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1.
JBI Database System Rev Implement Rep ; 17(12): 2417-2451, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31821188

RESUMO

OBJECTIVES: The objective of this review was to evaluate the cost-effectiveness of antimicrobial therapy for patients with carbapenem-resistant Klebsiella pneumoniae infection. INTRODUCTION: Among the main multi-resistant microorganisms, carbapenem-resistant K. pneumoniae is responsible for the mortality of 40% of patients following 30 days of infection. Treatment for carbapenem-resistant K. pneumoniae infection entails the use of high-cost antimicrobials. Inappropriate use of antimicrobials can increase the cost of treatment fourfold. This review aimed to evaluate the cost-effectiveness of antimicrobial therapy treatment for patients with carbapenem-resistant K. pneumoniae infection to better inform decision making in hospital services. INCLUSION CRITERIA: The review included studies on participants 18 years or over with carbapenem-resistant K. pneumoniae infection who had undergone antimicrobial therapy in hospital and acute care services. Studies that compared the cost-effectiveness of different antimicrobial therapy for carbapenem-resistant K. pneumoniae infection were included. Outcome measures were cost per unit of effect expressed in clinical outcome units; this included cost per avoided death, cost per prevention of sepsis and cost per duration of stay. Economic studies with a cost-effectiveness design were considered, as well as modeling studies. METHODS: A three-step search strategy was utilized to locate studies published in English, Spanish or Portuguese, with no date restrictions. Two independent reviewers screened titles and abstracts and the full texts of potentially relevant studies for eligibility. Methodological quality was assessed by two independent reviewers using the JBI critical appraisal checklist for economic evaluations. Data were extracted from included studies using the standardized JBI data extraction tool. Data were synthesized using narrative, tables and the JBI Dominance Ranking Matrix. RESULTS: This review identified eight studies that evaluated the cost-effectiveness of different treatments for carbapenem-resistant K. pneumoniae infection. The results of this study demonstrated that there was no gold standard treatment for carbapenem-resistant K. pneumoniae infection, hence treatment was generally directed by colonization pressure and resistance profiles. Furthermore, due to the moderate quality and limited number of studies, there was high uncertainty of the values of the cost-effectiveness ratio. CONCLUSIONS: Ofloxacin appears to be the most cost-effective treatment; however, conclusions are limited due to the small number and low quality of studies.

4.
Einstein (Sao Paulo) ; 17(4): eGS4444, 2019 May 16.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31116310

RESUMO

OBJECTIVE: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. METHODS: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). RESULTS: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. CONCLUSION: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.


Assuntos
Antibacterianos/economia , Hospitalização/economia , Infecções por Klebsiella/economia , Klebsiella pneumoniae , Antibacterianos/administração & dosagem , Proteínas de Bactérias , Feminino , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , beta-Lactamases
5.
Rev Bras Enferm ; 72(suppl 1): 137-142, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942355

RESUMO

OBJECTIVE: To estimate the cost of nursing care required and available through the use of the Nursing Activities Score. METHOD: Quantitative study, direct costing of nursing care required and available in the Intensive Care Units. Data collection included variables of the patients, nursing professionals and nursing workload measured by the Nursing Activities Score. The cost of nursing care was estimated by multiplying the cost of each hour with the total number of hours of care per category. RESULTS: The negative difference of R$ 94,791.5 between the cost of available and required nursing care indicated an increase of 3.2 nurses and 7.0 nursing technicians. CONCLUSION: The cost of nursing care required identified through the application of the Nursing Activities Score, which is higher than the cost of available care, indicates the need to adjust the number of professionals to meet patients' demands.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Cuidados de Enfermagem/métodos , Adulto , Idoso , Brasil , Custos e Análise de Custo , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/normas , Escala Psicológica Aguda Simplificada , Carga de Trabalho/psicologia , Carga de Trabalho/normas
6.
Rev Bras Epidemiol ; 21Suppl 02(Suppl 02): e180006, 2019 Feb 04.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30726351

