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A systematic review and meta-analysis were conducted to evaluate the benefit of an axillary surgical approach on overall survival and secondarily of breast surgery amongst patients with metastatic breast cancer which is considered to be an incurable disease. However, an axillary surgical approach showed no association with overall survival in patients with metastatic breast cancer. The true impact of locoregional therapies on long-term outcomes remains unknown, and randomised clinical trials are needed.
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Abstract Introduction: Chronic rhinosinusitis can lead to poor sleep quality in affected individuals. Endoscopic nasal surgery has been indicated for patients with chronic rhinosinusitis, resulting in improved quality of life, but it is still unknown if there is a similar improvement in sleep quality after the surgical procedure. Objective: To estimate the sleep quality of patients with chronic rhinosinusitis after undergoing endoscopic sinus surgery. Methods: The literature search was conducted in the indexed databases PubMed, Embase, Lilacs, SciELO, Google Scholar, Web of Science, Scopus, Database of Thesis and Dissertations of CAPES, Cochrane Library, Clinical Trials and in the grey literature. It included studies that reported the sleep quality of patients with chronic rhinosinusitis after undergoing endoscopic sinus surgery based on questionnaires assessing quality of life. Two researchers independently conducted the study selection and extraction. The random effects model was chosen to conduct the meta-analysis that was performed using the statistical package STATA, version 11. Results: Overall, 4 studies and 509 subjects were included in the systematic review. Improved sleep quality was observed in 90% of the patients. There was an improvement (on average, from 57% to 67%) in each of the five symptoms related to sleep quality. The results of the meta-analysis revealed high heterogeneity. Conclusions: This review shows that a large percentage of patients report improved sleep quality after endoscopic sinus surgery.
Resumo Introdução: A rinossinusite crônica pode levar a uma má qualidade do sono nos indivíduos afetados. A cirurgia endoscópica nasal tem sido indicada para pacientes com rinossinusite crônica, resulta em melhoria da qualidade de vida, mas ainda não se sabe se há melhoria semelhante na qualidade do sono após o procedimento cirúrgico. Objetivo: Estimar a qualidade do sono em pacientes com rinossinusite crônica após serem submetidos à cirurgia endoscópica nasossinusal. Método: A busca na literatura foi feita nas bases de dados indexadas PubMed, Embase, Lilacs, SciELO, Google Scholar, Web of Science, Scopus, Banco de Teses e Dissertações da Capes, Cochrane Library, Clinical Trials e na literatura cinzenta. Foram incluídos estudos que relataram a qualidade do sono de pacientes com rinossinusite crônica após ser submetidos à cirurgia endoscópica nasossinusal, com base em questionários que avaliaram a qualidade de vida. Dois pesquisadores conduziram independentemente a seleção e extração dos estudos. O modelo de efeitos aleatórios foi escolhido para conduzir a meta-análise que foi feita com o pacote estatístico STATA, versão 11. Resultados: No total, 4 estudos e 509 indivíduos foram incluídos na revisão sistemática. Melhora na qualidade do sono foi observada em 90% dos pacientes. Houve melhora (em média, de 57% a 67%) em cada um dos cinco sintomas relacionados à qualidade do sono. Os resultados da meta-análise apresentaram alta heterogeneidade. Conclusões: Esta revisão mostra que uma grande porcentagem de indivíduos relata melhoria na qualidade do sono após a cirurgia endoscópica nasossinusal.
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Humanos , Sinusite/cirurgia , Sono/fisiologia , Rinite/cirurgia , Endoscopia/métodos , Qualidade de Vida , Pólipos Nasais/cirurgia , Doença Crônica , Inquéritos e Questionários , Procedimentos Cirúrgicos NasaisRESUMO
INTRODUCTION: Chronic rhinosinusitis can lead to poor sleep quality in affected individuals. Endoscopic nasal surgery has been indicated for patients with chronic rhinosinusitis, resulting in improved quality of life, but it is still unknown if there is a similar improvement in sleep quality after the surgical procedure. OBJECTIVE: To estimate the sleep quality of patients with chronic rhinosinusitis after undergoing endoscopic sinus surgery. METHODS: The literature search was conducted in the indexed databases PubMed, Embase, Lilacs, SciELO, Google Scholar, Web of Science, Scopus, Database of Thesis and Dissertations of CAPES, Cochrane Library, Clinical Trials and in the grey literature. It included studies that reported the sleep quality of patients with chronic rhinosinusitis after undergoing endoscopic sinus surgery based on questionnaires assessing quality of life. Two researchers independently conducted the study selection and extraction. The random effects model was chosen to conduct the meta-analysis that was performed using the statistical package STATA, version 11. RESULTS: Overall, 4 studies and 509 subjects were included in the systematic review. Improved sleep quality was observed in 90% of the patients. There was an improvement (on average, from 57% to 67%) in each of the five symptoms related to sleep quality. The results of the meta-analysis revealed high heterogeneity. CONCLUSIONS: This review shows that a large percentage of patients report improved sleep quality after endoscopic sinus surgery.
