient was likely to be anemic at the time of admission. This study stresses the importance of evaluating the overall nutritional status of patients, including their ingestion of microelements. This is especially important in children, because of their greater susceptibility to anemia. Measures directed at the prevention and control of anemia, including increased coverage of supplementation and fortification programs are strongly recommended.

Efeito benéfico da correção da acidose metabólica no estado nutricional de pacientes em hemodiálise / Beneficial effects of metabolic acidosis correction in hemodialysis patients

Objetivo: Avaliar o efeito da correção da acidose metabólica no estado nutricional de pacientes em hemodiálise. Métodos: Foram estudados, durante seis meses, 20 pacientes com acidose metabólica, definida pela média de tr~es mensurações de bicarbonato sérico pré-diálise <22 mEq/L. os pacientes dialisavam há, pelo menos, seis meses, utilizando bicarbonato de 35 mEq/L no dialisato. A correção da acidose metabólica foi feita mediante elevação do bicarbonato no dialisato para valores que não ultrapassaram 40 mEq/L, objetivando um bicarbonato sérico entre 22-26 mEq/L. Foram avaliados no início e no final do estudo: avaliação antropométrica, dietética, bioquímica e Avaliação subjetiva Global (ASG). Resultados: A avaliação nutricional na fase inicial do estudo demonstrou índice de massa corporal normal (24,23 +- 3,83 Kg/m²). A circunferência muscular do braço, a prega cutânea tricipital e a ASG classificaram homens e mulheres como desnutridos. Os consumos de calorias e proteínas foram 29,7 +- 10,1 Kcal?kg/dia e 1,31 +- 0,35 g/Kg/dia, respectivamente. A avaliação bioquímica observou albumina sérica normal e colesterol reduzido. Após correção, bicarbonato sérico e pH aumentaram de 18,2 +- 1,64 para 22 +- 1,70 (p<0,001), e de 7,32+- 0,45 para 7,37 +-0,41 (p<0,001), respectivamente. Houve melhora da ASG (21,7 +- 6,4 versus 16,8 +-6,6, p<0,0001) e aumento na ingestão calórica (1.892,61 +-454,30 versus 2.110,30 +-869,24, p<0,05). Conclusão: A suplementação de bicarbonato na solução de hemodiálise foi método efetivo para a correção da acidose metabólica, determinando aumento da ingestão calórica e melhora nos escores da ASG.

Objective: To evaluate the effect of correction of metabolic acidosis on nutritional status of hemodialysis patients. Methods: We studied for six months, 20 patients with metabolic acidosis, defined as the average of tr ~ s measurements of predialysis serum bicarbonate <22 mEq / L. patients receiving dialysis treatment for at least six months, using bicarbonate of 35 mEq / L in the dialysate. The correction of metabolic acidosis was observed in the high bicarbonate dialysate for values that exceeded 40 mEq / L, aiming for a serum bicarbonate between 22-26 mEq / L. Were assessed at baseline and at the end of the study: anthropometric, dietary, biochemical and Subjective Global Assessment (SGA). Results: The nutritional assessment in the initial phase of the study showed normal BMI (24.23 + - 3.83 kg / m²). The arm muscle circumference, triceps skinfold and the ASG men and women classified as malnourished. The intake of calories and protein were 29.7 + - 10.1 Kcal? Kg / day and 1.31 + - 0.35 g / kg / day, respectively. The biochemical evaluation showed normal serum albumin and low cholesterol. After correction, serum bicarbonate and pH increased from 18.2 + - 1.64 for 22 + - 1.70 (p <0.001), and 7.32 + - 0.45 to 7.37 + -0.41 ( p <0.001), respectively. There was improvement in ASG (21.7 + - 6.4 versus 16.8 + -6.6, p <0.0001) and increased caloric intake (1892.61 + -454.30 vs 2110.30 + -869 , 24, p <0.05). Conclusion: Supplementation of bicarbonate in the dialysis solution was an effective method for correction of metabolic acidosis, determining increased caloric intake and improvement in the scores of the ASG.

Assistência ao parto normal no Estado de Pernambuco: aspectos geográficos, socioeconômicos e profissionais com ênfase no papel da enfermeira / Care to Normal Deliveries in the State of Pernambuco: Geographic, Socioeconomic and Professional Aspects, Emphasizing the Role Played by Nurses

Analisou-se a assistência ao parto normal prestada por diferentes agentes profissionais segundo aspectos geográficos e socioeconômicos das mulheres atendidas. Utilizou-se o banco de dados da II Pesquisa Estadual de Saúde e Nutrição (1997), mediante inquérito de base populacional de 2.078 crianças menores de cinco anos de idade, das quais 1.459 mães tiveram parto normal, na Região Metropolitana do Recife, Estado de Pernambuco, Brasil, no Interior Urbano e no Interior Rural. Constatou-se que 52,2 por cento dos partos foram assistidos por parteiras, 34,5 por cento por médicos e 13,2 por cento por enfermeiras (os). A distribuição dos atendimentos por categorias profissionais variou significativamente, em função do espaço geográfico, renda familiar, escolaridade das parturientes e acesso às consultas de pré-natal. Conclui-se que a assistência ao parto normal era substancialmente condicionada por fatores socioeconômicos e ambientais da clientela. O estudo representa uma linha de base para nova avaliação, dez anos após.