RESUMO

INTRODUCTION: The use of polypharmacy may be due to the concomitant presence of chronic conditions, medical care by several doctors simultaneously and self-medication. Combined with the vulnerability of the elderly to the effects of drugs due to pharmacokinetic and pharmacodynamic changes, polypharmacy makes this population more susceptible to adverse outcomes. In Brazil, studies show that polypharmacy is a common problem among elderly people. However, few information is available on the association between polypharmacy and mortality. OBJECTIVE: It was assessed the survival of the elderly from São Paulo city exposed to the use of polypharmacy (five or more medications). METHODS: That was a population-based cohort, the Health, Well-Being and Aging Study (SABE Study), conducted from 2006 to 2010. The sample was composed of 1,258 individuals aged 60 years or more. The Kaplan-Meier method and Cox proportional risks model were used to examine the association between polypharmacy and mortality. RESULTS: The probability of survival after five years of the users of polypharmacy at baseline was 77.2%, while among the non-users was 85.5%. Polypharmacy remained as a risk factor for death even after adjustment in other conditions associated with mortality, such as age, gender, income, chronic diseases and hospitalization. CONCLUSION: The results point polypharmacy as an indicator of mortality in elderly people. The use of multiple medications by the elderly should be carefully assessed to avoid or minimize the damage to this population.


Assuntos
Idoso/estatística & dados numéricos , Mortalidade , Polimedicação , Distribuição por Idade , Fatores Etários , Idoso de 80 Anos ou mais , Envelhecimento , Brasil/epidemiologia , Feminino , Nível de Saúde , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Farmacoepidemiologia , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Fatores de Tempo
7.
Rev Bras Epidemiol ; 21Suppl 02(Suppl 02): e180007, 2019 Feb 04.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30726352

RESUMO

INTRODUCTION: Self-medication involves the concept of the spontaneous search by the individual for some drug that he or she considers appropriate to solve a health problem. Self-medication practice is little explored by the elderly according to other studies based in population data. OBJECTIVE: To examine the trends in self-medication practice among the Brazilian elderly between 2006 and 2010. METHODS: This is a population-based study whose data were obtained from the Health, Well-being and Ageing Study (SABE Study). Thesample consisted of 1,257 elderly people in 2006 and 865 in 2010, who used drugs. RESULTS: The findings showed self-medication reduction from 42.3% in 2006 to 18.2% in 2010. In both periods, predominant utilized therapeutic classes were those acting on the nervous system (27.9% in 2006, and 29.6% in 2010) and on the alimentary tract and metabolism (25.5% in 2006, and 35.9% in 2010). The most commonly used medicines in 2006 and 2010 were analgesics, anti-inflammatories, and vitamins. There was a tendency to decrease the use of potentially inappropriate medicines between 2006 (26.4%) and 2010 (18.1%). The elderly themselves were the main responsible for the decision about the drug use in 2006 (62.5%) and 2010 (66.5%). CONCLUSION: Theextent of self-medication practice among the elderly who participated in the study decreased between 2006 and 2010, but the use of medicines that offer risks to health was still reported. Thus, the findings reinforce the importance of monitoring, evaluating, and continuously educating the elderly about risks and benefits of drug consumption, particularly over-the-counter medicines.


Assuntos
Idoso/estatística & dados numéricos , Automedicação/estatística & dados numéricos , Automedicação/tendências , Distribuição por Idade , Fatores Etários , Brasil/epidemiologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição/uso terapêutico , Polimedicação , Valores de Referência , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Fatores de Tempo
8.
Rev. bras. enferm ; 72(supl.1): 137-142, Jan.-Feb. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-990697

RESUMO

ABSTRACT Objective: To estimate the cost of nursing care required and available through the use of the Nursing Activities Score. Method: Quantitative study, direct costing of nursing care required and available in the Intensive Care Units. Data collection included variables of the patients, nursing professionals and nursing workload measured by the Nursing Activities Score. The cost of nursing care was estimated by multiplying the cost of each hour with the total number of hours of care per category. Results: The negative difference of R$ 94,791.5 between the cost of available and required nursing care indicated an increase of 3.2 nurses and 7.0 nursing technicians. Conclusion: The cost of nursing care required identified through the application of the Nursing Activities Score, which is higher than the cost of available care, indicates the need to adjust the number of professionals to meet patients' demands.