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Endoscopia/métodos , Rinite/cirurgia , Sinusite/cirurgia , Sono/fisiologia , Doença Crônica , Humanos , Pólipos Nasais/cirurgia , Procedimentos Cirúrgicos Nasais , Qualidade de Vida , Inquéritos e QuestionáriosAssuntos
Recém-Nascido de Baixo Peso , Fumar , América , Feminino , Humanos , Recém-Nascido , Gravidez , Fumar TabacoRESUMO
OBJECTIVES: To estimate the prevalence of multimorbidity and to identify factors associated with it in the adult population from the metropolitan region of Manaus. DESIGN: Cross-sectional population-based study. SETTING: Interviews conducted between May and August of 2015 in eight cities that compose the metropolitan region of Manaus, Amazonas, Brazil. PARTICIPANTS: 4001 adults aged ≥18 years. PRIMARY OUTCOME MEASURES: Multimorbidity, measured by the occurrence of ≥2 and ≥3 chronic diseases, was the primary outcome. The associated factors were investigated by calculating the prevalence ratio (PR) obtained by Poisson regression, with robust adjustment of the variance in a hierarchical model. A factor analysis was conducted to investigate multimorbidity clusters. RESULTS: Half of the interviewees were women. The presence of a chronic disease was reported by 57.2% (95% CI 56.6% to 59.7%) of the interviewees, and the mean morbidity was 1.2 (1.1-1.2); 29.0% (95% CI 27.6% to 30.5%) reported ≥2 morbidities and 15.2% (95% CI 14.1% to 16.4%) reported ≥3 chronic conditions. Back pain was reported by one-third of the interviewees. Multimorbidity was highest in women, PR=1.66 (95% CI 1.50 to 1.83); the elderly, PR=5.68 (95% CI 4.51 to 7.15) and individuals with worse health perception, PR=3.70 (95% CI 2.73 to 5.00). Associated factors also included undergoing medical consultations, hospitalisation in the last year, suffering from dengue in the last year and seeking the same healthcare service. Factor analysis revealed a pattern of multimorbidity in women. The factor loading the most strength of association in women was heart disease. In men, an association was identified in two groups, and lung disease was the disease with the highest factorial loading. CONCLUSION: Multimorbidity was frequent in the metropolitan region of Manaus. It occurred most often in women, in the elderly and in those with worse health perception.
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Múltiplas Afecções Crônicas/epidemiologia , Adolescente , Adulto , Dor nas Costas/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Dengue/epidemiologia , Análise Fatorial , Feminino , Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Distribuição de Poisson , Prevalência , Análise de Regressão , Fatores Sexuais , Adulto JovemRESUMO
OBJECTIVE: To systematically analyze the relationship between maternal anemia and low birth weight. METHODS: A search of studies was conducted in the main databases (Medline, Embase, Scopus, Web of Science, SciELO, and Lilacs), the gray literature, and the reference lists of selected articles. Cohort and case-control studies that met the eligibility criteria were included in the review. There was no limitation on the language or date of publication. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects, subgroup analyses and meta-regressions were performed. Publication bias was measured using Egger regression and visual funnel plot inspection. RESULTS: A total of 7243 articles were found, of which 71 comprised the systematic review and 68 were included in the meta-analyses. Maternal anemia was associated with low birth weight with an adjusted OR: 1.23 (95% CI: 1.06â»1.43) and I²: 58%. The meta-regressions confirmed that the sample size and the methodological quality may partially explain the statistical heterogeneity. CONCLUSIONS: Maternal anemia was considered a risk factor for low birth weight.
