Fatores associados à procura por serviços de saúde numa perspectiva relacional de gêneroFactors associated with the demand for health services from a gender-relational perspective

ResumoObjetivo: Identificar os principais fatores associados a quedas e fraturas de fêmur em idosos. Métodos: Trata-se de estudo caso-controle (um grupo de casos e dois grupos controle) na proporção de 1:1:1, em que foram estudados 135 indivíduos com idade ≥60 anos, pareados por sexo, no período de 2005 a 2012. Os dados foram coletados por meio de entrevistas nos domicílios dos participantes, e realizou-se levantamento de informações em prontuários. Para análise das diferenças entre proporções e médias entre os grupos, empregaram-se o teste qui-quadrado e o teste t Student, respectivamente. Para o estudo da associação entre variáveis, foram realizadas análises univariadas e multivariadas empregando-se regressão logística. Como medida de efeito, foram empregados odds ratio (OR) e seu intervalo de confiança a 95% (IC95%). Em todas as análises, considerou-se um nível de significância de 5%. Resultados: Após análise multivariada, os fatores de proteção contra fratura de fêmur foram: ouvir bem e possuir corrimão nas escadas de suas residências. Os fatores de risco para fratura de fêmur foram: hipertensão arterial sistêmica, sedentarismo e possuir superfície escorregadia na residência. Os fatores de proteção para queda foram: possuir corrimão nas escadas de suas residências, ser portador de osteoporose e depressão. O fator de risco de queda foi o sedentarismo. Conclusão: As fraturas de fêmur representam importante fator de morbidade em idosos. Conhecer os fatores de risco para fraturas pós-queda em idosos é essencial para o planejamento de ações individuais e coletivas voltadas à prevenção deste agravo e suas consequências. Atividades físicas, planos terapêuticos mais adequados e correção de inadequações nos domicílios desses indivíduos devem ser orientados e incentivados. Palavras

Fraturas de fêmur em pessoas com idade igual ou superior a 60 anos (idosos) representam um grande impacto para a saúde pública, e estão associadas à elevada morbimortalidade e grandes custos socioeconômicos. Buscou-se descrever temporal e espacialmente os casos de fratura de fêmur em idosos de todas as regiões do país, por sexo, em um período de cinco anos. Foram realizadas descrições de série temporal e espacial bayesiana, baseadas em dados obtidos do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS), empregando modelo de regressão de Poisson, sobre os casos ocorridos entre os anos de 2008-2012. No período estudado ocorreram mais de 181 mil casos de fratura de fêmur, predominando o sexo feminino, sem correlações espaciais e diferenças temporais importantes. Apesar de não se observar predomínio de comportamento temporal e espacial, o número de casos de fratura de fêmur no Brasil é alto e com grandes custos financeiros e sociais. Políticas públicas de saúde visando a controlar os fatores predisponentes para esse evento devem ser urgentemente implementadas.

Since the introduction of highly active antiretroviral therapy (HAART) in 1996, there have been worldwide shifts in the causes of hospitalization for patients with HIV/AIDS. The aim of this study was to describe the characteristics of HIV/AIDS patient hospitalizations between 1997 and 2012. This cross-sectional study used a hospital database that centralizes records of admissions in 31 hospitals, both public and private, across 26 municipalities in the interior of São Paulo. In order to verify associations between the variables, we used the prevalence ratio (PR) and a 95% confidence interval. Among 9,797 adults and children, 10,696 admissions were registered, which was equal to 1.09 admissions per patient. Most (62%) of the patients were male, and the predominant age group was 21 and 50 years (63.5%). Mortality was higher among male patients from all age groups (PR= 1.42 [95% CI: 1.28-1.57]; p < 0.05). The main cause of hospitalization (54.5% of the total) was infectious disease, whether opportunistic or not. This was true, even in the post-HAART era. Furthermore, gender and age differences were noted in patient mortality rates.

Objective:To describe and analyze the occurrence of hospitalizations for community-acquired pneumonia in children before and after the pneumococcal 10-valent conjugate vaccine implementation into the National Immunization Program.Methods:This is an ecological study that includes records of children younger than one year old, vaccinated and not vaccinated with the pneumococcal 10-valent conjugate vaccine in the periods pre- and post-inclusion of the vaccine in the National Immunization Program in the area covered by the Regional Health Superintendence of Alfenas, state of Minas Gerais, Brazil. Vaccination was considered as the exposure factor and hospitalization for community-acquired pneumonia as the endpoint, using secondary annual data by municipality. The prevalence ratio and its 95% confidence interval (95%CI) were used to verify the association between variables. The Z test was used to calculate the difference between proportions.Results:Considering the 26 municipalities of the Regional Health Superintendence of Alfenas, there was a significant reduction in hospitalizations for community-acquired pneumonia in children younger than one year of age, with prevalence ratio (PR)=0.81 (95%CI: 0.74-0.89; p<0.05), indicating a 19% lower prevalence of hospitalization for community-acquired pneumonia in the post-vaccination period.Conclusions:The results suggest the effectiveness of the pneumococcal 10-valent conjugate vaccine in preventing severe cases of community-acquired pneumonia in children younger than one year of age.

These findings contribute favourably to effectively minimising the risk factors related to the disease process and natural history of community-acquired pneumonia.

The study aimed to analyze the scientific production on the association between asthma and type 2 diabetes mellitus (T2DM) in adults, the mechanisms that explain this association, and its impact on asthma control. A literature review of scientific articles indexed in the MEDLINE/PUBMED, BVS, CINAHL, Cochrane Library, and Web of Science databases was carried out, considering publications from January 2009 to December 2019, using the following descriptors: “asthma”, “type 2 diabetes”, “adult,” and “association”. Of 962 articles found, 18 were included because they met the eligibility criteria. It is suggested that the association between asthma and T2DM is caused by low-grade systemic inflammation (7 articles) or the use of corticosteroids (7 articles). It is noticed that there is a limited scientific production regarding the consequences of this association for the control of asthma (5 articles). It is concluded that asthma and T2DM are two common chronic conditions of increasing prevalence and that often coexist in the same patient. It is suggested that this coexistence worsens asthma control. Therefore, the study may support public policies and clinical health practices that value the approach of comorbidities associated with asthma such as T2DM, in order to minimize additional health risks and reduce the quality of life.

Objective:To evaluate the relationship between obesity and asthma. Methods:This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. Results:Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). Conclusions:Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.