RESUMEN Objetivo: Determinar el costo de la asistencia de Enfermería requerida y disponible con el uso del Nursing Activities Score. Método: Estudio cuantitativo, con análisis de costo directo de la asistencia de Enfermería requerida y disponible en las Unidades de Terapia Intensiva. La recolección de los datos incluyó variables de los pacientes, profesionales de Enfermería y carga de trabajo de Enfermería medida por el Nursing Activities Score. El costo de la asistencia de Enfermería fue determinado por la multiplicación entre el costo de cada hora y el total de horas de la asistencia por categoría. Resultados: La diferencia negativa de 94.791,5 reales entre el costo de la asistencia de Enfermería disponible y requerida indicó un aumento de 3,2 enfermeros y 7,0 técnicos de Enfermería. Conclusión: El costo de la asistencia de Enfermería requerida identificado por medio de la aplicación del Nursing Activities Score, más elevado que el costo de la asistencia disponible, indica la necesidad de ajustar el número de profesionales para atender las demandas de los pacientes.


RESUMO Objetivo: Estimar o custo da assistência de enfermagem requerida e disponível com o uso do Nursing Activities Score. Método: Estudo quantitativo, análise de custo direto da assistência de enfermagem requerida e disponível nas Unidades de Terapia Intensiva. A coleta dos dados incluiu variáveis dos pacientes, profissionais de enfermagem e carga de trabalho de enfermagem medida pelo Nursing Activities Score. O custo da assistência de enfermagem foi estimado pela multiplicação entre o custo de cada hora e o total de horas da assistência por categoria. Resultados: A diferença negativa de R$ 94.791,5 entre o custo da assistência de enfermagem disponível e requerida indicou acréscimo de 3,2 enfermeiros e 7,0 técnicos de enfermagem. Conclusão: O custo da assistência de enfermagem requerida identificado por meio da aplicação do Nursing Activities Score, mais elevado que o custo da assistência disponível, indica a necessidade de ajustar o número de profissionais para atender às demandas dos pacientes.

9.
Einstein (Säo Paulo) ; 17(4): eGS4444, 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1001916

RESUMO

ABSTRACT Objective: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. Methods: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). Results: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. Conclusion: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.


RESUMO Objetivo: Estimar os custos médicos diretos da terapia medicamentosa de pacientes com infecção por carbapenemase por Klebsiella pneumoniae carbapenemase (KPC) em contexto hospitalar. Métodos: Estudo de custo de doença realizado com desenho de coorte prospectiva, com adultos hospitalizados infectados por KPC. A coleta de dados foi realizada usando instrumento composto por dados sociodemográficos, medicamentos clínicos e prescritos. As estimativas dos custos diretos associados a cada tratamento foram derivadas da perspectiva dos pagadores, no caso dos hospitais públicos federais do Brasil, e incluíram apenas custos de medicamentos, os quais basearam-se no preço médio disponível na Price Database Health do Brasil. Nenhuma taxa de desconto foi utilizada para o custo dos medicamentos. Os custos foram calculados em dólares norte-americanos (US$). Resultados: Um total de 120 pacientes hospitalizados participou do estudo. O custo total da droga desses pacientes internados foi de US$ 367,680.85. O grupo antimicrobianos de uso sistêmico foi responsável por 59,5% dos custos totais. O custo direto estimado de forma conservadora, por paciente, foi de aproximadamente US$ 4,100.00, e cerca de 60% destes se deram durante o período de infecção. Conclusão: Os achados deste estudo apontam um risco econômico importante relacionado a KPC, o qual todos os setores de saúde terão que enfrentar. A incidência mundial em elevação destas bactérias representa carga crescente, e a maioria dos sistemas de saúde é incapaz de resolvê-la. Há necessidade imperativa de se desenvolverem protocolos e novos antimicrobianos para o tratamento de KPC, com o objetivo de reorganizar os recursos para aumentar a efetividade dos serviços de saúde.

12.
PLoS One ; 13(8): e0201579, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30075021

RESUMO

BACKGROUND: Being aware of consumption patterns of antimicrobials is the first step in designing and implementing strategies to change behaviors and, thus, to reduce the occurrence of antimicrobial resistance. The present survey was carried out to identify and describe the use of antimicrobials without prescription in riverside dwellers of the Brazilian Amazon Basin. METHODS: A cross-sectional study was carried out from a conglomerate stratified sample in the rural municipality of Coari, Amazonas State, Brazil, between April and July 2016. The survey was conducted in the riverside dwellers' homes, and information was collected on all antimicrobials taken with and without medical or dental prescription for a 30-day period, together with indications of their use before the interview. RESULTS: A total of 492 riverside dwellers were included in the present survey; 346 (70.3%) had taken at least one medication during the previous month, and 74 (21.3% of those taking a medicine) used an antimicrobial. Two-thirds of the patients treated with an antimicrobial (49; 66.2%) obtained it without a prescription. Additionally, one-third of the antimicrobials consumed by the study sample (25) were used for non-infectious or non-bacterial conditions. DISCUSSION: The present survey showed not only that inappropriate use of antimicrobials is present in remote places such as the Amazon Basin, but also that one-third of those antimicrobials were taken to treat non-infectious or non-bacterial conditions. In addition to an unnecessary risk of adverse effects to the exposed populations, the inappropriate use of antibiotics without prescription helps to increase antibiotic-resistant strains. In the present case, this was happening near one of Latin America's most important water supplies, which could contribute to the global impact of antimicrobial resistance.


Assuntos
Antibacterianos/uso terapêutico , Revisão de Uso de Medicamentos/métodos , Medicamentos sem Prescrição , Prescrições/estatística & dados numéricos , Saúde da População Rural , Adulto , Amazona , Animais , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Tamanho da Amostra , Inquéritos e Questionários , Adulto Jovem
13.
JBI Database System Rev Implement Rep ; 16(6): 1454-1473, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29894411

RESUMO

OBJECTIVES: This implementation project aimed to identify the current practice in regards to central venous catheters (CVCs) maintenance to improve knowledge amongst nursing staff and to assess increased compliance with evidence-based best practice. INTRODUCTION: Central venous catheters are considered an important therapeutic resource for the administration of fluids, drugs, blood, collection of blood samples and hemodynamic monitoring. Despite the benefits, catheter use is associated with complications such as primary infection of the catheter-related bloodstream. METHODS: This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Nine of 10 criteria were audited through direct observation of nursing professionals or patient records in relation to CVC maintenance, and one criterion involved direct questioning of nursing staff. Baseline and follow-up audits were conducted in a 12-bed adult intensive care unit in a university hospital. RESULTS: The baseline audit revealed deficits between current practice and best practice in some criteria. Barriers to implementation of CVC maintenance best practice criteria were identified, and the strategies were implemented. The post-implementation (follow-up) audit showed improvement in compliance to best practice guidelines in all of the audit criteria, except in one criterion: the use of sterile gloves or surgical tweezers during the execution of the dressing. CONCLUSIONS: Best practice in CVC care was achieved in the hospital, strengthening and guiding nursing care, as well as highlighting the importance of nursing records throughout the care process. However, this project highlighted the need to improve compliance through follow-up audits and periodic training to support best practice.


Assuntos
Cateteres Venosos Centrais/efeitos adversos , Implementação de Plano de Saúde , Unidades de Terapia Intensiva , Guias de Prática Clínica como Assunto , Adulto , Brasil , Infecções Relacionadas a Cateter/prevenção & controle , Enfermagem Baseada em Evidências , Hospitais Universitários , Humanos , Recursos Humanos de Enfermagem no Hospital/educação
14.
Cad Saude Publica ; 34(2): e00002817, 2018 02 19.
Artigo em Português | MEDLINE | ID: mdl-29489939

