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1.
Cad Saude Publica ; 35(9): e00184918, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31508700

RESUMO

The act of crossing an international border for healthcare is a reality in border areas and the flow is in the direction of the city with more human and healthcare resources. Although several prognostic factors related to HIV+ patients are known, the prognostic value of this type of mobility for long term care is still neglected. This study compares the prognosis of HIV patients from three groups, one involved in regional mobility, another in cross-border mobility in search for healthcare and the reference group which is composed by patients living in the same city of the health facility. This is a retrospective cohort study using medical records from a healthcare service in Brazil. Following survival analysis with log-rank test and Cox proportional hazard models, overall survival had no significant difference between patients who were involved in regional (HR = 1.03; 95%CI: 0.69-1.54; p = 0.89) or international (HR = 1.07; 95%CI: 0.58-1.97; p = 0.83) mobility and those who were not. This lack of difference was kept when adjusted for known prognostic factors. In this retrospective cohort study, exposure to both regional and international migration did not have a significant association with the risk of death by any cause in crude or adjusted analyses for already known prognostic factors. This is the first study to consider the prognostic role of cross-border healthcare for HIV patients. Despite these findings, the need of monitoring the extent and the clinical and demographic characteristics of healthcare demand originated in the other side of the border and the use of these data for decision making in health management is emphasized.

2.
Clin Nutr ; 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31400996

RESUMO

BACKGROUND & AIMS: The bioimpedence phase angle has been considered as a predictor for morbidity and mortality in different clinical situations, although reference values from a large healthy population are lacking. The aim of this meta-analysis is to estimate mean phase-angle values in healthy individuals. METHODS: This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Web of Science and gray literature for studies estimating mean phase angles. Quality of evidence was assessed for all studies and subgroup (males and females) meta-analysis stratified by age group according to literature (up to 2; 3-5; 6-12; 13-15; 16-18; 19-28; 29-38; 39-48; 49-58; 59-69; 70-80 and >80 years of age) were conducted using random-effects models. RESULTS: A total of 46 studies including 249,844 subjects were selected for the present analysis. Males show a pooled estimate of the mean phase angle of 3.6 (95% CI: 3.0-4.1) for infants (0-2 y), increasing progressively to 7.3 (95% CI: 7.0-7.5) at the teenage phase (16-18 y), stabilizing during adult ages (18-38) and decreasing progressively with ongoing years with an estimate of 5.3 (95% CI: 4.5-6.0) for elderly above 80 years old. Similarly, females start from 3.7 (95% CI: 3.2-4.3) for infants (0-2 y), increasing progressively to 6.4 (95% CI: 6.1-6.8) at the teenage phase (16-18 y), stabilizing during adult ages (18-48) and decreasing progressively with ongoing years with an estimate of 5.4 (95% CI: 5.3-5.6) for elderly above 80 years old. Also, males have higher estimates than females for all age groups except for infants (0-2) and subjects older than 80 years old. Heterogeneity was high for all age groups. CONCLUSIONS: In both sexes, phase-angle values have a similar pattern that start from infants, increase progressively up to the teenage phase, stabilize during adult ages, and then decrease progressively in older subjects and the elderly.

3.
Cien Saude Colet ; 24(8): 2909-2922, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389538

RESUMO

This systematic review and meta-analysis aimed to estimate and compare the prevalences of dental fluorosis in Brazilian cities supplied with non-fluoridated water and in locations that uses groundwater. In December of 2016, cross-sectional studies were searched in eight databases, including the "grey literature". The prevalences were estimated through a mixed random effects model considering the locations as subgroups. The heterogeneity among the studies was assessed with I2 statistics and the Cochran's Q test. A total of 1038 records were found, from which only 18 articles met the inclusion criteria and were subjected to analysis. The meta-analytic model estimated a prevalence of dental fluorosis of 8.92 % (95 % CI: 5.41 % to 14.36 %) in cities supplied with non-fluoridated water, and of 51.96 % (95 % CI: 31.03 % to 72.22 %) in cities supplied by artesian wells. The heterogeneity among the studies was high: I2 = 95 % (p < 0.01) in the first subgroup of cities and I2 = 98 % (p < 0.01) in the second subgroup. The prevalence was significantly higher (p < 0.001) in populations exposed to artesian well water, indicating that the presence of natural fluoride at high concentrations represents a risk factor for the occurrence of dental fluorosis.

4.
Ciênc. Saúde Colet ; 24(8): 2909-2922, ago. 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1011878

RESUMO

Resumo Trata-se de uma revisão sistemática e metanálise para estimar e comparar as prevalências de fluorose dental em localidades brasileiras abastecidas com água tratada sem suplementação de flúor e em localidades que utilizam de água de origem subterrânea. Em dezembro de 2016 foram buscados estudos transversais em 8 bases de dados incluindo a "literatura cinzenta". As prevalências foram estimadas utilizando modelo misto de efeitos aleatórios considerando as localidades como subgrupo. A heterogeneidade entre os estudos foi avaliada através da estatística I2 e do teste Q de Cochran. Foram encontrados 1.038 registros, dos quais apenas 18 artigos preencheram os critérios de inclusão, sendo submetidos para análise. O modelo metanalítico estimou em 8,92% (IC95%:5,41% até 14,36%) a prevalência de fluorose dental em municípios com água tratada sem suplementação de flúor e em 51,96% (IC95%: 31,03% até 72,22%) em municípios abastecidos por poços artesianos. A heterogeneidade entre os estudos foi alta, I2 = 95% (p < 0,01) no primeiro subgrupo de municípios e I2 = 98% (p < 0,01) no segundo subgrupo. A prevalência foi significativamente maior (p < 0,001) em populações expostas à água de poços artesianos, indicando que a presença de flúor natural em concentrações elevadas representa um fator de risco para a ocorrência de fluorose dental.


Abstract This systematic review and meta-analysis aimed to estimate and compare the prevalences of dental fluorosis in Brazilian cities supplied with non-fluoridated water and in locations that uses groundwater. In December of 2016, cross-sectional studies were searched in eight databases, including the "grey literature". The prevalences were estimated through a mixed random effects model considering the locations as subgroups. The heterogeneity among the studies was assessed with I2 statistics and the Cochran's Q test. A total of 1038 records were found, from which only 18 articles met the inclusion criteria and were subjected to analysis. The meta-analytic model estimated a prevalence of dental fluorosis of 8.92 % (95 % CI: 5.41 % to 14.36 %) in cities supplied with non-fluoridated water, and of 51.96 % (95 % CI: 31.03 % to 72.22 %) in cities supplied by artesian wells. The heterogeneity among the studies was high: I2 = 95 % (p < 0.01) in the first subgroup of cities and I2 = 98 % (p < 0.01) in the second subgroup. The prevalence was significantly higher (p < 0.001) in populations exposed to artesian well water, indicating that the presence of natural fluoride at high concentrations represents a risk factor for the occurrence of dental fluorosis.

5.
Curr Probl Cardiol ; : 100429, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31326099

RESUMO

Myocardial injury after noncardiac surgery (MINS) includes patients with traditional myocardial infarction and those with ischemic myocardial injury after surgery. This study evaluated the prognostic value of MINS on major cardiovascular events and 30-day mortality, and determined independent preoperative predictors of MINS in patients after noncardiac surgery. This multicenter prospective cohort study was part of the VISION Study. The sample consisted of 2504 patients who underwent noncardiac surgery at 2 tertiary hospitals in Brazil between September 2008 and July 2012. Troponin Ts were measured 6-12 hours, and on days 1-3 after surgery. Cox regression analyses were performed to identify independent variables of major outcomes. A total of 314 (13%) patients were diagnosed with MINS, of which 26 (8%) died. Length-of-hospital stay of MINS patients was 3 times higher (18 ± 22 days vs 5.8 ± 11 days). In multivariate analysis, 30-day mortality was significantly higher among patients with MINS (hazard ratio [HR] 3.17 (95% confidence interval [CI] 1.56-6.41)), and major bleeding (HR 5.76 (95% CI 2.75-12.05)), sepsis (HR 5.08 (95% CI 2.25-11.46)), active cancer (HR 4.22 (95% CI 1.98-8.98)), and general surgery (HR 3.11 (95% CI 1.51-6.41)). Multivariable analysis indicated a higher chance of MINS in patients ≥75 years of age, history of diabetes mellitus, hypertension, heart failure, coronary disease, and end-stage renal failure. The incidence of MINS within 30 days after noncardiac surgery is related to higher mortality. Postoperative troponin monitoring in elder patients and with risk factors for atherosclerotic disease may help reduce postoperative cardiovascular events.

