Objective Risk factors for in-hospital mortality in confirmed COVID-19 patients have been summarized in numerous meta-analyses, but it is still unclear whether they vary according to the age, sex and health conditions of the studied populations. This study explored these variables as potential mortality predictors. Methods A systematic review was conducted by searching the MEDLINE, Scopus, and Web of Science databases of studies available through July 27, 2020. The pooled risk was estimated with the odds ratio (p-OR) or effect size (p-ES) obtained through random-effects meta-analyses. Subgroup analyses and meta-regression were applied to explore differences by age, sex and health conditions. The MOOSE guidelines were strictly followed. Results The meta-analysis included 60 studies, with a total of 51,225 patients (12,458 [24.3%] deaths) from hospitals in 13 countries. A higher in-hospital mortality risk was found for dyspnoea (p-OR = 2.5), smoking (p-OR = 1.6) and several comorbidities (p-OR range: 1.8 to 4.7) and laboratory parameters (p-ES range: 0.3 to -2.6). Age was the main source of heterogeneity, followed by sex and health condition. The following predictors were more markedly associated with mortality in studies with patients with a mean age ≤60 years: dyspnoea (p-OR = 4.3), smoking (p-OR = 2.8), kidney disease (p-OR = 3.8), hypertension (p-OR = 3.7), malignancy (p-OR = 3.7), diabetes (p-OR = 3.2), pulmonary disease (p-OR = 3.1), decreased platelet count (p-ES = -1.7), decreased haemoglobin concentration (p-ES = -0.6), increased creatinine (p-ES = 2.4), increased interleukin-6 (p-ES = 2.4) and increased cardiac troponin I (p-ES = 0.7). On the other hand, in addition to comorbidities, the most important mortality predictors in studies with older patients were albumin (p-ES = -3.1), total bilirubin (p-ES = 0.7), AST (p-ES = 1.8), ALT (p-ES = 0.4), urea nitrogen (p-ES), C-reactive protein (p-ES = 2.7), LDH (p-ES = 2.4) and ferritin (p-ES = 1.7). Obesity was associated with increased mortality only in studies with fewer chronic or critical patients (p-OR = 1.8). Conclusion The prognostic effect of clinical conditions on COVID-19 mortality vary substantially according to the mean age of patients. PROSPERO registration number CRD42020176595.

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RESUMOObjetivos: Identificar a prevalência de obesidade global e central através do índice de massa corpórea (IMC) e razão cintura-quadril (RCQ), e suas associações como o diabetes melito (DM), a hipertensão arterial (HA), a hipercolesterolemia, os baixos níveis de lipoproteína colesterol de alta densidade (HDL-c), a hipertrigliceridemia, nível social, a atividade física e o tabagismo em população de idosos atendida em ambulatórios. Metodologia: Foram avaliados 847 idosos ambulatoriais com 60 anos ou mais, através de um estudo transversal. Resultados: A obesidade definida pelo IMC≥ 30kg/m 2 foi identificada em 9,3% dos homens e 23,8% das mulheres (p< 0,001), sendo menor entre os idosos com 80 anos ou mais, em ambos os sexos (p< 0,05). Em homens obesos, identificou-se uma maior freqüência de DM, HDL-c baixo e hipertrigliceridemia, quando comparados aos homens com IMC< 30kg/m 2 . As mulheres obesas apresentavam uma freqüência maior apenas de HA. Os pacientes com RCQ≥ percentil 75 (RCQ> 1,01 para homens e RCQ> 0,96 para mulheres) apresentavam maiores freqüências de HA, DM, HDL-c baixo e hipertrigliceridemia no sexo masculino e HA e DM no sexo feminino. Conclusões: Os resultados revelam diferenças em relação ao sexo, com os homens apresentando menor prevalência de obesidade e maiores associações entre IMC ou RCQ com os fatores de riscos relacionados à gordura corpórea. Os dados obtidos por este estudo contribuem para ampliação do referencial antropométrico dos idosos, além de identificarem as correlações entre os indicadores antropométricos e as alterações metabólicas associadas à obesidade. ABSTRACTObjective: The goal was to define the prevalence of global and central obesity through the body mass index (BMI) and the waist-to-hip ratio (WHR). Besides, the associations between BMI and WHR were evaluated as the risk factors related to the excess of body fat and to the central pattern of distribution of fat, such as diabetes mellitus (DM), hypertension, hypercholesterolaemia, low levels of high density lipoprotein cholesterol (HDL-c), hypertriglyceridaemia, smoking, practice of physical activities, and social level. Methodology: Through a cross-sectional study, 847 outpatients 60 years old or more were evaluated. Results: Obesity was detected in 9.3% of the men and 23.8% of the women (p< 0.001), being lower among those of 80 years old or more (p< 0.05). In fat men, a higher frequency of DM, low HDL-c, and hypertriglyceridaemia were identified when compared to men with BMI< 30kg/m 2 . Fat women presented higher frequencies of hypertension only. Patients with WHR≥ percentile 75 (WHR> 1.01 for men and WHR> 0.96 for women) presented higher frequencies of hypertension, DM, low HDL-c, and hypertriglyceridaemia in the male and hypertension and DM in the female. Conclusions: The results reveal differences in relation to sex, with men presenting lower prevalence of obesity and higher associations between BMI or WHR, with risk factors related to the body fat. The data obtained contribute to the perspectivas Obesidade em Idosos...

