Fraturas de fêmur em idosos nas diferentes regiões do Brasil de 2015 a 2020: análise dos custos, tempo de internação e total de óbitos / Femur fractures in elderly in brazil from 2015 to 2020: analysis of costs, time of hospitalization and total deaths

INTRODUÇÃO: As fraturas de fêmur em idosos geram aumento da demanda funcional nesses indivíduos e são responsáveis por um alto número de internações hospitalares. OBJETIVO: Analisar retrospectivamente o total de casos, os custos, o tempo de internação e o total de óbitos por fratura de fêmur em idosos nas diferentes regiões do Brasil de 2015 a 2020. MÉTODOS: Estudo ecológico de série temporal e retrospectivo que avaliou os dados de fratura de fêmur em idosos, a partir de dados disponíveis nos sites de Ministério da Saúde. Foram avaliadas as seguintes variáveis: total de casos, Tempo Médio de Permanência Hospitalar (TMPH), número de óbitos, taxa de mortalidade, gastos com internações, total e por dia de internação hospitalar, Gasto Médio por Fratura (GMF) e o Tempo de Internação por Fratura (TIF) em cada região. RESULTADOS: Um total de 328.008 idosos sofreram fratura de fêmur no período estudado. A região Sudeste lidera em número de casos, óbitos e TIF; o segundo lugar alterna entre as regiões Sul (2015, 2016 e 2020) e Nordeste (2017 e 2019). Em relação ao TMPH, as regiões Norte e Nordeste aparecem em primeiro e segundo lugar, respectivamente, em todos os anos, ficando acima da média nacional em todos os anos estudados. CONCLUSÕES: Há uma discrepância para os casos de fratura de fêmur em idosos entre as regiões brasileiras, seja no número de casos, nos custos ou no total de óbitos. A maior densidade populacional em regiões como Sudeste e Sul, contribuiu para as maiores taxas de fraturas de fêmur em idosos, haja vista que estes também são maioria nessas regiões em comparação as demais.

INTRODUCTION: Femur fractures in the elderly generate increased functional demand for those who have and are responsible for a high number of hospital admissions. OBJECTIVE: Retrospectively analyze the total number of cases, costs, length of hospital stay, and total deaths from femoral fractures in the elderly in different regions of Brazil from 2015 to 2020. METHODS: Ecological study of temporal and retrospective series that evaluated fracture data of femur fracture in the elderly, based on data available on the websites of the Ministry of Health. The following variables were evaluated: total cases, Average Hospital Stay (AHS), number of deaths, mortality rate, hospitalization costs, total and per day of hospitalization, Average Fracture Cost (AFC), and Length of Hospitalization for Fracture (LHF) in each region. RESULTS: A total of 328,008 elderly people suffered a femur fracture during the study period. The Southeast region leads in cases, deaths, and LHF; the second-place alternates between the South (2015, 2016, and 2020) and Northeast (2017 and 2019) regions. Concerning the AHS, the North and Northeast regions appear in first and second place, respectively, in all years, being above the national average in all years studied. CONCLUSIONS: There is a discrepancy for cases of femoral fractures in the elderly among Brazilian regions, whether in the number of cases, costs, or total deaths. The higher population density in regions such as the Southeast and the South contributes to the higher rates of femur fractures in the elderly, given that they are also the majority in these regions compared to the others.

Influência dos requisitos cinéticos funcionais e desfechos de saúde na mobilidade funcional de idosos / Influence of kinetic and functional requirements of health outcomes in the functional mobility of elderly people

INTRODUÇÃO: A mobilidade funcional é um fator determinante para promover a independência do idoso, com influência na saúde física e mental. Os testes para avaliar a capacidade funcional de idosos devem ser direcionados a simularem as atividades de vida diárias de locomoção. OBJETIVO: Verificar a influência de requisitos cinéticos funcionais e desfechos da saúde sobre a mobilidade funcional de idosos em uma unidade básica de saúde. MATERIAIS E MÉTODOS: O estudo foi realizado com 88 idosos, que foram submetidos a testes funcionais para avaliação da mobilidade funcional, equilíbrio estático e força muscular de membros inferiores. Além disso foi aplicada uma escala de depressão e coletada variáveis relacionadas a saúde do idoso. RESULTADOS: Os requisitos cinéticos funcionais e a sintomatologia depressiva também foram correlacionadas à capacidade de locomoção, todavia a força muscular (correlação de Spearman = 0,52, p=0,000) exibiu uma maior influência na mobilidade funcional. As variáveis que tiveram associação com uma pior mobilidade funcional foram: histórico de quedas (p=0,001), diabetes (p=0,008) e hipertensão (p=0,015). CONCLUSÃO: Nos idosos avaliados, a força muscular dos membros inferiores apresenta maior influência sobre a mobilidade funcional. Ser hipertenso, diabético e/ou já ter caído pode influenciar o desempenho funcional de locomoção. [AU]

