Efetividade de um programa de exercício para prevenir risco de quedas em adultos com mais de 55 anos a residir na comunidade

Introdução: As quedas são um problema junto da população idosa, sabendo-se que atualmente cerca de 30% das pessoas com mais de 65 anos cai todos os anos. A União Europeia estima um custo de 281 € por habitante/ano, e um custo de 25 biliões de euros/ano para cuidados de saúde (Prevention of Falls Network for Dissemination [ProFouND]) o que se traduz num impacto económico significativo. A World Health Organization (WHO) defende que é possível diminuir estes custos, através de estratégias de prevenção e de promoção da saúde. Para isso, é importante consciencializar, avaliar fatores de risco e identificar e implementar programas de intervenção. Objetivos: Testar a efetividade de um programa de exercícios para prevenir o risco de queda. Métodos: Este estudo, que durou 4 meses, é experimental, prospetivo longitudinal. O grupo experimental (GE) realizou um programa de exercícios e o de controlo (GC) manteve a sua rotina habitual. Para a medição e avaliação das variáveis em estudo foram utilizados: Questionário de dados sociodemográficos, Questionário de autoeficácia para o exercício,Versão Portuguesa da Falls Efficacy Scale (FES), Teste de Velocidade Marcha 10m (VM), Teste Timed Up&Go (TUG), Teste Step (15seg) e Plataforma de Forças Hercules®. Considerou-se um nível de significância de 5% (p ≤ 0,05) para todas as comparações. Resultados: Verificou-se, no GE, após programa proposto, diferença estatisticamente significativa para o teste de velocidade de marcha (p<0,001), para a versão portuguesa da FES (p<0,001) e para os resultados da Plataforma Hércules® (p<0,001), e uma diferença estatisticamente significativa, menos evidente, para a Escala de Autoeficácia para o exercício (p=0,004). Conclusão: Este programa de exercícios integrados em atividades da vida diária (AVD), com componente de fortalecimento muscular, equilíbrio e flexibilidade, complementado com caminhadas, evidenciou melhorias no equilíbrio estático e na velocidade de marcha. Verificou-se ainda uma mudança no comportamento dos indivíduos através do aumento da confiança na execução das AVD e, também, no aumento da perceção da capacidade pessoal para a prática de exercício contribuindo assim para diminuir o risco de queda.Introduction: Falls are a problem among the elderly population, it is known that currently about 30% of people over 65 years falls every year. The European Union estimates a cost of € 281 per inhabitant per year and a cost of € 25 billion per year for health care (Prevention of Falls Network for Dissemination, [ProFouND]) which translates into a significant economic impact. The World Health Organization (WHO) argues that it is possible to reduce these costs through prevention and health promotion strategies. For this, it is important to raise awareness, evaluate risk factors and identify and implement intervention programs. Objectives: To test the effectiveness of an exercise program to prevent the risk of falls. Methods: This study, which lasted 4 months, is experimental, longitudinal prospective. The experimental group (GE) performed an exercise program and the control group (GC) maintained their usual routine. For the measurement and evaluation of the variables under study, were used: sociodemographic data questionnaire, Self-efficacy for exercise scale, Portuguese version of the Falls Efficacy Scale (FES), Speed Test 10m (VM), Timed Up & Go Test (TUG), Step Test and Hercules® Force Platform. A significance level of 5% (p ≤ 0.05) was considered for all comparisons. Results: After intervention, the experimental group found statistically significant difference for the gait velocity test (p <0.001), for the Portuguese version of the FES (p <0.001) and for the results of the Hercules® Platform (p <0.001), and a statistically significant difference, less evident, for the Self-efficacy Scale for exercise (p = 0.004). Conclusion: This exercise program integrated in daily living activities (AVD), with muscle strengthening, balance and flexibility, complemented with walking, showed improvements in the static balance and walking speed. There was also a change in the behavior of the individuals through the increase of the confidence in the performance of the AVD and also in the increase of the perception of the personal capacity for the practice of exercise, thus contributing to decrease the risk of fall

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit