RESUMO
OBJECTIVES: To evaluate postmenopausal women's knowledge of the risk of breast cancer associated with the use of hormone therapy (HT) and their perception of this risk when presented as a relative risk (RR), absolute risk (AbR) or attributable risk (AR). METHODS: A cross-sectional study was conducted with 402 postmenopausal women. The participants answered a self-response questionnaire in which data on the risk of breast cancer associated with HT were presented in the form of RR, AbR and AR. The women's concern with respect to this risk and their changes of opinion when the data were presented according to the different risk models were evaluated. RESULTS: More than 87% of the women mentioned breast cancer as one of the risks associated with the use of HT, with more women being concerned when the risk was presented as an RR. In contrast, most were unconcerned when the risk was presented as an AbR or AR. For the group as a whole, there was a significant change in opinion with respect to the women's concern regarding the risks when they were presented as an AbR or AR (p < 0.001); however, this was not the case for those women who had initially stated that breast cancer was a risk associated with HT. CONCLUSIONS: Providing information on breast cancer risk using examples that quantify the incidence of the disease provokes less concern in users and candidate users of HT. Changes of opinion occur when explanations regarding the risk are provided as RR, AbR and AR.
Assuntos
Neoplasias da Mama/induzido quimicamente , Terapia de Reposição de Estrogênios/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Medição de Risco , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
This study evaluated patients' knowledge on the risk of venous thromboembolism (VTE) associated with combined oral contraceptives (COCs) and their perception of this risk when it is presented as a relative risk (RR), absolute risk (AbR) or attributable risk (AR). This was a cross-sectional study involving 159 users or potential users of COCs. The participants answered a self-administered questionnaire in which the risk of VTE associated with COCs was presented as RR, AbR and AR. The degree of concern expressed regarding this risk and the women's changes of opinion when the information was communicated through a different risk model were evaluated. Most of the women (67.9%) expressed concern when the risk was presented as an RR. Conversely, they showed no concern when the risk was presented as an AbR (14.5%) or AR (10.7%). A significant number of women changed their opinion regarding their level of concern when the risk was presented as an AbR or AR (p < 0.001). In conclusion, concerns about thrombotic complications from the use of combined hormonal contraception is reduced when incidence rather than relative risk is presented. Presentation of thrombosis complications in terms of incidence rather than RR may improve communication of side effects during counseling for combined hormonal contraception initiation.
Assuntos
Anticoncepcionais Orais Combinados/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Educação de Pacientes como Assunto , Tromboembolia Venosa/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Fatores de Risco , Adulto JovemRESUMO
Objective: To evaluate the prevalence of cardiovascular risk factors (CRF) and absolute risk (AR) among first-degree consanguinity relatives of Colombian patients with hypertension.Methods: The study comprised 227 relatives (siblings and children of both sexes, between 12 and 40 years of age) and 204 hypertensive patients 34-84 years old from Quindío, Colombia. Lipid profile, glycemia, smoking, body mass index, and blood pressure were analyzed, and the AR of cardiovascular disease (CVD) to 10 years was estimated. Relatives were divided into two groups: GF1 relatives <18 years, GF2 relatives >18 years.Results: three or more CRF were found in the three groups. The prevalence for smoking was 20.1%, 9.1%, and 15.9% in patients, GF1, and GF2, respectively. Hypercholesterolemia was 42.2%, 15.2%, and 18.6% in patients, GF1, and GF2, respectively. The prevalence of low HDL-c levels was 50.5%, 44.9%, and 63.6% in relatives, GF1, and GF2, respectively. Obesity was present alone in patients, (32.4%) and GF2 (10.8%). The AR was 19.6 and 6.4 in male and female patients, respectively; 0.31 and 0 in GF1 females and males, respectively, and in GF2 it was 1.5 and 0.15 in males and females, respectively.Conclusions: Patients and relatives had more than three CRFs. HDL-c was low in all three groups. The AR was high in the young relatives. Programs are needed for weight, smoking, sedentary and dyslipidemia control to prevent or delay the development of CVD in relatives.
Objetivo: Evaluar la prevalencia de Factores de Riesgo Cardiovascular (FRC), y Riesgo Absoluto (RA) en familiares consanguíneos de pacientes colombianos hipertensos. Métodos: Se estudiaron 227 familiares (hermanos e hijos de ambos sexos, entre 12-40 años de edad), y 204 pacientes hipertensos (34-84 años) del Quindío, Colombia. Los familiares se dividieron en dos: grupo de familiares <18 años (GF1) y grupo de familiares >18 años (GF2). Se analizaron perfil lipídico, glicemia, tabaquismo e índice de masa corporal y se calculó el RA de sufrir enfermedad cardiovascular (ECV) a 10 años. Resultados: Se encontraron tres o más FRC en los tres grupos (pacientes, GF1 y GF2). La prevalencia de tabaquismo fue 20.1% 9.1% y 15.9% en pacientes, GF1 y GF2 respectivamente. La hipercolesterolemia fue 42.2% 15.2% y 18.6% en pacientes, GF1 y GF2 respectivamente. La prevalencia de niveles bajos de c-HDL fue 50.5%, 44.9% y 63.6% en familiares, GF1 y GF2, respectivamente. Mientras que la obesidad sólo estuvo presente en los pacientes (32.4%) y en el grupo GF2 (10.8%). El RA fue de 19.6 y 6.4 en los pacientes de género masculino y femenino, respectivamente; de 0.31 y 0 en el GF1 femenino y masculino, respectivamente; de 1.5 y 0.15 en el GF2 masculino y femenino, respectivamente. Conclusiones: Pacientes y familiares tenían más de tres FRC. El c-HDL fue bajo en los tres grupos. El RA fue alto en los familiares jóvenes. Se necesitan programas para el control de peso, tabaquismo, sedentarismo y dislipidemias para prevenir o retrasar el desarrollo de ECV en los familiares.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Doenças Cardiovasculares , Hipercolesterolemia , Hipertensão , Tabagismo , Hiperlipoproteinemia Tipo IIRESUMO
La eficacia de nuevos agentes farmacológicos para la prevención de fracturas osteoporóticas y la decisión de intervención con la misma finalidad en la práctica clínica han sido guiadas por la evaluación de la densitometría ósea (DMO). Sin embargo, reconociendo la naturaleza multifactorial de ese desenlace, recientemente se dio a conocer el calculador Fracture Risk Assessment Tool (FRAX) que persiguiendo los mismos objetivos de modelos previos, integra y combina varios de esos factores ponderadamente para estimar el riesgo absoluto de fractura de cadera o un combinado de fracturas osteoporóticas para los siguientes 10 años. El mismo sería ajustable a cualquier país incorporando al modelo la incidencia de fractura de cadera y las expectativas de vida edad- y sexo-específicas para la población a que pertenece el individuo. Este instrumento es presentado como un nuevo paradigma para ayudar en la toma de decisiones terapéuticas, especialmente farmacológicas. En la presente revisión se discuten algunas de sus características, como ser: la pretendida aplicabilidad a poblaciones de distintos países, la conveniencia de utilizar el riesgo absoluto a 10 años para todo el espectro etario de interés y si la eficacia de los tratamientos farmacológicos para la prevención de fracturas óseas en pacientes osteoporóticos podrá comprobarse también en pacientes seleccionados para tratamiento en base a este modelo. Finalmente, se llama la atención sobre el hecho de que aún no están claramente determinados los umbrales de riesgo orientadores para la toma de decisiones, los que obviamente tendrán un relevante impacto en el número de pacientes pasibles de tratamiento.
The efficacy of new pharmacological agents for the prevention of osteoporotic fractures and the clinical decision to intervene with that purpose in daily medical practice have been guided by the evaluation of bone mineral density (BMD). However, given the multifactorial nature of the proposed endpoint, a new calculator has been proposed: Fracture Risk Assessment Tool FRAX TM, which follows the same objectives of previous models, but integrates and combines several of those factors according to their relative weight. It can estimate absolute risk of hip fracture (or a combination of osteoporotic fractures) for the following 10 years. The calculator could be adapted for use in any country by the incorporation of hip fracture incidence and age- and sex-adjusted life expectancy in the same country. This instrument has been presented as a new paradigm to assist in clinical and therapeutic decision-making. In the present review some of its characteristics are discussed, such as: the purported applicability to different populations, the convenience of using 10-year absolute fracture risk for the whole age range under consideration, and whether the efficacy of pharmacological treatment for the prevention of bone fractures in osteoporotic patients can be expected to be equally effective among patients selected for treatment on the basis of this model. Finally, we would like to call attention to the fact that risk thresholds for intervention are not yet clearly defined; those thresholds can obviously be expected to have a profound impact on the number of patients amenable to treatment.
Assuntos
Feminino , Humanos , Masculino , Fraturas Ósseas/etiologia , Osteoporose/complicações , Medição de Risco/métodos , Absorciometria de Fóton , Densidade Óssea , Fraturas Ósseas/prevenção & controle , Valor Preditivo dos TestesRESUMO
Osteoporosis constitutes a major public health problem through its association with age related fractures. Fracture rates are generally higher in caucasian women than in other populations. Important determinants include estrogen deficiency in women, low body mass index, cigarette smoking, alcohol consumption, poor dietary calcium intake, physical inactivity, certain drugs and illnesses. Thus, modification of physical activity and dietary calcium/vitamin D nutrition should complement high risk approaches. In addition, the recently developed WHO algorithm for evaluation of 10-year absolute risk of fracture provides a means whereby various therapies can be targeted cost-effectively to those at risk. Risk factors, together with bone mineral density (BMD) and biochemical indices of bone turnover, can be utilised to derive absolute risks of fracture and cost-utility thresholds at which treatment is justified. These data will provide the basis for translation into coherent public health strategies aiming to prevent osteoporosis both in individuals and in the general population.
La osteoporosis constituye un importante problema de salud pública debido a su asociación con fracturas relacionadas con la edad. Las tasas de fractura generalmente son más altas en mujeres caucásicas que en otros grupos poblacionales. Los principales determinantes incluyen deficiencia de estrógeno en mujeres, bajo índice de masa corporal, consumo de tabaco y alcohol, escaso consumo de calcio, inactividad física y algunas drogas y enfermedades. De este modo, la modificación de la actividad física y el consumo de nutrimentos con calcio y vitamina D deben complementar los tratamientos en alto riesgo. Además, el recientemente desarrollado algoritmo de la OMS para la evaluación de riesgo de fractura absoluto a 10 años constituye una herramienta que permite plantear eficientemente diversas terapias a aquellos que están en riesgo. Los factores de riesgo, junto con la densidad mineral ósea y los índices bioquímicos de regeneración ósea pueden utilizarse para obtener riesgos de fractura absolutos así como umbrales costo-utilidad que justifiquen el tratamiento. Estos datos proveerán una base para su traducción en estrategias de salud pública con la finalidad de prevenir la osteoporosis tanto en los individuos como en la población en general.
Assuntos
Feminino , Humanos , Osso e Ossos/fisiologia , Fraturas Ósseas/etiologia , Osteoporose/etiologia , Absorciometria de Fóton/métodos , Densidade Óssea/fisiologia , Reabsorção Óssea/fisiopatologia , Fraturas Ósseas/epidemiologia , Osteoporose/diagnóstico , Osteoporose/prevenção & controle , Medição de Risco/métodos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodosRESUMO
En la generación de evidencias que surgen del seguimiento de pacientes, obtenidas a partir de los estudios epidemiológicos, el riesgo relativo (RR) y el riesgo absoluto (RA) son expresiones que se utilizan para cuantificar la asociación entre un factor de exposición y un evento de salud. Sendas expresiones son de variables dicotómicas. Permiten establecer la intensidad y la dirección de la asociación a través de la obtención de la probabilidad de ocurrencia del evento para cada nivel del factor de exposición. El cálculo, su interpretación y sus aplicaciones son ejemplificados.
In epidemiology, relative risk and absolute risk are expressions of measuring of the association between binary variables. In a direct way, they allow to settle down, the intensity of the relationship and to describe the probability of damage for the exposure variable. Their applications are described.