INTRODUCTION: Functional mobility is a determinant factor to promote the independence of the elderly, with influence on physical and mental health. Tests to assess the functional capacity of the elderly should be aimed at simulating daily living activities of locomotion. OBJECTIVE: To verify the influence of functional kinetic requirements and health outcomes on the functional mobility of the elderly in a basic health unit. MATERIALS AND METHODS: The study was performed with 88 elderly, who underwent functional tests to evaluate functional mobility, static balance and lower limb muscle strength. In addition, a depression scale was applied and variables related to elderly health were collected. RESULTS: Functional kinetic requirements and depressive symptomatology were also correlated with locomotion capacity, but muscle strength (Spearman correlation = 0.52, p = 0.000) showed a greater influence on functional mobility. The variables that had an association with a worse functional mobility were: history of falls (p = 0.001), diabetes (p = 0.008) and hypertension (p = 0.015). CONCLUSION: In the elderly evaluated, lower limb muscle strength has a greater influence on functional mobility. Being hypertensive, diabetic and/or already having fallen can influence the functional performance of locomotion. [AU]

Capacidade de manutenção postural em diferentes atividades funcionais de idosos hipertensos e não hipertensos / Posture maintenance capacity in different functional activities of hypertensive and non-hypertensive elderly / Capacidad del mantenimiento de la postura de ancianos hipertensos y no hipertensos en distintas actividades funcionales

Objetivo: Comparar a capacidade de manutenção postural estática e dinâmica em atividades funcionais entre idosos hipertensos e não hipertensos. Métodos: Participaram deste estudo indivíduos com idade igual ou superior a 60 anos, provenientes de uma Unidade Básica de Saúde (UBS) em um município de pequeno porte no norte do estado do Piauí. A capacidade de manutenção postural foi medida através de três testes. A mobilidade funcional foi ponderada através do teste Timed Up and Go (TUG); o equilíbrio estático, por meio do Teste de Alcance Funcional (TAF); e a força muscular (FM) dos membros inferiores, pelo teste Short Physical Performance Battery (SPPB). Os idosos foram divididos em grupo HAS (hipertensos) e grupo controle (não hipertensos). Os dados foram analisados através do Software Graph Pad Prism, utilizando o teste t student não pareado para identificar diferenças entre os grupos. Resultados: Dos 88 voluntários, 43 pertencem ao grupo de hipertensos e 45 ao grupo controle. Para o TAF, o grupo HAS teve média da mensuração do alcance funcional de 15 (±5,60) centímetros, enquanto o grupo controle teve média de 17 (±5,88) centímetros. No teste SPPB, a média da FM para grupo HAS foi de 17,67 (±6,46) segundos e, para o grupo controle, foi de 17,01 (±3,53) segundos. A média do TUG para o grupo HAS foi 14,03 (±2,95) segundos e, para o grupo controle, foi 12,41 (±3,90) segundos. Houve associação entre grupos HAS e controle para os testes TAF (p=0,03) e SPPB (p=0,02). Conclusão: A hipertensão arterial sistêmica parece interferir na manutenção postural estática em idosos.

Objective: To compare static and dynamic posture maintenance capacity in functional activities between hypertensive and non-hypertensive elderly individuals. Methods: This study was held with participation of individuals aged 60 years or older, coming from a Basic Health Unit (BHU) in a small municipality in the north of the Piauí State. The posture maintenance capacity was assessed through the Timed Up and Go (TUG) test; the static balance, by means of the Functional Reach Test (FRT); and the muscle strength (MS) of the lower limbs, through the Short Physical Performance Battery (SPPB) test. The elderly were divided into: group HAS (hypertensive) and control group (non-hypertensive). The data was analyzed with use of the Graph Pad Prism Software, and unpaired Student's t-test was applied for identification of differences between the groups. Results: Of the 88 volunteers, 43 belong to the hypertensive group and 45 to the control group. For the FRT, group HAS had a mean functional reach measuring 15 (±5.60) centimeters, while the control group had an average of 17 (±5.88) centimeters. In the SPPB test, the mean MS for group HAS was 17.67 (±6.46) seconds and, for the control group, it was 17.01 (±3.53) seconds. The mean TUG for group HAS was 14.03 (±2.95) seconds and, for the control group, it was 12.41 (±3.90) seconds. There were associations between groups HAS and Control for FRT (p=0.03) and SPPB (p=0.02). Conclusion: Systemic arterial hypertension seems to interfere with static posture maintenance in the elderly.

Objetivo: Comparar la capacidad del mantenimiento de la postura estática y dinámica de ancianos hipertensos y no hipertensos enactividades funcionales. Métodos: Participaron de ese estudio individuos con edad mayor o igual a 60 años vinculados a una Unidad Básica de Salud (UBS) de un municipio pequeño del norte del Estado de Piauí. La capacidad del mantenimiento de la postura ha sido medida através de tres pruebas. La movilidad funcional fue evaluada a través del test Timed Up and Go (TUG); el equilibrio estático con el Teste de Alcance Funcional (TAF); y la fuerza muscular (FM) de los miembros inferiores con el teste Short Physical Performance Battery (SPPB). Los ancianos se dividieron en: grupo HAS (hipertensos) y grupo Control (no hipertensos). Se analizaron los datos con el Software Graph Pad Prism utilizando la prueba t de student no pareado para identificar las diferencias entre los grupos. Resultados: De los 88 voluntarios, 43 son del grupo de hipertensos y 45 del grupo control. El grupo HAS tuvo la media de la mensuración del alcance funcional en el TAF de 15 (±5,60) centímetros; el grupo control tuvo una media de 17 (±5,88) centímetros. La media de la FM en el teste SPPB para el grupo HAS fue de 17,67 (±6,46) segundos y de 17,01 (±3,53) segundos para el grupo control. La media del TUG para el grupo HAS fue de 14,03 (±2,95) segundos y 12,41 (±3,90) segundos para el grupo control. Hubo asociación entre los grupos HAS y control para los testes TAF (p=0,03) y SPPB (p=0,02). Conclusión: La hipertensión arterial sistémica parece influenciar en la manutención de la postura estática de ancianos

Mortality risk after cardiac surgery: application of Inscor in a University Hospital in Brazil's northeast

Abstract Objective: To apply the InsCor in patients undergoing cardiac surgery in a university hospital in Brazil's northeast. Methods: It is a retrospective, quantitative and analytical study, carried out at the University Hospital of the Federal University of Maranhão. InsCor is a remodeling of two risk score models. It evaluates the prediction of mortality through variables such as gender, age, type of surgery or reoperation, exams, and preoperative events. Data from January to December 2015 were collected, using a Physical Therapy Evaluation Form and medical records. Quantitative variables were expressed as mean and standard deviation and qualitative variables as absolute and relative frequencies. Fisher's exact and Kruskal-Wallis tests were applied, considering significant differences when P value was < 0.05. Calibration was performed by Hosmer-Lemeshow test. Results: One hundred and forty-eight patients were included. Thirty-six percent were female, with mean age of 54.7±15.8 years and mean body mass index (BMI) equal to 25.6 kg/m2. The most frequent surgery was coronary artery bypass grafting (51.3%). According to InsCor, 73.6% of the patients had low risk, 20.3% medium risk, and only 6.1% high risk. In this sample, 11 (7.4%) patients died. The percentage of death in patients classified as low, medium and high risk was 6.3, 7.1% and 11.1%, respectively. Conclusion: InsCor presented easy applicability due to the reduced number of variables analyzed and it showed satisfactory prediction of mortality in this sample of cardiac surgery patients.

Effects of Resistance Exercise Applied Early After Coronary Artery Bypass Grafting: a Randomized Controlled Trial

ABSTRACT OBJECTIVE: To evaluate the effects of resistance exercise applied early after coronary artery bypass grafting. METHODS: It is a randomized controlled trial with 34 patients undergoing coronary artery bypass grafting between August 2013 and May 2014. Patients were randomized into two groups by simple draw: a control group (n=17), who received conventional physical therapy and an intervention group (n=17), who received, additionally, resistance exercise. Pulmonary function and functional capacity were evaluated in preoperative period and hospital discharge by spirometry and the six-minute walk test. For statistical analysis, we used the following tests: Shapiro-Wilk, Mann-Whitney, Student'st and Fisher's exact. Variables withP<0.05 were considered significant. RESULTS: Groups were homogeneous in terms of demographic, clinical and surgical variables. Resistance exercise exerted no effect on pulmonary function of intervention group compared to control group. However, intervention group maintained functional capacity at hospital discharge measured by percentage of predict distance in 6MWT (54.122.7% vs. 52.515.5%,P=0.42), while control group had a significant decrease (59.211.1% vs. 50.69.9%, P<0.016). CONCLUSION: Our results indicate that resistance exercise, applied early, may promote maintenance of functional capacity on coronary artery bypass grafting patients, having no impact on pulmonary function when compared to conventional physical therapy.