Associations of hospitalisation - admission, readmission and length to stay - with multimorbidity patterns by age and sex in adults and older adults: the ELSI-Brazil study

BACKGROUND: Although the association between multimorbidity (MM) and hospitalisation is known, the different effects of MM patterns by age and sex in this outcome needs to be elucidated. Our study aimed to analyse the association of hospitalisations' variables (occurrence, readmission, length of stay) and patterns of multimorbidity (MM) according to sex and age. METHODS: Data from 8.807 participants aged ≥ 50 years sourced from the baseline of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil) were analysed. Multimorbidity was defined as ≥ 2 (MM2) and ≥ 3 (MM3) chronic conditions. Poisson regression was used to verify the association between the independent variables and hospitalisation according to sex and age group. Multiple linear regression models were constructed for the outcomes of readmission and length of stay. Ising models were used to estimate the networks of diseases and MM patterns. RESULTS: Regarding the risk of hospitalisation among those with MM2, we observed a positive association with male sex, age ≥ 75 years and women aged ≥ 75 years. For MM3, there was a positive association with hospitalisation among males. For the outcomes hospital readmission and length of stay, we observed a positive association with male sex and women aged ≥ 75 years. Network analysis identified two groups that are more strongly associated with occurrence of hospitalisation: the cardiovascular-cancer-glaucoma-cataract group stratified by sex and the neurodegenerative diseases-renal failure-haemorrhagic stroke group stratified by age group. CONCLUSION: We conclude that the association between hospitalisation, readmission, length of stay, and MM changes when sex and age group are considered. Differences were identified in the MM patterns associated with hospitalisation according to sex and age group

Multimorbidity patterns and hospitalisation occurrence in adults and older adults aged 50 years or over

Multimorbidity is highly prevalent in older adults and can lead to hospitalisation. We investigate the prevalence, associated factors, and multimorbidity pattern associated to hospitalisation, readmission, and length of stay in the population aged 50 years and older. We analysed baseline data (2015-2016) from the ELSI-Brazil cohort, a representative sample of non-institutionalised Brazilians aged ≥ 50 years. In total, 8807 individuals aged ≥ 50 years were included. Poisson regression with robust variance adjusted for confounders was used to verify the associations with hospitalisation. Multiple linear regression was used to analyse the associations with readmission and length of stay. Network analysis was conducted using 19 morbidities and the outcome variables. In 8807 participants, the prevalence of hospitalisation was 10.0% (95% CI 9.1, 11), mean readmissions was 1.55 ± 1.191, and mean length of stay was 6.43 ± 10.46 days. Hospitalisation was positively associated with male gender, not living with a partner, not having ingested alcoholic beverages in the last month, and multimorbidity. For hospital readmission, only multimorbidity ≥ 3 chronic conditions showed a statistically significant association. Regarding the length of stay, the risk was positive for males and negative for living in rural areas. Five disease groups connected to hospitalisation, readmission and length of stay were identified. To conclude, sociodemographic variables, such as gender, age group, and living in urban areas, and multimorbidity increased the risk of hospitalisation, mean number of readmissions, and mean length of stay. Through network analysis, we identified the groups of diseases that increased the risk of hospitalisation, readmissions, and length of stay

Effect of the coaches' leadership style perceived by athletes on team cohesion among elite Brazilian futsal players

This study investigated the effect of the coach leadership style as perceived by athletes on team cohesion among elite futsal athletes. Participants were 120 athletes from the top-8 teams participating in the Paraná’s state Professional League 2013. Instruments used were the Leadership in Sport Scale and the Group Environment Questionnaire. For data analysis, Confirmatory Factor Analysis and Structural Equation Modelling were conducted, as well as Latent Profile Analysis. Results showed significant relationships between leadership style and both social (10%) and task cohesion (31%); in addition, the coach leadership style perceived by athletes characterized as democratic and based on social support, reinforcement and training-instruction influenced positively task cohesion (FL=0.55) and moderately social cohesion (FL=0.31). It is concluded that, for the futsal from the state of Parana, the coach’s leadership style based on democratic, reinforcement, social support and training-instruction behaviours is determinant to the development of task cohesion, however, does not have the same strong influence in social cohesion

Perfeccionismo: um traço adaptativo ou maldaptativo para as necessidades psicológicas básicas de motivação no futsal?