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Anemia Ferropriva/epidemiologia , Recém-Nascido de Baixo Peso , Feminino , Hemoglobinas/análise , Humanos , Recém-Nascido , Estudos Observacionais como Assunto , Gravidez , Fatores de RiscoRESUMO
BACKGROUND: The comparison between long acting insulin analogues (LAIA) and human insulin (NPH) has been investigated for decades, with many randomized controlled trials (RCTs) and systematic reviews giving mixed results. This overlapping and contradictory evidence has increased uncertainty on coverage decisions at health systems level. AIM: To conduct an overview of systematic reviews and update existing reviews, preparing new meta-analysis to determine whether LAIA are effective for T1D patients compared to NPH. METHODS: We identified systematic reviews of RCTs that evaluated the efficacy of LAIA glargine or detemir, compared to NPH insulin for T1D, assessing glycated hemoglobin (A1C) and hypoglycemia. Data sources included Pubmed, Cochrane Library, EMBASE and hand-searching. The methodological quality of studies was independently assessed by two reviewers, using AMSTAR and Jadad scale. We found 11 eligible systematic reviews that contained a total of 25 relevant clinical trials. Two reviewers independently abstracted data. RESULTS: We found evidence that LAIA are efficacious compared to NPH, with estimates showing a reduction in nocturnal hypoglycemia episodes (RR 0.66; 95% CI 0.57; 0.76) and A1C (95% CI 0.23; 0.12). No significance was found related to severe hypoglycemia (RR 0.94; 95% CI 0.71; 1.24). CONCLUSION: This study design has allowed us to carry out the most comprehensive assessment of RCTs on this subject, filling a gap in diabetes research. Our paper addresses a question that is important not only for decision makers but also for clinicians.
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Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina de Ação Prolongada/uso terapêutico , Hemoglobinas Glicadas/química , Humanos , Hipoglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina Detemir/uso terapêutico , Insulina Glargina/uso terapêutico , Modelos Estatísticos , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de RegressãoRESUMO
OBJECTIVES: To estimate the prevalence of healthcare use and associated factors in the Manaus metropolitan region and to describe the reasons for lack of access. DESIGN: Cross-sectional population-based study. SETTING: A survey conducted between May and August of 2015 in eight cities from Manaus metropolitan region, Amazonas, Brazil. PARTICIPANTS: 4001 adults ≥18 years of age. PRIMARY OUTCOMES MEASURES: Physician visits, dentist visits and hospitalisations in the last 12 months were the primary outcomes. Associated factors were investigated through the calculation of prevalence ratio (PR) obtained by hierarchical Poisson regression modelling. RESULTS: 4001 adults were included in the study, 53% of whom were women. The self-reported prevalence of medical visits was 77% (95% CI 75% to 77%); dentist visits, 36% (95% CI 34% to 37%) and hospital admission, 7% (95% CI 6% to 7%). Physician visits were higher in women PR=1.18 (95% CI 1.14 to 1.23), the elderly PR=1.18 (95% CI 1.10 to 1.26) and people with health insurance PR=1.14 (95% CI 1.10 to 1.19). Dentist visits declined with older age PR=0.38 (95% CI 0.30 to 0.49), lower education level PR=0.62 (95% CI 0.51 to 0.74) and lower economic class PR=0.65 (95% CI 0.57 to 0.75). Hospitalisations were found to be twice as frequent for women than for men and three times as frequent among those who reported very poor health status. Among the individuals who did not receive medical attention in the previous 2 weeks, 58% reported lack of facilities or appointment unavailable and 14% reported lack of doctors. CONCLUSION: While more than half visited the doctor in the last year, a lower proportion of people with socioeconomic inequities visited the dentist. Organisational and service policies are needed to increase equity in health services in the region.