RESUMO

Population-based health surveys are important tools for identifying disease determinants, especially in regions with widely dispersed populations and low health system coverage. The aim of this study was to describe the principal methodological aspects and to describe the socioeconomic, demographic, and health characteristics of the riverine populations of Coari, Amazonas State, Brazil. This was a population-based cross-sectional study in river-dwelling communities in the rural area of Coari, from April to July 2015. The probabilistic cluster sample consisted of 492 individuals. The results showed that the majority of the river-dwellers were females (53%), had up to 9 years of schooling (68.5%), and earned a monthly family income equivalent to one-third the minimum wage. The health problems reported in the previous 30 days featured conditions involving pain (45.2%). The main healthcare resources were allopathic medicines (70.3%), exceeding herbal remedies (44.3%). The river-dwellers travel an average of 60.4km and take some 4.2 hours to reach the urban area of Coari. The riverine population generally presents low economic status and limited access to the urban area. Health problems are mostly solved with allopathic medicines. Geographic characteristics, as barriers to access to health services and to improvements in living conditions for the riverine population, can limit the collection of epidemiological data on these populations.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/métodos , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência , Rios , População Rural , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
15.
JBI Database System Rev Implement Rep ; 16(2): 336-344, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29419620

RESUMO

REVIEW QUESTION/OBJECTIVE: The objective of this review is to evaluate the cost-effectiveness of antimicrobial therapy treatment for inpatients infected with Klebsiella pneumoniae carbapenemase.More specifically, the review question is: What is the best evidence on the cost-effectiveness of the antimicrobial treatment for inpatients infected with Klebsiella Pneumoniae Carbapenemase?"


Assuntos
Anti-Infecciosos/economia , Infecção Hospitalar/tratamento farmacológico , Pacientes Internados/estatística & dados numéricos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Proteínas de Bactérias , Análise Custo-Benefício , Infecção Hospitalar/economia , Humanos , Infecções por Klebsiella/economia , Projetos de Pesquisa , Revisão Sistemática como Assunto , beta-Lactamases
16.
Rev. bras. epidemiol ; 21(supl.2): e180006, 2018. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-985269

RESUMO

RESUMO: Introdução: O uso de polifarmácia pode ser resultante da presença concomitante de condições crônicas, atendimento por diversos médicos e automedicação. Combinada com a vulnerabilidade de idosos aos efeitos dos medicamentos devido a alterações farmacocinéticas e farmacodinâmicas, a polifarmácia torna essa população mais suscetível a desfechos adversos. No Brasil, estudos mostram que a polifarmácia é um problema frequente entre idosos, mas faltam informações sobre sua associação com mortalidade. Objetivo: Avaliar a sobrevida de idosos do município de São Paulo expostos ao uso de polifarmácia (cinco ou mais medicamentos). Métodos: Trata-se de uma coorte de base populacional, o Estudo Saúde, Bem-Estar e Envelhecimento (Sabe), da qual se pesquisou o seguimento de 2006 a 2010. A amostra foi composta por 1.258 indivíduos com 60 anos ou mais. O método de Kaplan-Meier e o modelo de riscos proporcionais de Cox foram usados para examinar a associação entre mortalidade e polifarmácia. Resultados: A probabilidade de sobrevida após cinco anos dos indivíduos usuários de polifarmácia na linha de base foi de 77,2%, enquanto nos não usuários foi de 85,5%. Apolifarmácia permaneceu como fator de risco para óbito mesmo após ajuste de demais condições associadas à mortalidade, como idade, sexo, renda, doenças crônicas e internação hospitalar. Conclusão: Os resultados apontam para a polifarmácia como um preditor de mortalidade para pessoas idosas. O uso de múltiplos medicamentos por idosos deve ser cuidadosamente avaliado para evitar ou minimizar danos a essa população.