Adesão ao tratamento farmacológico e não farmacológico e fatores associados na atenção primária da hipertensão arterialAdherence to pharmacological and non pharmacological treatment for arterial hypertension and associated factors in primary care

RESUMOOBJETIVO. Caracterizar a dor crônica e os métodos analgésicos utilizados por idosos residentes na área de abrangência de uma Unidade Básica de Saúde (UBS), localizada na região norte da cidade de Londrina (PR). MÉTODOS. Estudo transversal descritivo com todos os indivíduos com 60 anos ou mais residentes na área de abrangência da UBS, através de inquérito domiciliar. Utilizou-se como critério de dor crônica a dor de duração mínima de seis meses. Os idosos foram questionados sobre as características da dor quanto à localização, duração, freqüência, intensidade, fatores de melhora e de piora, assim como o impacto da dor na vida do indivíduo e descrição dos métodos analgésicos utilizados. RESULTADOS. Foram entrevistados 172 idosos (101 mulheres e 71 homens). A presença de dor crônica foi observada em 107 (62,21%); no sexo feminino esta prevalência foi de 69,3% e no masculino 52,1% (p = 0,004). Os idosos mais velhos -80 anos ou mais -apresentaram maior referência de dor crônica (p = 0,01), assim como os idosos com depressão (p<0,001). Os locais de maior prevalência de dor foram membros inferiores e região dorsal, com 31,25% cada, sendo que grande número de idosos referiam dor diária, contínua e de alta intensidade. Em relação aos métodos analgésicos, houve predomínio dos métodos farmacológicos, referidos por 86 idosos (80,37%), e com maior utilização de analgésicos simples (32,6%). CONCLUSÃO. Os dados mostram que há uma grande prevalência de dor crônica nessa população de idosos, principalmente nas mulheres com 80 anos ou mais e nos indivíduos depressivos. UNITERMOS: Analgesia. Dor. Doença crônica. Idoso. Centros de saúde. Estudos transversais.

Negative self-perception of oral health was associated with gender and depression, but not with poor oral health. Therefore, gender and the presence of depression are factors to be taken into account in assessments involving this age group.

BackgroundThe Brazilian healthcare system offers universal coverage but lacks information about how patients with PC needs are serviced by its primary care program, Estratégia Saúde da Família (ESF).MethodsCross-sectional study in community settings. Patients in ESF program were screened using a Palliative Care Screening Tool (PCST). Included patients were assessed with Karnofsky Performance Scale (KPS), Edmonton Symptom Assessment System (ESAS) and Palliative Care Outcome Scale (POS).ResultsPatients with PC needs are accessing the ESF program regardless of there being no specific PC support provided. From 238 patients identified, 73 (43 women, 30 men) were identified as having a need for PC, and the mean age was 77.18 (95 % Confidence Interval = ±2,78) years, with non-malignant neurologic conditions, such as dementia and cerebrovascular diseases, being the most common (53 % of all patients). Chronic conditions (2 or more years) were found in 70 % of these patients, with 71 % scoring 50 or less points in the KPS. Overall symptom intensity was low, with the exception of some cases with moderate and high score, and POS average score was 14.16 points (minimum = 4; maximum = 28). Most patients received medication and professional support through the primary care units, but limitations of services were identified, including lack of home visits and limited multi-professional approaches.ConclusionPatients with PC needs were identified in ESF program. Basic health care support is provided but there is a lack of attention to some specific needs. PC policies and professional training should be implemented to improve this area.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0125-4) contains supplementary material, which is available to authorized users.

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