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Serviços de Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Brasil , Estudos Transversais , Escolaridade , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores Sexuais , Fatores SocioeconômicosRESUMO
Objective: To estimate and compare the effect of self-reported long-term health conditions and sociodemographic factors on perceived health-related quality of life (HRQoL). Methods: A population-based survey of adults (18 to 65 years) living in Brasilia, Brazil, was conducted in 2012. Descriptive and multivariate analyses using a Tobit model were performed with data on sociodemographic variables, self-reported conditions, and the European Quality of Life-5 Dimensions (EQ-5D) health states, providing utility scores (preferred health state) between 0 and 1 for HRQoL estimates. Results: The mean utility of 1,820 adults interviewed (mean age: 38.4±12.6 years) was 0.883 (95% confidence interval [95%CI] 0.874-0.892), with 76.2% in the highest utility range (0.8 to 1.0). EQ-5D dimensions with moderate problems were pain/discomfort (33.8%) and anxiety/depression (20.5%). Serious problems were reported by only 0.3% of the sample in the mobility and self-care domain and by 3.1% in the pain/discomfort domain. Multivariate analysis revealed reduced HRQoL in individuals with depression, diabetes, and hypertension. Living in satellite towns (outside the city core), belonging to a lower economic class, or not being formally employed were also associated with decreased HRQoL. Beta coefficients for these impacts ranged from -0.033 (not formally employed) to -0.141 (depression), reflecting the strongest impact. Conclusion: Of the long-term health conditions studied, depression had the greatest impact on HRQoL. Social class, employment status, and place of residence also affected HRQoL.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Qualidade de Vida/psicologia , Autoimagem , Doença Crônica/psicologia , Depressão/psicologia , Fatores Socioeconômicos , Brasil , Vigilância da População , Nível de Saúde , Estudos TransversaisRESUMO
OBJECTIVE:: To estimate and compare the effect of self-reported long-term health conditions and sociodemographic factors on perceived health-related quality of life (HRQoL). METHODS:: A population-based survey of adults (18 to 65 years) living in Brasilia, Brazil, was conducted in 2012. Descriptive and multivariate analyses using a Tobit model were performed with data on sociodemographic variables, self-reported conditions, and the European Quality of Life-5 Dimensions (EQ-5D) health states, providing utility scores (preferred health state) between 0 and 1 for HRQoL estimates. RESULTS:: The mean utility of 1,820 adults interviewed (mean age: 38.4±12.6 years) was 0.883 (95% confidence interval [95%CI] 0.874-0.892), with 76.2% in the highest utility range (0.8 to 1.0). EQ-5D dimensions with moderate problems were pain/discomfort (33.8%) and anxiety/depression (20.5%). Serious problems were reported by only 0.3% of the sample in the mobility and self-care domain and by 3.1% in the pain/discomfort domain. Multivariate analysis revealed reduced HRQoL in individuals with depression, diabetes, and hypertension. Living in satellite towns (outside the city core), belonging to a lower economic class, or not being formally employed were also associated with decreased HRQoL. Beta coefficients for these impacts ranged from -0.033 (not formally employed) to -0.141 (depression), reflecting the strongest impact. CONCLUSION:: Of the long-term health conditions studied, depression had the greatest impact on HRQoL. Social class, employment status, and place of residence also affected HRQoL.
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Doença Crônica/psicologia , Depressão/psicologia , Qualidade de Vida/psicologia , Autoimagem , Adolescente , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND: Long-acting insulin analogues for type 1 diabetes (T1D) treatment have been available on the Brazilian market since 2002. However, the population cannot access the analogues through the public health system. OBJECTIVE: To estimate the incremental budget impact of long-acting insulin analogues coverage for T1D patients in the Brazilian public health system compared to NPH insulin. METHODS: We performed a budget impact analysis of a five-year period. The eligible population was projected using epidemiological data from the International Diabetes Federation estimates for patients between 0-14 and 20-79 years old. The prevalence of T1D was estimated in children, and the same proportion was applied to the 15-19-year-old group due to a gap in epidemiological information. We considered 4,944 new cases per year and a 34.61/100,000 inhabitants mortality rate. Market share for long-acting insulin analogues was assumed as 20% in the first year, reaching 40% in the fifth year. The mean daily dose was taken from clinical trials. We calculated the bargaining power of the Ministry of Health by dividing the price paid for human insulin in the last purchase by the average regulated price. We performed univariate and multivariate sensitivity analyses. RESULTS: The incremental budget impact of long-acting insulin analogues was US$ 28.6 million in the first year, and reached US$ 58.7 million in the fifth year. The total incremental budget impact was US$ 217.9 million over the five-year period. The sensitivity analysis showed that the percentage of T1D among diabetic adults and the insulin analogue price were the main factors that affected the budget impact. CONCLUSIONS: The cost of the first year of long-acting insulin analogue coverage would correspond to 0.03% of total public health expenditure. The main advantage of this study is that it identifies potential bargaining power because it features more realistic profiles of resource usage, once centralized purchasing is established as an economically sustainable strategy. Clinical guidelines restricting the use of insulin analogues would make the decision towards insulin analogue coverage more affordable.
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Diabetes Mellitus Tipo 1/economia , Hipoglicemiantes/economia , Insulina Isófana/economia , Insulina de Ação Prolongada/economia , Saúde Pública/economia , Adolescente , Adulto , Idoso , Brasil , Criança , Pré-Escolar , Análise Custo-Benefício/estatística & dados numéricos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Hipoglicemiantes/uso terapêutico , Lactente , Recém-Nascido , Insulina Isófana/uso terapêutico , Insulina de Ação Prolongada/uso terapêutico , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To estimate the prevalence of obesity and overweight and associated factors in indigenous people of the Jaguapiru village in Central Brazil. METHODS: We conducted a population-based cross-sectional study between January 2009 and July 2011 in the adult native population of the Jaguapiru village, Central Brazil. Sociodemographic and lifestyle data were obtained; anthropometric measures, arterial blood pressure, and blood glucose were measured. The independent variables were tested by Poisson regression, and the interactions between them were analyzed. RESULTS: 1,608 indigenous people (982 females, mean age 37.7 ± 15.1 years) were included. The prevalence of obesity was 23.2% (95% CI 20.9-25.1%). Obesity was more prevalent among 40- to 49-year-old and overweight among 50- to 59-year-old persons. Obesity was positively associated with female sex, higher income, and hypertension. Among indigenous people, interactions were found with hypertension and sedentary lifestyle - hypertension in males and sedentary lifestyle in females. CONCLUSIONS: The prevalence of obesity and overweight in indigenous people of the Jaguapiru village is high. Males as well as hypertensive and higher family income individuals have higher rates. Sedentary lifestyle and hypertension leverage the rates of obesity. Prevention and adequate public health policies can be critical for the control of excess weight and its comorbidities among Brazilian indigenous people.
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Indígenas Sul-Americanos/estatística & dados numéricos , Obesidade/epidemiologia , Adulto , Brasil/epidemiologia , Brasil/etnologia , Estudos Transversais , Feminino , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Distribuição de Poisson , Prevalência , Comportamento Sedentário , Fatores Socioeconômicos , Adulto JovemRESUMO
Aim. The aim of this study was to estimate the prevalence of diabetes and its associated risk factors in adults from Brasilia, Brazil. Methods. The present cross-sectional population-based study consisted of interviews with individuals aged 18-65 years. Participants were selected through two-stage probability sampling by clusters and stratified by sex and age. Demographic and clinical data were collected directly with participants from February to May 2012. Self-reported diabetes prevalence was calculated at a 95% confidence interval (CI). Prevalence ratios (PR) were adjusted by Poisson regression with robust variance. Results. In all, 1,820 individuals were interviewed. Diabetes prevalence in the adult population of Brasilia was 10.1% (95% CI, 8.5%-11.6%). Variables associated with diabetes were an age between 35 and 49 years (PR = 1.83; 95% CI, 1.19-2.82) or 50 and 65 years (PR = 1.95; 95% CI, 1.17-3.23), hypertension (PR = 4.04; 95% CI, 2.66-6.13), respiratory disease (PR = 1.67; 95% CI, 1.11-2.50), cardiovascular disease (PR = 1.74; 95% CI, 1.15-2.63), and pain/discomfort (PR = 1.71; 95% CI, 1.21-2.41). Conclusion. Diabetes is a prevalent condition in adults living in Brasilia, and disease risk increases with age and comorbidities. Future health policies should focus on screening programs and prevention for the more vulnerable groups.
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Objective: To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in population-based cross-sectional studies of Brazilian adults. Methods: We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects. Results: Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity could be identified. Conclusion: Depression morbidity was common among Brazilian adults, and affects more women than men. Inconsistencies across studies highlight the need for standardization of future research. Clinicians should routinely investigate for the presence of depression morbidity in this population. .
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Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Prevalência , Distribuição por Sexo , Fatores SexuaisRESUMO
OBJECTIVE: To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in population-based cross-sectional studies of Brazilian adults. METHODS: We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects. RESULTS: Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity could be identified. CONCLUSION: Depression morbidity was common among Brazilian adults, and affects more women than men. Inconsistencies across studies highlight the need for standardization of future research. Clinicians should routinely investigate for the presence of depression morbidity in this population.
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Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fatores Sexuais , Adulto JovemRESUMO
OBJECTIVE: To assess the effects of problem-based learning (PBL) on the learning achievements of pharmacy students. METHODS: We searched for controlled studies that compared PBL to traditional learning in pharmacy courses (graduate and undergraduate) in the major literature databases up to January 2014. Two independent researchers selected the studies, extracted the data, and assessed the quality of the studies. Meta-analyses of the outcomes were performed using a random effects model. RESULTS: From 1,988 retrieved records, five were included in present review. The studies assessed students' impressions about the PBL method and compared student grades on the midterm and final examinations. PBL students performed better on midterm examinations (odds ratio [OR] = 1.46; confidence interval [IC] 95%: 1.16, 1.89) and final examinations (OR = 1.60; IC 95%: 1.06, 2.43) compared with students in the traditional learning groups. No difference was found between the groups in the subjective evaluations. CONCLUSION: pharmacy students' knowledge was improved by the PBL method. Pharmaceutical education courses should consider implementing PBL.
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Educação em Farmácia , Aprendizagem Baseada em Problemas , HumanosRESUMO
PURPOSE: To assess the prevalence of medicine use in adults of Brasilia and to elucidate the associated factors. METHODS: A cross-sectional study was conducted with adults (18 to 65 years) living in Brasilia, who were selected using a two-stage probabilistic sampling and interviewed in their home, from February to May 2012. The primary outcome was the use of medicines in the last 7 days. A Poisson regression with robust variance was employed to adjust for covariates following a hierarchical model. RESULTS: The study included 1820 individuals (11% losses), 60% of which were women, and the mean age was 37 ± 12.6 years. The prevalence of drug consumption was 35.7% (95% confidence interval [95%CI]: 33.5%-37.9%). Medicine consumption was significantly higher in women (prevalence ratio [PR] = 1.54; 95%CI: 1.28-1.85); unemployed or retired people (PR = 1.35; 95%CI: 1.15-1.59); people with hypertension (PR = 2.33; 95%CI: 2.00-2.71), diabetes (PR = 1.46; 95%CI: 1.22-1.74), depression (PR = 1.32; 95%CI: 1.13-1.53), or other chronic diseases (PR = 1.50; 95%CI: 1.26-1.79); and study participants who had a recent medical consultation (PR = 1.49; 95%CI: 1.29-1.71). Medication use was significantly higher at older ages. The participants obtained about half of the drugs from the Brazilian public health system, but this access was significantly different according to the economic class. CONCLUSIONS: Medication use was common among adults living in Brasilia and is associated with sex, age, health conditions, and access to healthcare.
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Uso de Medicamentos/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Preparações Farmacêuticas/administração & dosagem , Prática de Saúde Pública/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: The aim of the present study was to assess the prevalence of hypertension and cardiovascular risk factors among the native indigenous of Jaguapiru village in Dourados, Mato Grosso do Sul, Brazil. METHOD: A cross-sectional, population-based study was conducted with adult indigenous aged 18 years or more. The subjects' blood pressure was measured twice, and the mean of the two measurements was calculated. Body weight, height, capillary blood glucose and waist circumference were measured. Pregnant women, individuals using glucocorticoids, and non-indigenous villagers and their offspring were excluded. Multivariate regression analyses were conducted on the socio-demographic and clinical independent variables. Interactions between independent variables were also tested. RESULTS: We included 1,608 native indigenous eligible to the research. The prevalence of hypertension was 29.5% (95% CI: 27-31.5), with no significant difference between the genders. For both men and women, diastolic hypertension was more common than systolic hypertension. The prevalence of hypertension was higher among obese, diabetic, and older participants, as well as those who consumed alcohol, had a lower educational level, or had a family history of hypertension. There was no association between hypertension and tobacco smoking or family income. CONCLUSION: Hypertension among the indigenous from Jaguapiru village was similar to the prevalence in the Brazilians, but may have a more negative effect in such disadvantaged population. The associated factors we found can help drawing prevention policies.