ABSTRACT: Introduction: The use of polypharmacy may be due to the concomitant presence of chronic conditions, medical care by several doctors simultaneously and self-medication. Combined with the vulnerability of the elderly to the effects of drugs due to pharmacokinetic and pharmacodynamic changes, polypharmacy makes this population more susceptible to adverse outcomes. In Brazil, studies show that polypharmacy is a common problem among elderly people. However, few information is available on the association between polypharmacy and mortality. Objective: It was assessed the survival of the elderly from São Paulo city exposed to the use of polypharmacy (five or more medications). Methods: That was a population-based cohort, the Health, Well-Being and Aging Study (SABE Study), conducted from 2006 to 2010. The sample was composed of 1,258 individuals aged 60 years or more. The Kaplan-Meier method and Cox proportional risks model were used to examine the association between polypharmacy and mortality. Results: The probability of survival after five years of the users of polypharmacy at baseline was 77.2%, while among the non-users was 85.5%. Polypharmacy remained as a risk factor for death even after adjustment in other conditions associated with mortality, such as age, gender, income, chronic diseases and hospitalization. Conclusion: The results point polypharmacy as an indicator of mortality in elderly people. The use of multiple medications by the elderly should be carefully assessed to avoid or minimize the damage to this population.

17.
Rev. bras. epidemiol ; 21(supl.2): e180007, 2018. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-985273

RESUMO

RESUMO: Introdução: Automedicação retrata o princípio do próprio indivíduo buscar espontaneamente por algum medicamento que considere adequado para resolver um problema de saúde. Essa prática é ainda pouco explorada entre idosos de acordo com outros estudos baseados em dados populacionais. Objetivo: Examinar as tendências da prática de automedicação dos idosos do Estudo SABE entre 2006 e 2010. Método: Estudode base populacional cujos dados foram obtidos do Estudo Saúde, Bem-Estar e Envelhecimento (SABE). Aamostra de 2006 foi constituída de 1.258 idosos e a de 2010, de 865 idosos que utilizaram medicamentos. Resultados: Observou-se redução da automedicação de 42,3% em 2006 para 18,2% em 2010. Em ambos os períodos, as classes terapêuticas predominantes foram as dos medicamentos com ação no sistema nervoso (27,9% em 2006 e 29,6% em 2010) e trato alimentar e metabolismo (25,5% em 2006 e 35,9% em 2010). Entreos medicamentos mais usados nos anos de 2006 e 2010 estão os analgésicos/anti-inflamatórios e vitaminas. Houve tendência a declínio da utilização de medicamentos potencialmente inapropriados entre 2006 (26,4%) e 2010 (18,1%). Oidoso foi o principal responsável pela indicação da automedicação em 2006 (65,2%) e 2010 (66,5%). Conclusão: A extensão da prática de automedicação nos idosos do SABE apresentou redução entre 2006 e 2010, porém o emprego de medicamentos que oferecem risco à saúde ainda foi relatado. Desse modo, os achados reforçam a importância de monitorar, avaliar e educar continuamente os idosos acerca dos riscos e benefícios do consumo de medicamentos, sobretudo daqueles isentos de prescrição.


ABSTRACT: Introduction: Self-medication involves the concept of the spontaneous search by the individual for some drug that he or she considers appropriate to solve a health problem. Self-medication practice is little explored by the elderly according to other studies based in population data. Objective: To examine the trends in self-medication practice among the Brazilian elderly between 2006 and 2010. Methods: This is a population-based study whose data were obtained from the Health, Well-being and Ageing Study (SABE Study). Thesample consisted of 1,257 elderly people in 2006 and 865 in 2010, who used drugs. Results: The findings showed self-medication reduction from 42.3% in 2006 to 18.2% in 2010. In both periods, predominant utilized therapeutic classes were those acting on the nervous system (27.9% in 2006, and 29.6% in 2010) and on the alimentary tract and metabolism (25.5% in 2006, and 35.9% in 2010). The most commonly used medicines in 2006 and 2010 were analgesics, anti-inflammatories, and vitamins. There was a tendency to decrease the use of potentially inappropriate medicines between 2006 (26.4%) and 2010 (18.1%). The elderly themselves were the main responsible for the decision about the drug use in 2006 (62.5%) and 2010 (66.5%). Conclusion: Theextent of self-medication practice among the elderly who participated in the study decreased between 2006 and 2010, but the use of medicines that offer risks to health was still reported. Thus, the findings reinforce the importance of monitoring, evaluating, and continuously educating the elderly about risks and benefits of drug consumption, particularly over-the-counter medicines.