6.
Int Psychogeriatr ; : 1-9, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30827285

RESUMO

ABSTRACTBackground:Childhood maltreatment is an important factor associated with adverse mental health outcomes including geriatric depression and the "big five" personality characteristics. The objective of this study was to evaluate a model where personality characteristics mediate the relationship between childhood maltreatment and geriatric depression. METHOD: In this cross-sectional study, elderly subjects from socioeconomically disadvantaged neighborhoods of Porto Alegre, Brazil (n = 260) completed the Childhood Trauma Questionnaire (CTQ), NEO-Five Factor Inventory (NEO-FFI), and Mini International Neuropsychiatric Interview 5.0 (MINI plus). We used structural equation modeling (SEM) to evaluate the mediation hypothesis. RESULTS: The five personality factors (neuroticism, extraversion, agreeableness, openness, and conscientiousness) were related to childhood maltreatment and depression. Mediation analysis revealed that neuroticism and extraversion are complete mediators, agreeableness and conscientiousness are partial mediators, and openness is not a mediator. CONCLUSIONS: These findings support the hypothesis in which childhood maltreatment is associated with geriatric depression and mediated by personality factors. These results suggest that reducing the maladaptive personality trait in elderly people who suffered childhood maltreatment could prevent geriatric depression.

7.
Clin Nutr ; 2018 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-30224304

RESUMO

OBJECTIVE: To evaluate the relationship between physical activity and phase angle. DESIGN: Systematic Review and Meta-analysis. DATA SOURCES: Electronic searches of MEDLINE (via PUBMED), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), SciELO, LILACS, SPORTDiscus, Scopus, and Web of Science from inception to December 10th, 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The PICOS strategy was defined, in which "P" corresponded to participants of any age, sex or ethnicity, "I" indicated any type of physical activity program, "C" denoted lack of exercise or irregular physical activity, "O" corresponded to the phase angle obtained by bio-impedance, and "S" indicated longitudinal or cross-sectional studies. RESULTS: In cross-sectional studies the phase angle was higher among the active individuals (MD = 0.70; 95% CI: 0.48, 0.92, P < 0.001), with low heterogeneity (I2 = 0%; P = 0.619). In longitudinal studies, the mean of the difference of phase angles from the baseline was significantly higher for the active group than the control group (MD = 0.30; 95% CI: 0.11, 0.49, P = 0.001), with low heterogeneity (I2 = 13%, P = 0.331). No evidence of publication bias was found and the overall risk of bias was moderate to high. SUMMARY/CONCLUSION: The positive association of physical activity with phase angle reinforces the importance of routinely including exercise in health care. We also identified the need for further studies to define with different types, intensities and frequencies of exercises should be conducted in order to find the best dose-effect relationship.

8.
Hematol Oncol ; 2018 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30129104

RESUMO

Autologous transplantation continues to be the cornerstone of younger and fit multiple myeloma patients. It is known that frontline induction therapy before transplantation can influence post-transplant results. Therefore, best frontline treatment for transplant-eligible patients should be based on best available evidence to guide therapy. Furthermore, until now due to data scarcity, it was not possible to thoroughly compare lenalidomide to other regimens in this setting. We performed a systematic review and network (mixed treatment comparison) meta-analysis of 21 clinical trial publications, enrolling 6474 patients and comparing 11 different treatment frontline setting regimens regarding survival, response, and safety outcomes. OS analysis showed superiority of CRD (cyclophosphamide-lenalidomide-dexamethasone) over TD-based (thalidomide-dexamethasone, HR = 0.76,0.62-0.90), VAD-based (HR = 0.71,0.52-0.90), and Z-Dex (idarubicin-dexamethasone, HR = 0.37,0.17-0.76) regimens. Concerning PFS, VTD (bortezomib-thalidomide-dexametasone) showed superior results when compared with TD-based (HR = 0.66,0.51-0.84), VAD-based (HR = 0.61,0.46-0.82), Z-Dex (HR = 0.42,0.22-0.78), and high dose dexamethasone (Dex, HR = 0.62,0.41-0.90) regimens. Bortezomib/thalidomide regimens were not superior to lenalidomide, considering these outcomes. Also, concerning complete and overall response, VTD ranked first among other regimens, showing clear superiority over thalidomide-only containing protocols. Safety outcome evaluated infectious, cardiac, gastrointestinal, neurological, thrombotic, and hematological grade 3 to 4 adverse events. Risk of thrombotic events was higher with TAD (thalidomide-doxorubicin-dexamethasone), neurological with PAD (bortezomib-doxorubicin-dexamethasone), infectious with Dex, hematological with Z-Dex, gastrointestinal with VTD, and cardiac with PAD regimens. Our study endorses current recommendations on combined immunomodulatory drugs and proteasome inhibitors frontline regimens (in triplets) in transplant-eligible multiple myeloma patients, but also formally demonstrates the favorable performance of lenalidomide in overall and progression-free survival, when compared with bortezomib/thalidomide protocols.

9.
PLoS One ; 13(8): e0202404, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30138422

RESUMO

BACKGROUND: Little is known about the best strategy for weaning patients with chronic obstructive pulmonary disease (COPD) from mechanical ventilation. Spontaneous breathing trials (SBT) using a T-piece or pressure-support ventilation (PSV) have a central role in this process. Our aim was to compare T-piece and PSV SBTs according to the duration of mechanical ventilation (MV) in patients with COPD. METHODS: Patients with COPD who had at least 48 hours of invasive MV support were randomized to 30 minutes of T-piece or PSV at 10 cm H2O after being considered able to undergo a SBT. All patients were preemptively connected to non-invasive ventilation after extubation. Tracheostomized patients were excluded. The primary outcome was total invasive MV duration. Time to liberation from MV was assessed as secondary outcome. RESULTS: Between 2012 and 2016, 190 patients were randomized to T-piece (99) or PSV (91) groups. Extubation at first SBT was achieved in 78% of patients. The mean total MV duration was 10.82 ± 9.1 days for the T-piece group and 7.31 ± 4.9 days for the PSV group (p < 0.001); however, the pre-SBT duration also differed (7.35 ± 3.9 and 5.84 ± 3.3, respectively; p = 0.002). The time to liberation was 8.36 ± 11.04 days for the T-piece group and 4.06 ± 4.94 for the PSV group (univariate mean ratio = 2.06 [1.29-3.27], p = 0.003) for the subgroup of patients with difficult or prolonged weaning. The study group was independently associated with the time to liberation in this subgroup. CONCLUSIONS: The SBT technique did not influence MV duration for patients with COPD. For the difficult/prolonged weaning subgroup, the T-piece may be associated with a longer time to liberation, although this should be clarified by further studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT01464567, at November 3, 2011.

10.
J Affect Disord ; 240: 48-56, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30053683

RESUMO

BACKGROUND: There have been very few studies exploring the occupational risk factors for major depressive disorder (MDD) in the working populations in Latin America. The aim of this study was to explore the associations between a large set of occupational factors and MDD in the Brazilian working population. METHODS: The study was based on the cross-sectional data from the Brazilian National Health Survey, 2013. 60,202 people were interviewed (response rate: 91.9%). Among them, 36,442 were working, 19,450 men and 16,992 women. MDD was measured using the diagnostic algorithm (DSM-IV criteria) of the PHQ-9. Occupational factors included job characteristics, working time factors, psychosocial work stressors and physico-chemical exposures. Logistic regression models were performed and adjusted for sociodemographic factors. All analyses were conducted using weighted and stratified data by gender. RESULTS: The following occupational factors were associated with a higher risk of MDD: working part time (≤20 h a week) and stress at work for both genders, workplace violence, intense physical activity, exposure to noise and chemicals among women, and prolonged exposure to sun among men. Associations of stress and violence at work with MDD were particularly strong. LIMITATIONS: Cross-sectional study design, healthy worker effect and reporting bias may have impacted the results. CONCLUSIONS: This study, one of the first studies among the Brazilian working population, showed that psychosocial work stressors were the strongest risk factors for MDD. Physico-chemical exposures deserve more attention in association with MDD. Prevention policies oriented toward the work environment may help to prevent depression at the workplace.