Este estudo investigou os traços de perfeccionismo e a satisfação das necessidades psicológicas básicas de atletas de futsal. Todos os atletas (n=301) inscritos na Liga Nacional de Futsal 2013 participaram da pesquisa, sendo categorizados quanto a titularidade (Titulares=156 e Não-titulares=145 atletas) e a classificação para a fase final do campeonato (classificados=134 atletas e não classificados=167 atletas). Os instrumentos foram a Escala Multidimensional de Perfeccionismo para o Esporte-2, possuindo quatro subescalas (padrões pessoais/organização, preocupação com os erros, pressão parental percebida e dúvidas na ação) e a Escala de Necessidades Básicas no Esporte, que possui três subescalas (autonomia, competência e relacionamento). Para análise dos dados utilizou-se a ANOVA de Medidas Repetidas, Mann-Whitney, Correlação de Spearman, e a Análise de Equações Estruturais (p<0,05). Como resultados, “Padrões pessoais/organização” impactou positivamente as necessidades básicas em todos os grupos observados, para os titulares impactou o “Relacionamento”, para os classificados a “Autonomia”, enquanto para os não-titulares e não-classificados a “Competência” (p<0,05). A variável preditora “Dúvidas na ação” apresentou impacto negativo sobre a dimensão de “Autonomia” em todos os grupos (titulares e não-titulares; classificados e não-classificados) e sobre a “Competência” dos atletas não-titulares e não-classificados (p<0,05). Concluiu-se que enquanto os esforços perfeccionistas favorecem a satisfação das necessidades psicológicas básicas de atletas, as preocupações perfeccionistas prejudicam a satisfação destas necessidades

Correlação espacial da covid-19 com leitos de unidades de terapia intensiva no Paraná

OBJETIVO Analisar a correlação espacial entre os casos confirmados de covid-19 com os leitos de unidades de terapia intensiva exclusivos para a doença nos municípios do Paraná. MÉTODO Trata-se de um estudo epidemiológico, do tipo ecológico que utilizou dados do Informe Epidemiológico fornecido pela Secretaria de Estado da Saúde do Paraná sobre os casos confirmados de covid-19, no período de 12 de março de 2020 a 18 de janeiro de 2021. A quantidade de leitos de terapia intensiva exclusivos para covid-19 de cada município paranaense foi obtida pelo Cadastro Nacional de Estabelecimentos de Saúde disponibilizado online pelo Departamento de Informática do Sistema Único de Saúde. A variável leito de terapia intensiva foi analisada pelo Índice Bivariado de Moran (local e global). Para a identificação de áreas críticas e de transição utilizou-se o LISA Map. Para avaliar a correlação espacial foi utilizado o Índice Bivariado de Moran, considerando o nível de significância de 5%. RESULTADOS No período analisado foram confirmados 499.777 casos de covid-19 no Paraná e identificados 1.029 leitos de terapia intensiva exclusivos para a doença entre os municípios do estado. Foi identificado autocorrelação espacial positiva entre os casos confirmados de covid-19 (0,404–p ≤ 0,001) com os leitos de terapia intensiva exclusivos para a doença (0,085–p ≤ 0,001) e disparidades entre as regiões do Paraná. CONCLUSÃO A análise espacial permitiu confirmar a relação entre os casos confirmados de covid-19 e a distribuição de leitos de terapia intensiva exclusivos para a doença no Paraná e possibilitou identificar áreas prioritárias de atenção no estado, relacionadas à disseminação e controle da doença.OBJECTIVE To analyze the spatial correlation between confirmed cases of covid-19 and the intensive care unit beds exclusive to the disease in municipalities of Paraná. METHODS This is an epidemiological study of ecological type which used data from the Epidemiological Report provided by the Department of Health of Paraná on the confirmed cases of covid-19 from March 12, 2020, to January 18, 2021. The number of intensive care beds exclusive to covid-19 in each municipality of Paraná was obtained by the Cadastro Nacional de Estabelecimentos de Saúde (CNES - National Registry of Health Establishments), provided online by the Departamento de Informática do Sistema Único de Saúde (Datasus - Informatics Department of the Brazilian Unified Health System). The Bivariate Moran’s Index (local and global) was used to analyze the intensive care bed variable and spatial correlation, with a 5% significance level. LISA Map was used to identify critical and transition areas. RESULTS In the analyzed period, we found 499,777 confirmed cases of covid-19 and 1,029 intensive care beds exclusive to the disease in Paraná. We identified a positive spatial autocorrelation between the confirmed cases of covid-19 (0.404–p ≤ 0.001) and intensive care beds exclusive to the disease (0.085–p ≤ 0.001) and disparities between the regions of Paraná. CONCLUSION Spatial analysis indicated that confirmed cases of covid-19 are related to the distribution of intensive care beds exclusive to the disease in Paraná, allowing us to find priority areas of care in the state regarding the dissemination and control of the disease

Effects of single low dose of dexamethasone before noncardiac and nonneurologic surgery and general anesthesia on postoperative cognitive dysfunction : a phase III double blind, randomized clinical trial

Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS: One hundred and forty patients (ASA I-II; age 60–87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35–45 or 46–55. Neuropsychological tests were applied preoperatively and on the 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. S100β was evaluated before and 12 hours after induction of anesthesia. The generalized estimating equations (GEE) method was applied, followed by the posthoc Bonferroni test considering P<0.05 as significant. RESULTS: On the 3rd postoperative day, POCD was diagnosed in 25.2% and 15.3% of patients receiving dexamethasone, BIS 35–45, and BIS 46–55 groups, respectively. Meanwhile, POCD was present in 68.2% and 27.2% of patients without dexamethasone, BIS 35–45 and BIS 46–55 groups (p<0.0001). Neuropsychological tests showed that dexamethasone associated to BIS 46–55 decreased the incidence of POCD, especially memory and executive function. The administration of dexamethasone might have prevented the postoperative increase in S100β serum levels. CONCLUSION: Dexamethasone can reduce the incidence of POCD in elderly patients undergoing surgery, especially when associated with BIS 46–55. The effect of dexamethasone on S100β might be related with some degree of neuroprotection

Esporte é um contexto que possibilita emancipação ou colonização no processo de formação identitária?

Este estudo analisou a influência do esporte na formação da identidade de 25 atletas de Futsal por meio da caracterização do padrão semântico do discurso e do relato de história de vida. Foram identificados três grupos caracterizados pela expressão de suas metamorfoses identitárias. O primeiro grupo apresentou uma forma de racionalidade instrumental, ligados à vitória, sucesso e outras características do esporte espetáculo. Os dois grupos mais autonômicos uniram experiências esportivas e não esportivas, alcançando racionalidade comunicativa e multiplicidade de papéis em manifestações de personagens. Concluiu-se que o esporte pode possibilitar fragmentos emancipatórios dependendo da multiplicidade e riqueza de papéis e estimulações ambientais, favorecendo pluralidade de experiências que instiguem transições ecológicas de autonomia.Este estudio examinó la influencia del deporte de forjar una identidad de 25 atletas através de la caracterización de la forma semántica y informe de historial de vida. Se identificaron tres grupos caracterizados por la expresión de sus metamorfosis de identidad. El primer tenía una forma de racionalidad instrumental ligados a la victoria, el éxito y otras características del deporte espectáculo. Los dos grupos más autonómicos unieron experiencias deportivas y no deportivas, llegando a la racionalidad comunicativa y la multiplicidad de roles en caracteres manifestaciones. Se concluyó que el deporte puede permitir fragmentos de emancipación dependiendo de la variedad y riqueza de funciones y estímulos ambientales, favoreciendo la pluralidad de experiencias que fomentan las transiciones ecológicas de autonomía.This study analyzed the influence of sport on identity formation of 25 athletes through a semantic pattern and the life story characterization. Three groups characterized by the expression of their identity metamorphoses were identified. The first presented a form of instrumental rationality, linked to the victory, success and other characteristics of the spectacle sport. Two most autonomous groups united sports and non-sports experiences, reaching communicative rationality and multiplicity of roles in character manifestations. It was concluded that sport could enable emancipatory fragments depending on the multiplicity and richness of roles and environmental stimuli, favoring a plurality of experiences that instigate ecological transitions of autonomy

Characteristics of primary care and rates of pediatric hospitalizations in Brazil

OBJECTIVE: To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD: In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil’s federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS: In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97–0.99), structural conditions (RR: 0.98; 95%CI: 0.97–0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97–0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02–1.48), it forms (RR: 1.01, 95%CI: 1.01–1.02), and more medications (RR: 1.02, 95%CI: 1.01–1.03). CONCLUSION: Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations