As condições de vida e saúde de pessoas acima de 50 anos com deficiência e seus cuidadores em um município paulista

As disabled people become older, they often have more complex problems, due to the difficulties of social active insertion. This study aims to characterize the socio-demographic and health conditions of people with disabilities aged 50 years and over, and their caregivers. This is a descriptive study conducted through interviews with 43 disabled elderly and 39 caregivers. It was found that people with disabilities live with a relative, 51.2% did not attend formal education, 69.8% survive of retirement, 46.5% used three or more drugs and 69.8% did not do Pap smear / breast or prostate preventive screening. Among caregivers, 79.5% were female, 84.7% have little or no schooling, were sibling or nephew, have been caregivers for ten years or more, do not get help from other relatives and do not have regular leisure activity. Among them, 18% reported three or more health problems and 44% use three or more drugs. Disabled people over 50 exhibit some characteristics similar to other elderly dependents, but their condition of dependency is long lasting, which requires special health actions both for elderly and caregivers.Pessoas com deficiência, ao se tornarem idosas, muitas vezes apresentam problemas mais complexos, devido às dificuldades de inserção social ativa. Este estudo se propõe a caracterizar as condições sociodemográficas e de saúde de pessoas com deficiência com idade acima de 50 anos, e de seus respectivos cuidadores. Trata-se de estudo descritivo realizado por meio de entrevistas com 43 idosos com deficiência e 39 cuidadores. Constatou-se que as pessoas com deficiência vivem com algum familiar, 51,2% não frequentaram o ensino formal, 69,8% sobrevivem da aposentadoria, 46,5% utilizam três medicamentos ou mais e 69,8% não realizam exame preventivo de câncer de mama/útero ou próstata. Dos cuidadores, 79,5% são do gênero feminino, 84,7% têm pouca ou nenhuma escolaridade, sendo irmão(a) ou sobrinho(a), são cuidadores há dez anos ou mais, não recebem ajuda de outros parentes e não têm atividade regular de lazer. Entre eles, 18% relatam três ou mais problemas de saúde e 44% fazem uso de três ou mais medicamentos. As pessoas acima dos 50 anos, com deficiência, apresentam algumas características semelhantes a outros idosos dependentes, mas sua condição de dependência é de longa duração, o que demanda ações de saúde diferenciadas tanto para esse idoso como para o cuidador.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Faculdade de Medicina de Marília Programa de Pós-graduação em Biologia e EnvelhecimentoFaculdade de Medicina de MaríliaUniversidade Estadual Paulista Faculdade de Filosofia e Ciências Programa de Pós-graduação em EducaçãoSecretaria Municipal da Saúde Coordenadoria da Saúde MentalUniversidade Estadual Paulista Faculdade de Filosofia e Ciências Programa de Pós-graduação em Educaçã

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries