RESUMO
BACKGROUND: Inflammatory bowel diseases (IBD) have been associated with a low quality of life (QoL) and a negative impact on work productivity compared to the general population. Information about disease control, patient-reported outcomes (PROs), treatment patterns and use of healthcare resources is relevant to optimizing IBD management. AIM: To describe QoL and work productivity and activity impairment (WPAI), treatment patterns and use of healthcare resources among IBD patients in Brazil. METHODS: A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn's disease (CD) or ulcerative colitis (UC). At enrolment, active CD and UC were defined as having a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or calprotectin > 200 µg/g or previous colonoscopy results suggestive of inadequate control (per investigator criteria) and a 9-point partial Mayo score ≥ 5, respectively. The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L, the Inflammatory Bowel Disease Questionnaire (IBDQ), and the WPAI questionnaire. Information about healthcare resources and treatment during the previous 3 years was collected from medical records. Chi-square, Fisher's exact and Student's t-/Mann-Whitney U tests were used to compare PROs, treatment patterns and the use of healthcare resources by disease activity (α = 0.05). RESULTS: Of the 407 patients in this study (CD/UC: 64.9%/35.1%, mean age 42.9/45.9 years, 54.2%/56.6% female, 38.3%/37.1% employed), 44.7%/25.2% presented moderate-to-severe CD/UC activity, respectively, at baseline. Expressed in median values for CD/UC, respectively, the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2, the EQ-visual analog scale score was 80.0/70.0, and the IBDQ overall score was 164.0/165.0. Moderate to severe activity, female gender, being unemployed, a lower educational level and lower income were associated with lower QoL (P < 0.05). Median work productivity impairment was 20% and 5% for CD and UC patients, respectively, and activity impairment was 30%, the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity (75.0% vs 10.0%, P < 0.001). For CD/UC patients, respectively, 25.4%/2.8% had at least one surgery, 38.3%/19.6% were hospitalized, and 70.7%/77.6% changed IBD treatment at least once during the last 3 years. The most common treatments at baseline were biologics (75.3%) and immunosuppressants (70.9%) for CD patients and 5-ASA compounds (77.5%) for UC patients. CONCLUSION: Moderate to severe IBD activity, especially among CD patients, is associated with a substantial impact on QoL, work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.
Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Brasil/epidemiologia , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/cirurgia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Estudos Transversais , Emprego/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Hypoglycemia affects patient safety and glycemic control during insulin treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). The Hypoglycemia Assessment Tool study in Brazil aimed to determine the proportion of patients experiencing hypoglycemic events and to characterize patient awareness and fear about hypoglycemia, among insulin-treated T1DM or T2DM patients. METHODS: This was a non-interventional, multicenter study, with a 6-month retrospective and a 4-week prospective evaluation of hypoglycemic events. Patients completed a questionnaire at baseline and at the end of the study, and also a patient diary. The answers 'occasionally' and 'never' to the question 'Do you have symptoms when you have a low sugar level?' denoted impaired hypoglycemia awareness. Fear was reported on a 10-point scale, from 'not afraid at all' to 'absolutely terrified'. RESULTS: From 679 included patients, 321 with T1DM and 293 T2DM, median age of 33.0 and 62.0 years, 59% and 56% were female, and median diabetes duration was 15.0 and 15.0 years, respectively. Median time of insulin use was 14.0 and 6.0 years. During the prospective period, 91.7% T1DM and 61.8% T2DM patients had at least one hypoglycemic event. In the same period, 54.0% T1DM and 27.4% T2DM patients had nocturnal hypoglycemia, 20.6% T1DM and 10.6% T2DM patients had asymptomatic hypoglycemia, and severe events occurred in 20.0% and 10.3%, respectively. At baseline, 21.4% T1DM and 34.3% T2DM had hypoglycemia unawareness. The mean score of hypoglycemia fear was 5.9 ± 3.1 in T1DM and 5.4 ± 3.9 in T2DM. The most common attitude after hypoglycemic events were to increase calorie intake (60.3%) and blood glucose monitoring (58.0%) and to reduce or skip insulin doses (30.8%). CONCLUSIONS: Referred episodes of hypoglycemia were high, in both T1DM and T2DM insulin users. Patient attitudes after hypoglycemia, such as reduction in insulin and increase in calorie intake, can affect diabetes management. These findings may support clinicians in tailoring diabetes education and insulin treatment for patients with diabetes, in order to improve their glycemic control while reducing the risk of hypoglycemic events.
RESUMO
Em uma lesão por queimadura, existe o prejuízo e/ou perdas de funções da pele além de complicações pulmonares quando associado à inalação de gases aquecidos. Objetivou-se com o estudo avaliar o efeito de um programa de hidroterapia e cinesioterapia respiratória associado a massoterapia sobre as variáveis respiratórias em uma voluntária portadora de queimadura na região torácica e cervical que foi submetida à avaliação fisioterapêutica constituída de espirometria, pico de fluxo expiratório, força muscular respiratória, mobilidade toracoabdominal e aplicação de Escala Análoga Visual (EVA) para avaliação de dor, desconforto e aderência cicatricial. O tratamento englobou alongamentos gerais para membros superiores e coluna cervical, recursos terapêuticos manuais, hidroterapia associada a cinesioterapia respiratória. Os resultados indicaram melhora da ADM de cervical e membros superiores, dos volumes, fluxos, capacidades e endurance respiratórias, da sensação de dor e desconforto. Verificou uma melhora nas variáveis respiratórias e amplitude de movimento, permitindo a reabilitação funcional e bem-estar do paciente grande queimado.
A burn injury can induce decrease of some or all skin function and can cause pulmonary complications when occur an association of warm gases inhalation. The aim of this work was to evaluate the effect of a hydrotherapy, respiratory kinesiotherapy and massotherapy program in respiratory volumes and flows in a burn volunteer with scars in thoracic and cervical regions. This volunteer was submitted to a physical therapy evaluation with range motion measurement (ROM) of cervical and arms (shoulder), spirometry, peak flow and respiratory muscular strength, thoracoabdominal mobility and application of Visual Analogous Scales (EVAs) for pain, discomfort and cicatrix malleability. The treatment was constituted by muscle stretching for superior member and cervical column, massotherapy using Cyriax, Watterwald, classic massage and respiratory kinesiotherapy performed in a 60 minutes session, totalizing 10 sessions. The results showed an increase in shoulder and cervical ROM, in respiratory capacities and strength and a decrease in pain and discomfort. Therefore it can be concluded in this program using hydrotherapy, respiratory kinesiotherapy and massotherapy was benefic for burned patient inducing an improvement in functional and welfare.