18.
Cad. Saúde Pública (Online) ; 34(2): e00002817, 2018. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-952363

RESUMO

Os inquéritos populacionais de saúde são instrumentos importantes para o reconhecimento de determinantes de morbidades, sobretudo em regiões de grande dispersão demográfica e baixa cobertura do sistema de saúde. O objetivo deste estudo foi apresentar os principais aspectos metodológicos e descrever as características socioeconômicas, demográficas e de saúde dos ribeirinhos de Coari, Amazonas, Brasil. Estudo transversal de base populacional conduzido com ribeirinhos residentes na zona rural do Município de Coari, no período de abril a julho de 2015. A amostra probabilística por conglomerados foi composta por 492 sujeitos. Os resultados indicaram que a maioria dos ribeirinhos é do sexo feminino (53%), tem até 9 anos de estudos (68,5%), apresenta em média renda familiar mensal equivalente a 1/3 do salário mínimo. Dentre os problemas de saúde relatados nos últimos 30 dias, destacaram-se as queixas álgicas (45,2%). Os principais recursos utilizados nos cuidados com a saúde foram medicamentos alopáticos (70,3%), superando o uso de plantas medicinais (44,3%). Os ribeirinhos navegam em média 60,4km e demoram cerca de 4,2 horas para acessar a zona urbana do município. De maneira geral, a população ribeirinha estudada é caracterizada pelo baixo nível econômico e acesso limitado à zona urbana. Os problemas de saúde são solucionados na maior parte das vezes pelo uso de medicamentos alopáticos. As limitações geográficas que constituem barreiras ao acesso aos serviços de saúde e à melhoria das condições de vida dos ribeirinhos podem limitar a aquisição de informações epidemiológicas dessas populações.


Population-based health surveys are important tools for identifying disease determinants, especially in regions with widely dispersed populations and low health system coverage. The aim of this study was to describe the principal methodological aspects and to describe the socioeconomic, demographic, and health characteristics of the riverine populations of Coari, Amazonas State, Brazil. This was a population-based cross-sectional study in river-dwelling communities in the rural area of Coari, from April to July 2015. The probabilistic cluster sample consisted of 492 individuals. The results showed that the majority of the river-dwellers were females (53%), had up to 9 years of schooling (68.5%), and earned a monthly family income equivalent to one-third the minimum wage. The health problems reported in the previous 30 days featured conditions involving pain (45.2%). The main healthcare resources were allopathic medicines (70.3%), exceeding herbal remedies (44.3%). The river-dwellers travel an average of 60.4km and take some 4.2 hours to reach the urban area of Coari. The riverine population generally presents low economic status and limited access to the urban area. Health problems are mostly solved with allopathic medicines. Geographic characteristics, as barriers to access to health services and to improvements in living conditions for the riverine population, can limit the collection of epidemiological data on these populations.


Las encuestas poblacionales de salud son instrumentos importantes para el reconocimiento de determinantes de morbilidades, sobre todo en regiones de gran dispersión demográfica y baja cobertura del sistema de salud. El objetivo de este estudio fue presentar los principales aspectos metodológicos y descibir las características socioeconómicas, demográficas y de salud los ribereños de Coari, Amazonas, Brasil. Se trata de un estudio transversal con base poblacional, realizado con ribereños residentes en la zona rural del municipio de Coari, durante el período de abril a julio de 2015. La muestra probabilística por conglomerados estaba compuesta por 492 sujetos. Los resultados indicaron que la mayoría de los ribereños es de sexo femenino (53,0%), tiene hasta 9 años de estudios (68,5%), presenta de media una renta familiar mensual equivalente a 1/3 del salario mínimo. Entre los problemas de salud relatados en los últimos 30 días, se destacaron las quejas álgicas (45,2%). Los principales recursos utilizados en los cuidados con la salud fueron medicamentos alopáticos (70,3%), superando el uso de plantas medicinales (44,3%). Los ribereños navegan de media 60,4km y tardan casi 4,2 horas para acceder a la zona urbana del municipio. De manera general, la población ribereña estudiada está caracterizada por el bajo nivel económico y acceso limitado a zonas urbanas. Los problemas de salud se solucionan la mayor parte de las veces mediante el uso de medicamentos alopáticos. Las limitaciones geográficas que constituyen barreras al acceso a los servicios de salud, y a la mejoría de las condiciones de vida de los ribereños, pueden limitar la obtención de información epidemiológica de esa población.

