Survival Analysis of COPD Patients in a 13-Year Nationwide Cohort Study of the Brazilian National Health System

Background: Chronic obstructive pulmonary disease (COPD) has an appreciable socioeconomical impact in low- and middle-income countries, but most epidemiological data originate from high-income countries. For this reason, it is especially important to understand survival and factors associated with survival in COPD patients in these countries. Objective: To assess survival of COPD patients in Brazil, to identify risk factors associated with overall survival, including treatment options funded by the Brazilian National Health System (SUS). Methodology: We built a retrospective cohort study of patients dispensed COPD treatment in SUS, from 2003 to 2015 using a National Database created from the record linkage of administrative databases. We further matched patients 1:1 based on sex, age and year of entry to assess the effect of the medicines on patient survival. We used the Kaplan-Meier method to estimate overall survival of patients, and Cox's model of proportional risks to assess risk factors. Result: Thirty seven thousand and nine hundred and thirty eight patients were included. Patient's survival rates at 1 and 10 years were 97.6% (CI 95% 97.4–97.8) and 83.1% (CI 95% 81.9–84.3), respectively. The multivariate analysis showed that male patients, over 65 years old and underweight had an increased risk of death. Therapeutic regimens containing a bronchodilator in a free dose along with a fixed-dose combination of corticosteroid and bronchodilator seem to be a protective factor when compared to other regimens. Conclusion: Our findings contribute to the knowledge of COPD patients' profile, survival rate and related risk factors, providing new evidence that supports the debate about pharmacological therapy and healthcare of these patients

Perda dentária e expectativa da reposição protética: estudo qualitativo Dental loss and prosthetic replacement expectation: qualitative study

Esse estudo qualitativo analisou as repercussões da perda dentária total de usuários do serviço público. Aplicou-se o Oral Health Impact Profile simplificado(OHIP14) a cinquenta voluntários e, após a apuração dos resultados, foram selecionados treze pacientes para entrevistas individuais baseadas em um roteiro com questões abertas. A seleção das pessoas foi de acordo com o grau de percepção do impacto da condição bucal na qualidade de vida, medida pela pontuação OHIP, de forma a incluir a maior variedade de perfis da amostra inicial. Da análise do conteúdo dos depoimentos, verificou-se que a perda dentária total tem forte impacto na vida das pessoas e implica consequências negativas como vergonha, dificuldade em se alimentar, prejuízo ao relacionamento social e sentimento de incompletude. A possibilidade de reposição protética dos dentes gera ansiedade nas pessoas e, embora elas saibam que a utilização das próteses possa representar sacrifícios, a expectativa de retorno ao padrão social geralmente aceito e de recuperação de sua própria imagem rejuvenescida faz valer a pena quaisquer sacrifícios.<br>This qualitative research analyses the repercussions of total dental loss on people's quality of life. The Oral Health Impact Profile short-form (OHIP14) was applied to 50 volunteers, and after analyzing the results, 13 out of those 50, were selected to be individually interviewed in an opened questions script. The criteria to select these 13 people were: perception of the impact of mouth condition on quality of life measured by the score reached on OHIP. We tried to comprise the sample with a good variety, according to the profile of the initial sample. After analyzing people's statements, it was possible to verify that dental loss had strong negative consequences on people's life, like shame, difficulty to eat, impact on social relationship and feeling of not being complete. The possibility of having their teeth replaced generates some anxiety. Although being aware that wearing total prosthesis represents some sacrifices, people considered it worthwhile because the possibility of regaining the social pattern and the self-image is renewed