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1.
Front Pharmacol ; 13: 927179, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36034836

RESUMO

Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient's response to the treatment and the adverse events experienced, biological DMARDs (bDMARDs) are initiated. bDMARDs are more specific to inflammatory factors than csDMARDs and more efficient in inducing remission and low disease activity. Thus, this study aimed to assess the effectiveness of biological therapy in patients with rheumatoid arthritis in administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science databases were searched from inception to 21 October 2021, to identify observational studies that evaluated the effectiveness of biological therapy in patients with rheumatoid arthritis using administrative databases and real-world data. The methodological quality was assessed by the methodological index for non-randomized studies (MINORS). A fixed or random-effects model estimated risk ratios with 95% confidence intervals. The analysis was divided into four groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus TNFi (adalimumab, etanercept, and golimumab versus infliximab); bDMARDs versus Janus kinase inhibitors (JAKi); and bDMARDs monotherapy versus combination therapy (bDMARDs and MTX). Results: Twenty-one records were eligible for inclusion in this systematic review and meta-analysis; seven population-based cohorts, eight prospective, and six retrospective cohort studies. Overall, 182,098 rheumatoid arthritis patients were evaluated. In the meta-analysis, lower effectiveness was observed among TNFi users than in non-TNFi (RR: 0.88; 95% CI: 0.81-0.95; p < 0.01; I2 = 94.0%) and bDMARDs than in JAKi (RR: 0.86; 95% CI: 0.79-0.94; p < 0.01; I2 = 93.0%). Higher effectiveness among adalimumab, etanercept, and golimumab than in infliximab (RR: 1.19; 95% CI: 1.05-1.36; p < 0.01; I2 = 96.0%) was found. No significant differences in the effectiveness of bDMARD monotherapy compared to combination therapy (RR: 0.83; 95% CI: 0.68-1.00; p < 0.01; I2 = 81.0%) was observed. E-value analysis indicated that the estimates were not robust against unmeasured confounding. Conclusion: According to the available real-world data, our results suggest that biological therapy effectively treats patients with rheumatoid arthritis, indicating higher effectiveness with non-TNFi and JAKi than with TNFi. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID#CRD42020190838, identifier CRD42020190838.

2.
Front Pharmacol ; 13: 928471, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36034855

RESUMO

Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the synovial fluid of joints, tendons, and some extra-articular sites. Biologic agents have been highly effective and are comparable in reducing RA symptoms, slowing disease progression, and improving physical function; however, concerns have been raised about the risks of several potential adverse effects. Thus, this study aimed to assess the safety of biological therapy in patients with rheumatoid arthritis in observational studies using administrative health databases. Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science were searched from inception to 21 October 2021. The analysis was divided into five groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus csDMARDs; bDMARDs versus csDMARDs; abatacept versus bDMARDs; and TNFi versus Janus kinase inhibitors (JAKi). The adverse events were cancer, cardiovascular events, infection, herpes zoster, tuberculosis, and death. The methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. A random-effects model estimated risk ratios with 95% confidence intervals. Results: Thirty-one studies were eligible for inclusion in the present systematic review, published from 2014 to 2021. A total of 1,039,398 RA patients were assessed. The 31 studies evaluated eleven different biological drugs. No significant differences were found regarding safety between TNFi versus non-TNFi (RR 1.08; 95% CI 0.92-1.28; p < 0.01; I2 = 93.0%), TNFi versus csDMARDs (RR 0.91; 95% CI 0.75-1.10; p < 0.01; I2 = 87.0%), bDMARDs versus csDMARDs (RR 0.99; 95% CI 0.82-1.20; p < 0.01; I2 = 93.0%), abatacept versus bDMARDs (RR 0.80; 95% CI 0.54-1.18; p < 0.01; I2 = 90.0%), and TNFi versus JAKi (RR 3.54; 95% CI 0.30-42.09; p = 0.01; I2 = 81.0%). In the subgroup analysis, among studies comparing abatacept to TNFi, a lower risk of cardiovascular events was associated with abatacept (RR 0.37; 95% CI 0.24-0.55). Conclusion: Our results do not suggest an increased risk of adverse events associated with biological therapy in treating RA patients, indicating a lower risk of cardiovascular events with abatacept than TNFi. However, these findings must be interpreted with caution given the limitations of this study and the low/very low certainty of the evidence. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?, identifier [CRD42020190838].