11.
Sci Rep ; 8(1): 7230, 2018 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-29740001

RESUMO

BACKGROUND: There is uncertainty regarding which factors are associated with in-hospital mortality among patients with pulmonary TB (PTB). The aim of this systematic review and meta-analysis is to identify predictors of in-hospital mortality among patients with PTB. METHODS: We searched MEDLINE, EMBASE, and Global Health, for cohort and case-control studies that reported risk factors for in-hospital mortality in PTB. We pooled all factors that were assessed for an association, and presented relative associations as pooled odds ratios (ORs). RESULTS: We identified 2,969 records, of which we retrieved 51 in full text; 11 cohort studies that evaluated 5,468 patients proved eligible. Moderate quality evidence suggested an association with co-morbid malignancy and in-hospital mortality (OR 1.85; 95% CI 1.01-3.40). Low quality evidence showed no association with positive sputum smear (OR 0.99; 95% CI 0.40-2.48), or male sex (OR 1.09, 95% CI 0.84-1.41), and very low quality evidence showed no association with diabetes mellitus (OR 1.31, 95% IC 0.38-4.46), and previous TB infection (OR 2.66, 95% CI 0.48-14.87). CONCLUSION: Co-morbid malignancy was associated with increased risk of in-hospital death among pulmonary TB patients. There is insufficient evidence to confirm positive sputum smear, male sex, diabetes mellitus, and previous TB infection as predictors of in-hospital mortality in TB patients.

12.
Ann Intensive Care ; 8(1): 50, 2018 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-29808412

RESUMO

BACKGROUND: Point-of-care ultrasonography (POCUS) has recently become a useful tool that intensivists are incorporating into clinical practice. However, the incorporation of ultrasonography in critical care in developing countries is not straightforward. METHODS: Our objective was to investigate current practice and education regarding POCUS among Brazilian intensivists. A national survey was administered to Brazilian intensivists using an electronic questionnaire. Questions were selected by the Delphi method and assessed topics included organizational issues, POCUS technique and training patterns, machine availability, and main applications of POCUS in daily practice. RESULTS: Of 1533 intensivists who received the questionnaire, 322 responded from all of Brazil's regions. Two hundred and five (63.8%) reported having access to an ultrasound machine dedicated to the intensive care unit (ICU); however, this was more likely in university hospitals than in non-university hospitals (80.6 vs. 59.6%; risk ratio [RR] = 1.35 [1.16-1.58], p = 0.002). The main applications of POCUS were ultrasound-guided central vein catheterization (49.4%) and bedside echocardiographic assessment (33.9%). Two hundred and fifty-eight (80.0%) reported having at least one POCUS-trained intensivist in their staff (trained units). Trained units were more likely to perform routine ultrasound-guided jugular vein catheterization than non-trained units (38.6 vs. 16.4%; RR = 2.35 [1.31-4.23], p = 0.001). The proportion of POCUS-trained intensivists and availability of a dedicated ultrasound machine were both independently associated with performing ultrasound-guided jugular vein catheterization (RR = 1.91 [1.32-2.77], p = 0.001) and (RR = 2.20 [1.26-3.29], p = 0.005), respectively. CONCLUSIONS: A significant proportion of Brazilian ICUs had at least one intensivist with POCUS capability in their staff. Although ultrasound-guided central vein catheterization constitutes the main application of POCUS, adherence to guideline recommendations is still suboptimal.

13.
Braz Oral Res ; 32: e10, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29513886

RESUMO

This study aimed to compare the longevity of different conventional restorative materials placed in posterior primary teeth. This systematic review was conducted following the PRISMA statement and registered in PROSPERO (CRD42016035775). A comprehensive electronic search without date or language restrictions was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, Turning Research Into Practice (TRIP) and Clinical Trials databases up to January 2017, selecting randomized clinical trials that assessed the longevity of at least two different conventional restorative materials performed in primary molars. Seventeen studies were included in this systematic review. Pairwise and network meta-analyses were performed and relative risks and 95% confidence intervals (CI) calculated. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Restorations of primary molars with conventional glass ionomer cement showed increased risk of failure than compomer, resin-modified glass ionomer cement, amalgam, and composite resin. Risk of bias was low in most studies (45.38% of all items across studies). Pediatric dentists should avoid conventional glass ionomer cement for restoring primary molars.


Assuntos
Materiais Dentários/uso terapêutico , Restauração Dentária Permanente/métodos , Dente Decíduo , Cárie Dentária/terapia , Falha de Restauração Dentária , Humanos , Meta-Análise em Rede , Viés de Publicação , Medição de Risco , Resultado do Tratamento
14.
Braz. oral res. (Online) ; 32: e10, 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-889487

RESUMO

Abstract This study aimed to compare the longevity of different conventional restorative materials placed in posterior primary teeth. This systematic review was conducted following the PRISMA statement and registered in PROSPERO (CRD42016035775). A comprehensive electronic search without date or language restrictions was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, Turning Research Into Practice (TRIP) and Clinical Trials databases up to January 2017, selecting randomized clinical trials that assessed the longevity of at least two different conventional restorative materials performed in primary molars. Seventeen studies were included in this systematic review. Pairwise and network meta-analyses were performed and relative risks and 95% confidence intervals (CI) calculated. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Restorations of primary molars with conventional glass ionomer cement showed increased risk of failure than compomer, resin-modified glass ionomer cement, amalgam, and composite resin. Risk of bias was low in most studies (45.38% of all items across studies). Pediatric dentists should avoid conventional glass ionomer cement for restoring primary molars.


Assuntos
Humanos , Materiais Dentários/uso terapêutico , Restauração Dentária Permanente/métodos , Dente Decíduo , Cárie Dentária/terapia , Falha de Restauração Dentária , Meta-Análise em Rede , Viés de Publicação , Medição de Risco , Resultado do Tratamento
15.
Biol Trace Elem Res ; 175(2): 254-262, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27301656

RESUMO

Polycystic ovary syndrome (PCOS) is a prevalent condition in women of reproductive age. PCOS is characterized by androgen excess and chronic anovulation and associated with low-grade inflammation and metabolic comorbidities. Some trace elements have been linked to pathophysiological mechanisms of oxidative stress and inflammation in different disorders. Therefore, we conducted a systematic review and meta-analysis of the available evidence regarding trace element concentrations in PCOS. We reviewed MEDLINE and EMBASE in search of case-control, cross-sectional, and cohort studies published until September 2015. Of 183 studies identified, six were selected for systematic review. All used the Rotterdam criteria for the diagnosis of PCOS. Two studies evaluating chromium and one assessing cobalt levels did not observe differences between PCOS and controls. Another study recorded similar nickel and vanadium levels between the groups, but lower selenium concentrations in women with PCOS compared to controls. Four studies were included in the random effects model meta-analysis, for a total of 264 PCOS and 151 control women. Copper levels were found to be higher in women with PCOS than in controls [mean difference 0.12 ppm (95 % CI 0.07; 0.17 ppm); I 2 = 0 %]. Manganese [mean difference 0.04 ppm (95 % CI -0.05; 0.13 ppm); I 2 = 94.4 %] and zinc concentrations [mean difference 0.02 ppm (95 % CI -0.12; 0.16 ppm); I 2 = 92.4 %] were similar between the groups. The present results suggest a relationship between increased copper concentration and PCOS. This systematic review and meta-analysis is registered in PROSPERO under number CRD42016034036.


Assuntos
Estresse Oxidativo , Síndrome do Ovário Policístico/metabolismo , Oligoelementos/metabolismo , Adulto , Feminino , Humanos , Síndrome do Ovário Policístico/patologia
16.
Curr Gerontol Geriatr Res ; 2017: 8703503, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29358947

RESUMO

Purpose: Anthropometry is a useful tool for assessing some risk factors for frailty. Thus, the aim of this study was to verify the discriminatory performance of anthropometric measures in identifying frailty in the elderly and to create an easy-to-use tool. Methods: Cross-sectional study: a subset from the Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS) evaluating 538 older adults. Individuals were classified using the Fried Phenotype criteria, and 26 anthropometric measures were obtained. The predictive ability of anthropometric measures in identifying frailty was identified through logistic regression and an artificial neural network. The accuracy of the final models was assessed with an ROC curve. Results: The final model comprised the following predictors: weight, waist circumference, bicipital skinfold, sagittal abdominal diameter, and age. The final neural network models presented a higher ROC curve of 0.78 (CI 95% 0.74-0.82) (P < 0.001) than the logistic regression model, with an ROC curve of 0.71 (CI 95% 0.66-0.77) (P < 0.001). Conclusion: The neural network model provides a reliable tool for identifying prefrailty/frailty in the elderly, with the advantage of being easy to apply in the primary health care. It may help to provide timely interventions to ameliorate the risk of adverse events.

17.
Acta sci., Health sci ; 38(1): 9-18, jan.-jun. 2016. tab, graf
Artigo em Inglês | LILACS | ID: biblio-831498

RESUMO

The aim of this study was to describe the association between frailty and geriatric syndromes (GS) [cognitive impairment (CI); postural instability (PI); urinary/fecal incontinence (UFI); polypharmacy (PP); and immobility (IM)] and the frequency of these conditions in elderly people assisted in primary health care. Five hundred twenty-one elderly participants of The Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS) were evaluated. Sociodemographic data, identification of frailty (Fried phenotype) and GS were collected. Multinomial logistic regression analysis was performed. The frequency of frailty was 21.5%, prefrailty 51.1% and robustness 27.4%. The frequency of CI was 54.7%, PP 41.2%, PI 36.5%, UFI 14% and IM 5.8%. The odds of frailty when compared to robustness and adjusted for gender, age, depression, self-perception of health, nutritional status, falls, vision and hearing, was significantly higher in elderly with CI, PI and PP. The adjusted odds of prefrail when compared to robustness was significantly higher only in elderly with CI. The most frequently presented number of GS (0- 5) was two geriatric syndromes (26.87%). The frequency of frailty was high among elderly in primary health care and was associated with three of five GS (CI - PI - PP).


O objetivo deste estudo foi descrever a associação entre fragilidade e síndromes geriátricas (SG) [declínio cognitivo (DC); instabilidade postural (IP); incontinência urinária/fecal (IUF); polifarmácia (PF); e imobilidade (IM)] e a frequência destas condições em idosos assistidos na atenção básica. Foram avaliados 521 idosos, participantes do Estudo Multidimensional dos Idosos da Estratégia Saúde da Família (EMI-SUS). Foram coletados dados sociodemográficos, de identificação da fragilidade (fenótipo de Fried) e das SG. Realizou-se análise de regressão logística multinomial. A frequencia de fragilidade foi 21,5%, de pré-fragilidade 51,1% e de robustez 27,4%. A frequência de DC foi 54,7%, de PF 41,2%, de IP 36,5%, de IUF 14% e de IM 5,8%. A chance de fragilidade quando comparada à robustez, ajustada para sexo, idade, depressão, autopercepção de saúde, estado nutricional, quedas, visão e audição, foi significativamente maior em idosos com DC, IP e PF. A chance ajustada de pré -fragilidade, quando comparada à robustez foi significativamente maior somente nos idosos com DC. O número mais frequente de SG (0-5) presentes foram duas SG (26,8%). A frequência de fragilidade foi alta entre idosos da atenção básica e mostrou-se associada a três das cinco SG (DC-IP-PF).


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso Fragilizado , Geriatria , Atenção Primária à Saúde
18.
Arq. bras. cardiol ; 104(1): 32-44, 01/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-741128

RESUMO

Background: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. Objective: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. Methods: We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Results: Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Conclusions: Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil. .


Fundamento: Estatinas tem eficácia comprovada na redução de eventos cardiovasculares, mas o impacto financeiro de seu uso disseminado pode ser substancial. Objetivo: Conduzir análise de custo-efetividade de três esquemas de doses de estatinas na perspectiva do SUS. Métodos: Foi desenvolvido modelo de Markov para avaliar a razão de custo-efetividade incremental (RCEI) de regimes de dose baixa, intermediária e alta, em prevenção secundária e quatro cenários de prevenção primária (risco em 10 anos de 5%, 10%, 15% e 20%). Regimes com redução de LDL abaixo de 30% (ex: sinvastatina 10mg) foram considerados dose baixa; entre 30-40% (atorvastatina 10mg, sinvastatina 40mg), dose intermediária; e acima de 40% (atorvastatina 20-80 mg, rosuvastatina 20 mg), dose alta. Dados de efetividade foram obtidos de revisão sistemática com aproximadamente 136.000 pacientes. Dados nacionais foram usados para estimar utilidades e custos (expressos em dólares internacionais - Int$). Um limiar de disposição a pagar (LDP) igual ao produto interno bruto per capita nacional (aproximadamente Int$11.770) foi utilizado. Resultados: A dose baixa foi dominada por extensão nos cenários de prevenção primária. Nos cinco cenários, a RCEI da dose intermediária ficou abaixo de Int$10.000 por QALY. A RCEI de dose alta ficou acima de Int$27.000 por QALY em todos os cenários. Nas curvas de aceitabilidade de custo-efetividade, dose intermediária teve probabilidade de ser custo-efetiva acima de 50% com RCEIs entre Int$9.000-20.000 por QALY em todos os cenários. Conclusões: Considerando um LDP razoável, uso de estatinas em doses intermediárias é economicamente atrativo, e deveria ser intervenção prioritária na redução de eventos cardiovasculares no Brasil. .


Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Custo-Benefício , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Programas Nacionais de Saúde/economia , Atorvastatina , Brasil , Fluorbenzenos/administração & dosagem , Fluorbenzenos/economia , Ácidos Heptanoicos/administração & dosagem , Ácidos Heptanoicos/economia , Modelos Econômicos , Prevenção Primária/economia , Pirimidinas/administração & dosagem , Pirimidinas/economia , Pirróis/administração & dosagem , Pirróis/economia , Medição de Risco , Fatores de Risco , Rosuvastatina Cálcica , Prevenção Secundária/economia , Sinvastatina/administração & dosagem , Sinvastatina/economia , Sulfonamidas/administração & dosagem , Sulfonamidas/economia
19.
Hematol Oncol ; 33(4): 212-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25363800

RESUMO

Previous meta-analyses suggested that acute myeloid leukaemia induction regimens containing idarubicin (IDA) or high-dose daunorubicin (HDD) induce higher rates of complete remission (CR) than conventional-dose daunorubicin (CDD), with a possible benefit in overall survival. However, robust comparisons between these regimens are still lacking. We conducted a mixed treatment comparison meta-analysis regarding these three regimens. Mixed treatment comparison is a statistical method of data summarization that aggregates data from both direct and indirect effect estimates. Literature search strategy included MEDLINE, EMBASE, Cochrane, Scielo and LILACS, from inception until August 2013 and resulted in the inclusion of 17 trials enrolling 7258 adult patients. HDD [relative risk (RR) 1.13; 95% credible interval (CrI) 1.02-1.26] and IDA (RR 1.13; 95% CrI 1.05-1.23) showed higher CR rates than CDD. IDA also led to lower long-term overall mortality rates when compared with CDD (RR 0.93, 95% CrI 0.86-0.99), whereas HDD and CDD were no different (RR 0.94, 95% CrI 0.85-1.02). HDD and IDA comparison did not reach statistically significant differences in CR (RR 1.00; 95% CrI 0.89-1.11) and in long-term mortality (RR 1.01, 95% CrI 0.91-1.11). IDA and HDD are consistently superior to CDD in inducing CR, and IDA was associated with lower long-term mortality. On the basis of these findings, we recommend incorporation of IDA and HDD instead of the traditional CDD as standard treatments for acute myeloid leukaemia induction. The lack of HDD benefit on mortality, when compared with CDD in this study, should be cautiously addressed, because it may have been susceptible to underestimation because of statistical power limitations.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Daunorrubicina/uso terapêutico , Idarubicina/uso terapêutico , Leucemia Mieloide Aguda/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Daunorrubicina/administração & dosagem , Intervalo Livre de Doença , Feminino , Humanos , Idarubicina/administração & dosagem , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/patologia , Masculino , Indução de Remissão
20.
Arq Bras Cardiol ; 104(1): 32-44, 2015 Jan.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25409878

RESUMO

BACKGROUND: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. OBJECTIVE: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. METHODS: We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40 mg), intermediate dose; and above 40% (atorvastatin 20-80 mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. RESULTS: Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. CONCLUSIONS: Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.


Assuntos
Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Programas Nacionais de Saúde/economia , Idoso , Idoso de 80 Anos ou mais , Atorvastatina , Brasil , Feminino , Fluorbenzenos/administração & dosagem , Fluorbenzenos/economia , Ácidos Heptanoicos/administração & dosagem , Ácidos Heptanoicos/economia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Prevenção Primária/economia , Pirimidinas/administração & dosagem , Pirimidinas/economia , Pirróis/administração & dosagem , Pirróis/economia , Medição de Risco , Fatores de Risco , Rosuvastatina Cálcica , Prevenção Secundária/economia , Sinvastatina/administração & dosagem , Sinvastatina/economia , Sulfonamidas/administração & dosagem , Sulfonamidas/economia
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