Functionality in the elderly: knowledge production in the last decade

Objective: discussing the scientific production on health about the functional capacity of the elderly through an integrative literature review of the last ten years. Method: an integrative review was used, since this method allows for searching, critical evaluation and synthesis of the available evidence from the research theme, being its final product the current state of knowledge and identifying gaps that drive development of future research. Results: starting the process of defining descriptors, it used the operator "terminology in health" where it identified terms relevant to their studies as descriptors: Functionality and Elderly; being able to selecting 13 articles that met the inclusion and exclusion criteria. Conclusion: through the characterization of the analyzed reports, it believes that Brazilian articles on health that punctuate Functionality in the Elderly in daily activities, demonstrate that this field is not yet saturated

The health handbook of the elderly people through the view of seniors assisted in the family health strategy

Introduction: The ageing population is a global reality, even in developing countries people have never had a chance to live so long. This new demographic situation caused the necessity to develop legal provisions to guide social and health actions. Among them, the National Health Policy for the Elderly, marked by the paradigm of the functional capacity and along with it comes the Health Handbook of the Elderly, which represents a delimitation instrument of the profile of the elderly, identifying frail elderly people or in the process of embrittlement, collaborating with the formulation of health actions focused on aging well. Objective: The objective of this study is to know the social representations of elderly about the health booklet of the elderly and to understand its membership in the context of primary care. Methodology: This is an exploratory-descriptive study with a qualitative approach performed with 103 elderly people with age above sixty years at the units of the Sanitary District V. The study was conducted between July and September 2014, respecting the ethical criteria of the Resolution 466/12.The data collection was performed by a semi-structured interview contemplating questions related to the booklet. The socio-demographic data were analyzed twice once using Categorical Thematic Content Analysis Technique, which showed six classes or categories: 1) Support for the service; 2) Guidance tool for the elderly; 3) Modality of health information; 4) Descriptions of complications in health; 5) Types of monitoring the health of the elderly; 6) security instrument; referring to two dimensions of social representations: information and knowledge about the book and the position or attitude of the elderly. The second analysis was carried out using Iramuteq 0.7 software was responsible for the social representations: images and representation field of the booklet. Results: Among the interviewed elderly, 40.8% said that they use the booklet, 48.5% affirm that they do not have knowledge about the book and 10.7% have the book but do not use it. In addition, 83.5% of the elderly are female and 78.6% with age between 60-70 years. The results show representations of positive content related the use of the book showing a good acceptance of this, besides recognizing it as a facilitator instrument for the care of the elderly defined in six categories. The elderly utilize the booklet as security and protection. The elderly people who do not use the book justify not using it due to lack of information. Conclusion Having the opportunity of knowing the elderly social representations about the health booklet for elderly was important to get to know and understand the thinking of the elderly in relation to the booklet and the significance of these representations. It is expected that this study will stimulate further research in the social representations in the ambit concerning the health booklet for elderly, in compliance with the National Health Policy for the Elderly.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESIntrodução: O envelhecimento populacional é uma realidade mundial, até mesmo nos países subdesenvolvidos, nunca se teve a chance de viver tanto. Com este novo quadro demográfico, surgiu a necessidade do desenvolvimento de dispositivos legais para nortear ações sociais e de saúde. Dentre eles, a Política Nacional de Saúde da Pessoa Idosa, marcada pelo paradigma da capacidade funcional, parametrizando assim, a Caderneta de Saúde da Pessoa Idosa, que representa um instrumento de delineamento do perfil dos idosos, identificando-os a partir da configuração de um estado de fragilização, colaborando com a formulação das ações de saúde focadas no envelhecimento com qualidade. Objetivo: Conhecer as representações sociais de idosos sobre a Caderneta de Saúde da Pessoa Idosa e suas influências na adesão pelos idosos no contexto da Atenção Básica. Metodologia: Trata-se de um estudo exploratório de abordagem qualitativa, realizado nas unidades do Distrito Sanitário V, com 103 idosos com idade igual ou superior a sessenta anos. A pesquisa ocorreu no período de julho a setembro de 2014, respeitando os critérios éticos da Resolução 466/12, em que os dados foram coletados a partir de uma entrevista semiestruturada contemplando questões relacionadas ao uso da caderneta de saúde pelos idosos. Os dados foram submetidos a dois tipos de análise: a primeira realizou-se a Técnica de Análise de Conteúdo Temática Categorial, apontou-se seis categorias: 1) Suporte para o atendimento; 2) Instrumento de orientação para o idoso; 3) Tipos de informações sobre a saúde; 4) Descrições de intercorrências de saúde; 5) Formas de acompanhamento da saúde do idoso; 6) Instrumento de segurança, responsáveis por duas dimensões das representações sociais: as informações ou conhecimentos dos idosos sobre a caderneta e o posicionamento ou atitude dos idosos frente à caderneta; na segunda análise, os dados foram estudados com o apoio do software Iramuteq 0.7, responsável pelas imagens ou campo de representação sobre a caderneta. Resultados: Dos idosos entrevistados, sendo 83,5% do sexo feminino e 78,6% com idade entre 60-70 anos, 40,8% disseram utilizar caderneta, 48,5% afirmam não conhecer e 10,7% possuem a caderneta, mas não a utilizam. Os resultados apontam representações de conteúdos positivos frente ao uso da caderneta, demonstrando uma boa aceitação desta, além de reconhecê-la como um instrumento facilitador para o atendimento da pessoa idosa, definido nas seis categorias. Ressalta-se ainda que os idosos representam a caderneta como segurança e proteção, bem como que aqueles que não a utilizam justificam o não uso por falta de informação. Conclusão: Conhecer as representações sociais dos idosos sobre a Caderneta de Saúde da Pessoa Idosa foi importante para se conhecer o que pensa esse segmento social sobre o instrumento e a importância destas na adesão para o fortalecimento de ações preconizadas na Política Nacional da Saúde da Pessoa Idosa

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

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