3.
Sao Paulo Med J ; 140(4): 595-603, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35946676

RESUMO

BACKGROUND: There are few studies on the influence of a cash transfer program on nutritional outcomes from pregnancy. OBJECTIVES: To analyze how a Brazilian conditional cash transfer program (Bolsa Familia Program, BFP) was associated with changes in body mass index (BMI) and food consumption among pregnant women. DESIGN AND SETTING: Cohort study on 250 pregnant women (≥ 18 years of age) in Brazilian prenatal services. METHODS: A food frequency questionnaire was used to evaluate dietary intake. Weight was measured in each gestational trimester. Generalized estimation equations and structural equation modeling were used for statistical analyses. Correlations were analyzed using standardized coefficients (SCs). RESULTS: Women benefitting from the BFP were of greater age and had lower education. The BFP exerted a direct negative effect on the pregnant women's consumption choices regarding refined grains, regional foods, vegetable oil, sausages, salted meats and snacks (SC = -0.10) and on maternal BMI (SC = -0.12). Among the intermediate variables, we observed that the time elapsed since pregnancy and the month of prenatal onset had direct negative effects; and that the number of visits to doctors, family income and number of years of education had direct positive effects. CONCLUSIONS: Beneficiaries were less likely to increase their BMI outside of the recommended standards and had a greater tendency to receive prenatal care. Participation in the BFP had a direct negative effect on adherence to unhealthy diets.


Assuntos
Cuidado Pré-Natal , Fenômenos Fisiológicos da Nutrição Pré-Natal , Brasil , Estudos de Coortes , Feminino , Humanos , Fenilpropionatos , Óleos Vegetais , Gravidez
4.
Säo Paulo med. j ; 140(4): 595-603, July-Aug. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1410194

RESUMO

ABSTRACT BACKGROUND: There are few studies on the influence of a cash transfer program on nutritional outcomes from pregnancy. OBJECTIVES: To analyze how a Brazilian conditional cash transfer program (Bolsa Familia Program, BFP) was associated with changes in body mass index (BMI) and food consumption among pregnant women. DESIGN AND SETTING: Cohort study on 250 pregnant women (≥ 18 years of age) in Brazilian prenatal services. METHODS: A food frequency questionnaire was used to evaluate dietary intake. Weight was measured in each gestational trimester. Generalized estimation equations and structural equation modeling were used for statistical analyses. Correlations were analyzed using standardized coefficients (SCs). RESULTS: Women benefitting from the BFP were of greater age and had lower education. The BFP exerted a direct negative effect on the pregnant women's consumption choices regarding refined grains, regional foods, vegetable oil, sausages, salted meats and snacks (SC = -0.10) and on maternal BMI (SC = -0.12). Among the intermediate variables, we observed that the time elapsed since pregnancy and the month of prenatal onset had direct negative effects; and that the number of visits to doctors, family income and number of years of education had direct positive effects. CONCLUSIONS: Beneficiaries were less likely to increase their BMI outside of the recommended standards and had a greater tendency to receive prenatal care. Participation in the BFP had a direct negative effect on adherence to unhealthy diets.

5.
J. pediatr. (Rio J.) ; 98(3): 296-302, May-June 2022. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1386088

RESUMO

Abstract Objectives: To contribute to a better understanding of the maternal genetic mechanisms that influence obstetric outcomes and that are involved in maternal and child health, this study aimed to evaluate the association between maternal genetic variants and the offspring birth weight by analyzing single-nucleotide polymorphisms (SNPs) in genes related to glucose homeostasis. Methods: Three polymorphisms were analyzed (GCK rs1799884, TCF7L2 rs7903146 and LEPR rs1137101) in 250 pregnant women who participated in a Brazilian prospective cohort study. Genotyping was performed by Real-Time Polymerase Chain Reaction (qPCR) using pre-designed TaqMan® SNP genotyping assays. Vitamin D dosage was performed by chemiluminescence. Variance, Pearson's chi-square test and multiple linear regression were used for the statistical analysis. Results: It was possible to verify a significant association between birth weight and maternal GCK rs1799884 when obstetric outcomes, clinical and anthropometric characteristics were taken into consideration. The children of homozygous women for the minor allele GCK rs1799884 presented lower birth weight (β = -335.25, 95% CI = -669.39; -1.17, p = 0.04). Furthermore, a direct link between a leptin receptor variant and gestational duration was found (p = 0.037). Conclusion: The variant GCK rs1799884 (mm) was associated with a reduction in newborn weight in the miscegenated Brazilian population.

6.
Artigo em Inglês | MEDLINE | ID: mdl-35564740

RESUMO

This study aimed to assess the impact of the Bolsa Familia Program on perinatal outcomes of pregnant women. A cohort study was conducted with pregnant women supported by prenatal services at 17 Family Health Units in Bahia, Brazil. A previously tested structured questionnaire, which has sociodemographic, economic, prenatal care, lifestyle, and nutritional variables, has been used to collect data. The outcomes included premature birth and low birth weight. A hierarchical conceptual model was constructed, and logistic regression analysis was performed. From a total of 1173 pregnant women, the identified average age was 25.44 years and 34.10% had pre-gestational overweight. The non-beneficiary pregnant women presented a 1.54 (95% CI = 0.46-5.09) times higher chance of giving birth to children with low weight and a 1.03 (95% CI = 95% CI = 0.53-2.00) times chance of premature birth when compared to the beneficiary group. In the multilevel model, some variables were statistically significant, such as age between 18 and 24 years (p = 0.003), age greater than or equal to 35 years (p = 0.025), family income (p = 0.008), employment status (p = 0.010), and maternal height (p = 0.009). The Bolsa Familia Program, as an integrated strategy of social inclusion and economic development, is suggested to exert a protective effect on the health of mother-concept binomial.


Assuntos
Nascimento Prematuro , Adolescente , Adulto , Brasil/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Renda , Gravidez , Gestantes , Nascimento Prematuro/epidemiologia , Adulto Jovem
7.
PLoS One ; 17(4): e0267270, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35436308

RESUMO

BACKGROUND: Paracetamol is widely used to manage fever and pain during pregnancy worldwide. However, paracetamol may affect the pregnant woman and fetus, once this drug crosses the placental barrier after therapeutic doses and may impair fetal liver function, affecting fetus growth and development. Thus, this study aimed to investigate the association between paracetamol use during pregnancy and perinatal outcomes as preterm birth, low birth weight, and small for gestational age. METHODS AND FINDINGS: Data from 760 pregnant women within the NISAMI Cohort between June 2012 and February 2014 were analyzed. Logistic regression was used to estimate the association among paracetamol use during pregnancy and preterm birth, low birth weight, and small for gestational age. Multivariate analyses were adjusted for socioeconomic, maternal, pregnancy, and newborn covariates. Around 14% of women were exposed to paracetamol during pregnancy. A decrease in paracetamol use throughout pregnancy was observed. Lower risk of low birth weight in infants born to women exposed to the drug (OR 0.21; IC 95% 0.01-0.99) was found. Paracetamol use during pregnancy was not statistically associated with preterm birth or small for gestational age. CONCLUSIONS: The findings of this study do not suggest an increased risk of perinatal outcomes. However, it should not be assumed that paracetamol is a risk-free medication and its use must be rational.


Assuntos
Acetaminofen , Nascimento Prematuro , Acetaminofen/efeitos adversos , Feminino , Retardo do Crescimento Fetal , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Placenta , Gravidez , Resultado da Gravidez , Nascimento Prematuro/induzido quimicamente , Estudos Prospectivos
8.
Nutrients ; 14(5)2022 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-35268031

RESUMO

The polymorphisms of fatty acid desaturase genes FADS1 and FADS2 have been associated with an increase in weight gain. We investigated FADS1 and FADS2 gene polymorphisms and the relation between ω-3 and ω-6 fatty acid plasma concentrations and gestational weight gain. A prospective cohort study of 199 pregnant women was followed in Santo Antônio de Jesus, Brazil. Plasma levels of polyunsaturated fatty acids (PUFAs) were measured at baseline and gestational weight gain during the first, second, and third trimesters. Fatty acid recognition was carried out with the aid of gas chromatography. Single nucleotide polymorphisms (SNPs) were genotyped using real-time PCR. Statistical analyses included Structural Equation Modelling. A direct effect of FADS1 and FADS2 gene polymorphisms on gestational weight was observed; however, only the SNP rs174575 (FADS2) showed a significant positive direct effect on weight over the course of the pregnancy (0.106; p = 0.016). In terms of the influence of SNPs on plasma levels of PUFAs, it was found that SNP rs174561 (FADS1) and SNP rs174575 (FADS2) showed direct adverse effects on plasma concentrations of ω-3 (eicosapentaenoic acid and alpha-linoleic acid), and only SNP rs174575 had positive direct effects on plasma levels of ARA and the ARA/LA (arachidonic acid/linoleic acid) ratio, ω-6 products, while the SNP rs3834458 (FADS2) had an adverse effect on plasma concentrations of EPA, leading to its increase. Pregnant women who were heterozygous and homozygous for the minor allele of the SNP rs3834458 (FADS2), on the other hand, showed larger concentrations of series ω-3 substrates, which indicates a protective factor for women's health.


Assuntos
Dessaturase de Ácido Graxo Delta-5 , Ácidos Graxos Dessaturases , Ácidos Graxos Ômega-3 , Ácidos Graxos Ômega-6 , Ganho de Peso na Gestação , Estudos de Coortes , Dessaturase de Ácido Graxo Delta-5/sangue , Dessaturase de Ácido Graxo Delta-5/genética , Ácidos Graxos Dessaturases/sangue , Ácidos Graxos Dessaturases/genética , Ácidos Graxos Ômega-3/sangue , Ácidos Graxos Ômega-6/sangue , Feminino , Humanos , Polimorfismo de Nucleotídeo Único , Gravidez , Estudos Prospectivos
9.
Cien Saude Colet ; 27(1): 315-324, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35043910

RESUMO

The objective of this study was to evaluate the socioeconomic and nutritional assistance factors of pregnant women who are beneficiaries of the Bolsa Família Program and were attended at a prenatal service in the city of Recôncavo da Bahia. A cohort study was conducted with 250 pregnant women from the prenatal service in 16 Family Health Units from August 2013 to December 2014. A structured and previously tested questionnaire was used to collect data. Socioeconomic and nutritional variables were used. It was identified that the average age was 28.3 years, of these, 85.2% studied until high school, 72.4% of pregnant women reported having income less than or equal to two minimum wages, with a mean of 1,036.3 and 26.8% reported receiving the benefit. It was observed that 40% had a pre-gestational Body Mass Index of overweight, 38% presented adequate weight gain for Gestational Age; 90.57% performed more than 7 consultations and 75.6% reported that they made use of alcoholic beverages or stopped in the gestation. The Bolsa Família Program as an integrated strategy for social inclusion and economic development seems to have a protective effect on the nutritional health of pregnant women in the municipality.


Assuntos
Renda , Gestantes , Adulto , Idoso de 80 Anos ou mais , Brasil , Estudos de Coortes , Feminino , Humanos , Gravidez , Fatores Socioeconômicos
10.
Ciênc. Saúde Colet. (Impr.) ; 27(1): 315-324, jan. 2022. tab
Artigo em Inglês | LILACS | ID: biblio-1356023

RESUMO

Abstract The objective of this study was to evaluate the socioeconomic and nutritional assistance factors of pregnant women who are beneficiaries of the Bolsa Família Program and were attended at a prenatal service in the city of Recôncavo da Bahia. A cohort study was conducted with 250 pregnant women from the prenatal service in 16 Family Health Units from August 2013 to December 2014. A structured and previously tested questionnaire was used to collect data. Socioeconomic and nutritional variables were used. It was identified that the average age was 28.3 years, of these, 85.2% studied until high school, 72.4% of pregnant women reported having income less than or equal to two minimum wages, with a mean of 1,036.3 and 26.8% reported receiving the benefit. It was observed that 40% had a pre-gestational Body Mass Index of overweight, 38% presented adequate weight gain for Gestational Age; 90.57% performed more than 7 consultations and 75.6% reported that they made use of alcoholic beverages or stopped in the gestation. The Bolsa Família Program as an integrated strategy for social inclusion and economic development seems to have a protective effect on the nutritional health of pregnant women in the municipality.


Resumo Objetivou-se avaliar os fatores socioeconômicos e de assistência nutricional de gestantes beneficiárias do Programa Bolsa Família que foram atendidas em serviço de pré-natal em município do Recôncavo da Bahia. Estudo transversal realizado com 250 gestantes do serviço de pré-natal em 16 Unidades de Saúde da Família, de agosto de 2013 a dezembro de 2014. Para a coleta de dados, utilizou-se questionário fechado envolvendo informações socioeconômicas, antropométricas e de saúde da gestante. Identificou-se que a média de idade das gestantes foi de 28,3 anos, das quais 85,2% estudaram até o ensino médio, 72,4% das gestantes afirmaram possuir renda menor ou igual a dois salários mínimos, com uma média de 1.036,3 reais, e 26,8% declararam receber o benefício. Observou-se que 40% encontravam-se com Índice de Massa Corporal pré-gestacional de excesso de peso, 38% apresentaram um ganho de peso adequado para Idade Gestacional; 90,57% realizaram mais de 7 consultas, e 75,6% relataram que fizeram uso de bebida alcoólica ou pararam na gestação. O Programa Bolsa Família, enquanto uma estratégia integrada de inclusão social e de desenvolvimento econômico, parece exercer efeito protetor na saúde nutricional das gestantes do município.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Idoso , Gestantes , Renda , Fatores Socioeconômicos , Brasil , Estudos de Coortes
11.
J Pediatr (Rio J) ; 98(3): 296-302, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34508664

RESUMO

OBJECTIVES: To contribute to a better understanding of the maternal genetic mechanisms that influence obstetric outcomes and that are involved in maternal and child health, this study aimed to evaluate the association between maternal genetic variants and the offspring birth weight by analyzing single-nucleotide polymorphisms (SNPs) in genes related to glucose homeostasis. METHODS: Three polymorphisms were analyzed (GCK rs1799884, TCF7L2 rs7903146 and LEPR rs1137101) in 250 pregnant women who participated in a Brazilian prospective cohort study. Genotyping was performed by Real-Time Polymerase Chain Reaction (qPCR) using pre-designed TaqMan® SNP genotyping assays. Vitamin D dosage was performed by chemiluminescence. Variance, Pearson's chi-square test and multiple linear regression were used for the statistical analysis. RESULTS: It was possible to verify a significant association between birth weight and maternal GCK rs1799884 when obstetric outcomes, clinical and anthropometric characteristics were taken into consideration. The children of homozygous women for the minor allele GCK rs1799884 presented lower birth weight (ß = -335.25, 95% CI = -669.39; -1.17, p = 0.04). Furthermore, a direct link between a leptin receptor variant and gestational duration was found (p = 0.037). CONCLUSION: The variant GCK rs1799884 (mm) was associated with a reduction in newborn weight in the miscegenated Brazilian population.


Assuntos
Glucose , Polimorfismo de Nucleotídeo Único , Peso ao Nascer/genética , Criança , Estudos de Coortes , Feminino , Homeostase/genética , Humanos , Recém-Nascido , Polimorfismo de Nucleotídeo Único/genética , Gravidez , Estudos Prospectivos
12.
Am J Hum Biol ; 34(4): e23687, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34636455

RESUMO

OBJECTIVES: Few studies have investigated the influence of polyunsaturated fatty acid consumption on excessive weight gain during pregnancy. Thus, we analyzed the association between the intake of polyunsaturated fatty acids (ω-6 and ω-3) and weight gain in women during pregnancy. METHODS: This is a cohort study of 250 pregnant women enrolled in municipal pre-natal services. Weight, height, and dietary intake of polyunsaturated fatty acids were evaluated at the baseline. The semi-quantitative food frequency questionnaire was employed to assess the main exposure. Gestational weight was measured in the first, second, and third trimesters. A dietary pattern involving the consumption of fatty acids was identified through factor analysis. A generalized estimating equation was used for the data analysis. RESULTS: The prevalence of excessive weight gain at the end of pregnancy was 35.2%. Consumption patterns 1 (salted meats, offal, vegetable oil, snacks, legumes, and oleaginous foods) and 2 (red meat, sausages, butter, margarine, mayonnaise, acarajé, caruru, vatapá, and refined cereals) revealed a risk for the accumulation of excess weight during pregnancy. Women who adhered to consumption patterns 1 (RR: 2.39; 95% CI: 1.44-3.94) and 2 (RR: 2.39; 95% CI: 1.44-3.94) were more susceptible to excess weight gain during pregnancy. CONCLUSIONS: Women who adhered to dietary patterns involving foods that are sources of ω-6 fatty acids and saturated fatty acids were more susceptible to gaining weight during pregnancy compared to those who adhered less to these patterns.


Assuntos
Ácidos Graxos Ômega-3 , Aumento de Peso , Estudos de Coortes , Dieta , Ácidos Graxos Insaturados , Feminino , Humanos , Gravidez
14.
Nutrients ; 13(11)2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34836305

RESUMO

The mother's diet during pregnancy is associated with maternal and child health. However, there are few studies with moderation analysis on maternal dietary patterns and infant birth weight. We aim to analyse the association between dietary patterns during pregnancy and birth weight. A prospective cohort study was performed with pregnant women registered with the prenatal service (Bahia, Brazil). A food frequency questionnaire was used to evaluate dietary intake. Birth weight was measured by a prenatal service team. Statistical analyses were performed using factor analysis with a principal component extraction technique and structural equation modelling. The mean age of the pregnant women was 27 years old (SD: 5.5) and the mean birth weight was 3341.18 g. It was observed that alcohol consumption (p = 0.05) and weight-gain during pregnancy (p = 0.05) were associated with birth weight. Four patterns of dietary consumption were identified for each trimester of the pregnancy evaluated. Adherence to the "Meat, Eggs, Fried Snacks and Processed foods" dietary pattern (pattern 1) and the "Sugars and Sweets" dietary pattern (pattern 4) in the third trimester directly reduced birth weight, by 98.42 g (Confidence interval (CI) 95%: 24.26, 172.59) and 92.03 g (CI 95%: 39.88, 165.30), respectively. It was also observed that insufficient dietary consumption in the third trimester increases maternal complications during pregnancy, indirectly reducing birth weight by 145 g (CI 95%: -21.39, -211.45). Inadequate dietary intake in the third trimester appears to have negative results on birth weight, directly and indirectly, but more studies are needed to clarify these causal paths, especially investigations of the influence of the maternal dietary pattern on the infant gut microbiota and the impacts on perinatal outcomes.


Assuntos
Peso ao Nascer , Dieta , Comportamento Alimentar , Análise de Classes Latentes , Fenômenos Fisiológicos da Nutrição Materna , Adulto , Brasil , Fast Foods , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Aumento de Peso
15.
Cad Saude Publica ; 37(10): e00119021, 2021.
Artigo em Português | MEDLINE | ID: mdl-34644754

RESUMO

This essay aims to present and discuss the theoretical framework for the COVID-19 syndemic. The first part presents the foundations and principles of syndemic theory. For the purposes of this essay, syndemic was defined as a process of synergic interaction between two or more diseases, in which the effects are mutually enhanced. We discussed the three principal typologies of syndemic interaction: mutually causal epidemics; epidemics interacting synergically; and serial causal epidemics. In the second part, COVID-19 is analyzed as a syndemic resulting from the interaction between various groups of diseases and the socioeconomic context. The theoretical model considered the interaction between COVID-19 and chronic noncommunicable diseases, infectious and parasitic diseases, and mental health problems. The essay addressed how social iniquities and conditions of vulnerability act at various levels to increase the effect of COVID-19 and other pandemics. The last section discusses the need for comprehensive, multisector, and integrated responses to COVID-19. A model for intervention was presented that involves the patient care and socioeconomic dimensions. In the sphere of patient care, the authors defend the structuring of strong and responsive health systems, accessible to the entire population. The economic and social dimension addressed the issue of reclaiming the ideals of solidarity, the health promotion strategy, and emphasis on social determinants of health. In conclusion, the lessons learned from the syndemic approach to COVID-19 call on government and society to develop policies that link clinical, sanitary, socioeconomic, and environmental interventions.


Este ensaio tem como objetivo apresentar e discutir o quadro teórico da sindemia da COVID-19. Na primeira parte, são apresentados os fundamentos e princípios da teoria sindêmica. Adotou-se o conceito de sindemia como processo de interação sinérgica entre duas ou mais doenças, no qual os efeitos se potencializam mutuamente. Foram discutidas as três principais tipologias de interação sindêmica: epidemias mutuamente causais; epidemias interagindo sinergicamente; e epidemias causais em série. Na segunda parte, a COVID-19 é analisada como uma sindemia resultante da interação entre vários grupos de doenças e o contexto socioeconômico. O modelo teórico considerou a interação entre COVID-19 e doenças crônicas não transmissíveis, doenças infecciosas e parasitárias e problemas de saúde mental. Abordou-se como as iniquidades sociais e as condições de vulnerabilidade atuam em diversos níveis e potencializam a atuação da COVID-19 e das demais pandemias. Na última seção, discute-se a necessidade de respostas abrangentes, multisetoriais e integradas ao enfrentamento da COVID-19. Foi apresentado um modelo de intervenção envolvendo as dimensões assistencial e socioeconômica. No âmbito assistencial, defendeu-se a estruturação de sistemas de saúde fortes, responsivos e acessíveis a toda a população. A dimensão econômica e social abordou o resgate dos ideais de solidariedade, da estratégia da promoção da saúde e a ênfase sobre os determinantes sociais. Conclui-se que as lições aprendidas com a abordagem sindêmica da COVID-19 exortam governos e a sociedade para o desenvolvimento de políticas que articulem intervenções clínicas, sanitárias, socioeconômicas e ambientais.


Este ensayo tiene como objetivo presentar y discutir el cuadro teórico de la sindemia de la COVID-19. En la primera parte, se presentan los fundamentos y principios de la teoría sindémica. Se adoptó el concepto de sindemia como un proceso de interacción sinérgica entre dos o más enfermedades, en el que los efectos se potencializan mutuamente. Se discutieron las tres principales tipologías de interacción sindémica: epidemias mutuamente causales; epidemias interactuando sinérgicamente; y epidemias causales en serie. En la segunda parte, la COVID-19 es analizada como una sindemia resultante de la interacción entre varios grupos de enfermedades y el contexto socioeconómico. El modelo teórico consideró la interacción entre COVID-19 y enfermedades crónicas no transmisibles, enfermedades infecciosas y parasitarias, así como problemas de salud mental. Se abordó cómo las inequidades sociales y las condiciones de vulnerabilidad actúan en diversos niveles y potencializan la actuación de la COVID-19 y de las demás pandemias. En la última sección, se discute la necesidad de respuestas integrales, multisectoriales e integradas en el combate a la COVID-19. Se presentó un modelo de intervención implicando las dimensiones asistencial y socioeconómica. En el ámbito asistencial, se defendió la conformación de sistemas de salud fuertes, con capacidad de respuesta y accesibles a toda la población. La dimensión económica y social abordó el rescate de los ideales de solidaridad, de la estrategia de promoción de la salud, así como el énfasis sobre los determinantes sociales. Se concluye que las lecciones aprendidas con el abordaje sindémico de la COVID-19 exhortan a gobiernos y sociedad a que desarrollen políticas que implementen y coordinen intervenciones clínicas, sanitarias, socioeconómicas y ambientales.


Assuntos
COVID-19 , Sindemia , Brasil , Humanos , Modelos Teóricos , SARS-CoV-2
16.
Cien Saude Colet ; 26(8): 3209-3219, 2021 Aug.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34378710

RESUMO

The study aimed to perform a systematic review to identify and evaluate the prevalence of potentially inappropriate medicines (PIM) prescriptions for the elderly, according to Beers Criteria, in hospitalized elderly individuals aged 65 years or older. Five databases consulted: VHL; Cochrane Library; CINAHL; MEDLINE and Web of Science. Nineteen articles identified, selected based on eligibility criteria. The mean age was 78.2 years and the most used criterion for the identification of PIM for the elderly was Beers 2015 (57.9%). A total of 221,879 elderly received a prescription for PIM, the mean prevalence was 65.0%, for the gastrointestinal system (15.3%) and proton-pump inhibitors (27.7%) highlighted as the main class of medicine prescribed. It concluded that the Beers Criteria have made it possible to identify the high prevalence in the prescription of PIM. The results of this review may help in the decision making of health professionals, to avoid the administration of PIM and to propose best practices to ensure the safety of the elderly hospitalized.


Objetivou-se realizar uma revisão sistemática para identificar e avaliar a prevalência da prescrição de medicamentos potencialmente inapropriados (MPI), segundo os Critérios de Beers, em idosos hospitalizados com ≥65 anos. Foram consultadas cinco bases de dados: BVS, Cochrane Library, CINAHL, MEDLINE e Web of Science. Foram identificados 19 artigos, selecionados a partir de critérios de elegibilidade. A média de idade foi 78,2 anos e o critério mais utilizado para a identificação dos MPI para idosos foi o de Beers 2015 (57,9%). Um total de 221.879 idosos recebeu prescrição inapropriada, a prevalência média foi de 65.0%, com destaque para o sistema gastrointestinal (15,3%) e os inibidores da bomba de prótons (27,7%) como a principal classe de medicamento prescrita. Conclui-se que os Critérios de Beers possibilitaram a identificação da alta prevalência na prescrição dos MPI. Os resultados desta revisão poderão auxiliar na tomada de decisão dos profissionais de saúde, no intuito de se evitar a administração dos MPI e propor melhores práticas que garantam a segurança do idoso hospitalizado.


Assuntos
Prescrição Inadequada , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Estudos Transversais , Humanos , Prescrição Inadequada/prevenção & controle , Prevalência
17.
Ciênc. Saúde Colet ; 26(8): 3209-3219, ago. 2021. tab, graf
Artigo em Inglês, Português | LILACS | ID: biblio-1285951

RESUMO

Resumo Objetivou-se realizar uma revisão sistemática para identificar e avaliar a prevalência da prescrição de medicamentos potencialmente inapropriados (MPI), segundo os Critérios de Beers, em idosos hospitalizados com ≥65 anos. Foram consultadas cinco bases de dados: BVS, Cochrane Library, CINAHL, MEDLINE e Web of Science. Foram identificados 19 artigos, selecionados a partir de critérios de elegibilidade. A média de idade foi 78,2 anos e o critério mais utilizado para a identificação dos MPI para idosos foi o de Beers 2015 (57,9%). Um total de 221.879 idosos recebeu prescrição inapropriada, a prevalência média foi de 65.0%, com destaque para o sistema gastrointestinal (15,3%) e os inibidores da bomba de prótons (27,7%) como a principal classe de medicamento prescrita. Conclui-se que os Critérios de Beers possibilitaram a identificação da alta prevalência na prescrição dos MPI. Os resultados desta revisão poderão auxiliar na tomada de decisão dos profissionais de saúde, no intuito de se evitar a administração dos MPI e propor melhores práticas que garantam a segurança do idoso hospitalizado.