20.
Enferm. glob ; 16(48): 24-34, oct. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-166711

RESUMO

Objetivo: Identificar los factores relacionados con la carga de trabajo de enfermería generada por pacientes onco-hematológicos hospitalizados. Método: Cohorte prospectivo realizado con 151 pacientes ingresados en unidad de Onco-Hematología de un hospital universitario, en el Estado de São Paulo, Brasil. Se utilizó para la colecta de datos una ficha con informaciones demográfico-clínicas y el Nursing Activities Score (NAS). En el análisis de los datos se utilizo estadística descriptiva, inferencial y modelos de regresión linear. Resultados: La media del NAS en la unidad fue del 47,8% (11,5 horas). Pacientes con enfermedades oncológicas y hematológicas malignas demandaron mayor carga de trabajo de enfermería, comparados a aquellos con enfermedades no malignas (p=0,0034); los pacientes que murieron presentaron mayor puntuación de NAS, comparada a la de los supervivientes (p<0,0001); en la regresión linear, las variables, diagnóstico y condición de salida, determinaron un R2 de 0,26. Conclusión: Pacientes onco-hematológicos demandan asistencia semi-intensiva, información que ofrece subsidios al enfermero para planear recursos humanos en esta especialidad (AU)


Objetivo: Identificar os fatores relacionados à carga de trabalho de enfermagem gerada por pacientes onco-hematológicos hospitalizados. Método: Coorte prospectiva realizada com 151 pacientes internados em unidade de Onco-Hematologia de um hospital universitário, no Estado de São Paulo, Brasil. Utilizou-se para a coleta de dados uma ficha com informações demográfico-clínicas e o Nursing Activities Score (NAS). Na análise dos dados utilizou-se estatística descritiva, inferencial e modelos de regressão linear. Resultados: A média do NAS na unidade foi de 47,8% (11,5 horas). Pacientes com doenças oncológicas e hematológicas malignas demandaram maior carga de trabalho de enfermagem, comparados àqueles com doenças não malignas (p=0,0034); os pacientes que morreram apresentaram maior pontuação de NAS, comparada a dos sobreviventes (p<0,0001); na regressão linear, as variáveis, diagnóstico e condição de saída, determinaram um R2 de 0,26. Conclusão: Pacientes onco-hematológicos demandam assistência semi-intensiva, informação que oferece subsídios ao enfermeiro para planejar recursos humanos nesta especialidade (AU)


Objective: To identify workload-related factors of nursing generated by hematology/oncology inpatients. Methods: Prospective cohort study conducted with 151 inpatients at a hematology/oncology unit of a university hospital in São Paulo, Brazil. Data were collected using a form with demographic-clinical information and the Nursing Activities Score (NAS). The collected data were analyzed using descriptive and inferential statistics and linear regression models. Results: Mean NAS in the unit was 47.8% (11.5 hours). Patients with malignant oncological and hematological diseases generated a higher nursing workload than patients with non-malignant diseases (p = 0.0034). Patients who died had higher NAS scores than survivors (p <0.0001). In the linear regression, the variables diagnosis and condition at discharge determined an R2 of 0.26. Conclusion: Hematology and oncology patients require high dependency care. This finding can support nurses when planning human resources in this specialty (AU)


Assuntos
Humanos , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/enfermagem , Institutos de Câncer , Recursos Humanos de Enfermagem/psicologia , Recursos Humanos de Enfermagem/normas , Serviço Hospitalar de Oncologia/organização & administração , Unidades Hospitalares/organização & administração , Estudos Prospectivos , Análise de Dados/métodos
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