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Hipertensão/epidemiologia , Adulto , Pressão Sanguínea , Peso Corporal , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar , Adulto JovemRESUMO
BACKGROUND: Because the incidence of depression increases after puberty, it is possible that pubertal timing in girls influences the onset of depression. Our objective was to assess the effect of early and late puberty in girls on the incidence of depression. METHODS: We systematically searched relevant databases for controlled studies that assessed the impact of pubertal timing in girls on the incidence of depression or depressive symptoms. The last search was completed in August 2013. Two authors selected the studies, extracted the data, and assessed the quality of the evidence. Meta-analyses of the adjusted and unadjusted results were calculated using random effects. RESULTS: Four cohort studies were included (n=8055 participants). Early puberty significantly increased the risk of new cases of depression in the unadjusted meta-analysis (RR=1.33; CI 95%: 1.02, 1.73) but not in the adjusted estimate of two of the included studies (RR=1.48; CI 95%: 0.69, 2.28). For late puberty, no significant associations were found (unadjusted RR=1.28; CI 95%: 0.87, 1.88). Two studies assessed the effect of early puberty on depressive symptoms and found positive associations. The quality of the available evidence was rated as very low. LIMITATIONS: The polled results had wide confidence intervals, and the available evidence was of very low quality. CONCLUSIONS: The available evidence supports little confidence regarding the impact of pubertal timing on the onset of depression in girls but suggests that early puberty in girls may increase the risk of depression. Further higher quality studies are needed to clarify the association between pubertal timing and the incidence of depression in girls and women.
Assuntos
Depressão/epidemiologia , Puberdade , Adolescente , Adulto , Distribuição por Idade , Criança , Estudos de Coortes , Ensaios Clínicos Controlados como Assunto , Feminino , Humanos , Incidência , Medição de RiscoRESUMO
Antídotos e determinados medicamentos são essenciais ao tratamento de algumas intoxicações e não podem sofrer falhas no abastecimento, sob o risco de prejudicar a saúde e a segurança da população. O objetivo deste trabalho foi avaliar a disponibilidade de antídotos e medicamentos recomendados para o tratamento de intoxicações no Brasil. A partir de consensos internacionais, foram selecionados 41 antídotos para análise, todos sem patente em vigência. Desses, 27 são registrados, porém 11 estão disponíveis em formas inadequadas ao tratamento de intoxicações, restando 16 medicamentos comercialmente disponíveis. Somente um terço dos medicamentos necessários para o tratamento de intoxicações está incluído na relação de medicamentos essenciais do país. Em adição, é apresentada proposta de suprimento das demandas a um dos antídotos, anticorpo antidigoxina, considerando a capacidade de produção nacional de imunobiológicos. Os resultados demonstram limitação da assistência adequada aos pacientes intoxicados no país e reforçam a necessidade urgente de políticas públicas na área.
Antidotes and certain other drugs are essential for treating some types of poisoning. Failures in their supply can jeopardize the population's health and safety. The current study aimed to assess the availability of antidotes and other drugs used in the treatment of poisonings in Brazil. International guidelines were used as the basis for selecting 41 antidotes for analysis, none of which currently protected by patents. Of these, 27 are registered in Brazil, but 11 of these are available in inadequate forms for treating poisoning, leaving 16 commercially available antidotes. Only one-third of the drugs needed for treating poisoning are included in the country's list of essential drugs. The article also presents a proposal for supplying the demand for one of the antidotes, anti-digoxin antibody, considering Brazil's domestic capacity for manufacturing immunobiologicals. The study's results show the limitations to adequate treatment for poison victims in Brazil and reinforce the urgent need to strengthen public policies in this area.
Los antídotos y determinados medicamentos son esenciales para el tratamiento de algunas intoxicaciones, y su disponibilidad no puede fallar, o la salud y la seguridad de la población se ponen en peligro. Este estudio tuvo como objetivo evaluar la disponibilidad de antídotos y fármacos recomendados para el tratamiento por intoxicaciones en Brasil. Se seleccionaron para el análisis 41 antídotos de reconocido consenso internacional, todos ellos sin patentes en vigor. Veintisiete estaban registrados en Brasil, pero 11 se venden en preparados farmacéuticos, no apropiados para el tratamiento de intoxicaciones, lo que da como resultado 16 medicamentos disponibles en el mercado. Sólo se incluyen en la lista brasileña de medicamentos esenciales un tercio de los medicamentos necesarios para tratar intoxicaciones. Además, se presenta una propuesta para suplir uno de los antídotos, anticuerpo antidigoxina, considerando la capacidad de producción nacional. Los resultados muestran limitaciones en una atención adecuada a los pacientes intoxicados en Brasil y refuerzan la necesidad urgente de fortalecer las políticas públicas en este ámbito.