Abstract The study aimed to perform a systematic review to identify and evaluate the prevalence of potentially inappropriate medicines (PIM) prescriptions for the elderly, according to Beers Criteria, in hospitalized elderly individuals aged 65 years or older. Five databases consulted: VHL; Cochrane Library; CINAHL; MEDLINE and Web of Science. Nineteen articles identified, selected based on eligibility criteria. The mean age was 78.2 years and the most used criterion for the identification of PIM for the elderly was Beers 2015 (57.9%). A total of 221,879 elderly received a prescription for PIM, the mean prevalence was 65.0%, for the gastrointestinal system (15.3%) and proton-pump inhibitors (27.7%) highlighted as the main class of medicine prescribed. It concluded that the Beers Criteria have made it possible to identify the high prevalence in the prescription of PIM. The results of this review may help in the decision making of health professionals, to avoid the administration of PIM and to propose best practices to ensure the safety of the elderly hospitalized.


Assuntos
Humanos , Idoso , Prescrição Inadequada/prevenção & controle , Lista de Medicamentos Potencialmente Inapropriados , Prevalência , Estudos Transversais
18.
Sao Paulo Med J ; 139(2): 107-116, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33825769

RESUMO

BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.


Assuntos
Prescrição Inadequada , Médicos , Idoso , Brasil , Estudos Transversais , Humanos , Polimedicação , Atenção Primária à Saúde
19.
Säo Paulo med. j ; 139(2): 107-116, Mar.-Apr. 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1290229

RESUMO

ABSTRACT BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.


Assuntos
Humanos , Idoso , Médicos , Prescrição Inadequada , Atenção Primária à Saúde , Brasil , Estudos Transversais , Polimedicação
20.
Preprint em Português | SciELO Preprints | ID: pps-2143

RESUMO

Objective: To identify in the scientific literature the clinical overview of the pediatric population that tested positive for SARS-CoV-2 and care recommendations and recommendations among children who tested positive for SARS-CoV-2 in the scientific literature.Method: Rapid review based on the guidelines of the Joana Briggs Institute: elaboration of the research question, structured search of the literature in April 2020, in nine databases, selection and critical analysis of the eighteen primary studies (using two instruments to assess methodological quality), elaboration of the synthesis, incorporation of suggestions and dissemination.Result: The most frequent clinical overview was respiratory, gastrointestinal symptoms and fever. The images showed irregular frosted glass opacification. It is recommended to screen the pediatric population and family members who show signs and symptoms and to adopt isolation for more than fourteen days.Conclusion: The clinical overview in pediatric population is varied, not exclusively with respiratory symptoms, and a significant number of asymptomatic patients. The importance of new investigations is highlighted, such as randomized clinical trial or cohort studies, identifying their participation in the transmission of COVID-19.


Objetivo: Identificar en la literatura científica el estado clínico de la población pediátrica que probó positivo para el SARS-CoV-2 y las recomendaciones de atención.Método: Revisión rápida basada en las directrices del Instituto Joana Briggs: elaboración de la pregunta de investigación, búsqueda estructurada de la literatura en abril de 2020, en nueve bases de datos, selección y análisis crítico de los dieciocho estudios primarios (utilizando dos instrumentos para evaluar la calidad metodológica), elaboración de la síntesis, incorporación de sugerencias y difusión.Resultado: El cuadro clínico más frecuente fue respiratorio, síntomas gastrointestinales y fiebre. Las imágenes mostraron opacificación irregular de vidrio esmerilado. Se recomienda evaluar a población pediátrica y familiares que muestran signos y síntomas y adoptar aislamiento durante más de catorce días.Conclusiones: El cuadro clínico en la población pediátrica es variado, no exclusivamente con síntomas respiratorios, y un número importante de pacientes asintomáticos. Se destaca la importancia de nuevas investigaciones, como ensayos clínicos aleatorizados o estudios de cohorte, identificando su participación en la transmisión del COVID-19.


Objetivo: Identificar, na literatura científica, o quadro clínico da população pediátrica que testou positivo para SARS-CoV-2 e recomendações de cuidados.Método: Revisão rápida baseada nas diretrizes da Joana Briggs Institute: elaboração da pergunta de investigação, busca estruturada da literatura no mês de abril de 2020, em nove bases de dados, seleção e análise crítica dos dezoito estudos primários (utilizando dois instrumentos para avaliação da qualidade metodológica), elaboração da síntese, incorporação das sugestões e divulgação.Resultado: O quadro clínico mais frequente foi sintomas respiratórios, gastrointestinais e febre. As imagens demonstraram opacificação irregular de vidro fosco. Recomenda-se triagem da população pediátrica e familiares que apresentam sinais e sintomas e adotar isolamento por período superior a quatorze dias.Conclusão: Quadro clínico na população pediátrica é variado, não exclusivamente com sintomas respiratórios, e número significativo de assintomáticos. Destaca-se importância de novas investigações, como ensaios clínicos randomizados ou estudos de coorte, identificando a participação dessas na transmissão da COVID-19.

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