Polypharmacy Among The Elderly In The City Of São Paulo, Brazil - Sabe Study [polifarmácia Entre Idosos Do Município De São Paulo - Estudo Sabe]

Polypharmacy for the elderly and associated factors were assessed. A cross-sectional study was conducted using data from the SABE Study (Health, Well-being and Aging), 2006. 1,115 individuals representing 422,377 elderly aged 65 or more, living in São Paulo City, were interviewed. Polypharmacy was defined as the use of five or more medications. A multivariate regression logistics was used. Polypharmacy prevalence was 36%. Female (OR = 1.7; IC 95%: 1.0; 2.9), age over 75 years (OR = 1.9; CI 95%: 1.3; 2.7), higher income (OR = 1.8; CI 95%: 1.2; 2.8), working (OR = 1.8; CI 95%: 1.1; 2.9), regular self assessed health (OR = 1.6; CI 95%: 1.1; 2.3) or poor (OR = 2.6; CI 95%: 1.4; 4.9), hypertension (OR = 2.0; CI 95%: 1.4; 2.9), diabetes (OR = 4.1; CI 95%: 2.2; 7.5), rheumatic diseases (OR = 2.3; CI 95%: 1.5; 3.6) and cardiac problems (OR = 2.9; CI 95%: 1.9; 4.5) were associated positively with polypharmacy. Using only the public health system (OR = 0.5, 95% CI: 0.3; 0.7) was inversely associated with polypharmacy. Medicines for the cardiovascular system and for the alimentary tract and metabolism were the most used. The knowledge of factors associated with polypharmacy, such as those identified in this study, may be useful to alert health professionals about the importance of identifying and monitoring the elderly groups most vulnerable to polypharmacy.154817827Ramos, L.R., Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano: Projeto Epidoso, São Paulo (2003) Cad Saúde Pública, 19, pp. 793-798(2002) Active Ageing. A Policy Framework, , http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf, World Health Organization, Geneva: WHO;,. Disponível em, [Acessado em 20 de fevereiro de 2006]Coelho Filho, J.M., Marcopito, L.F., Castelo, A., Medication use patterns among elderly people in urban area in Northeastern Brazil (2004) Rev Saude Publica, 38, pp. 557-564Qato, D.M., Alexander, G.C., Conti, R.M., Johnson, M., Schumm, P., Lindau, S.T., Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States (2008) JAMA, 300, pp. 2867-2878Ribeiro, A.Q., Rozenfeld, S., Klein, C.H., César, C.C., Acurcio Fde, A., Survey on medicine use by elderly retirees in Belo Horizonte, Southeastern Brazil (2008) Rev Saúde Pública, 42, pp. 724-732Flores, L.M., Mengue, S.S., Uso de medicamentos por idosos em região do sul do Brasil (2005) Rev Saúde Pública, 39, pp. 924-929Kaufman, D.W., Kelly, J.P., Rosenberg, L., Anderson, T.E., Michell, A.A., Recent patterns of medication use in the ambulatory adult population of the United States (2002) JAMA, 287, pp. 337-344Safran, D.G., Neuman, P., Schoen, C., Kitchman, M.S., Wilson, I.B., Cooper, B., Prescription drug coverage and seniors: Findings from a 2003 national survey (2005) Health Aff, , (Millwood),Suppl Web Exclusives: W5-152-W5-166Prybys, K.M., Melville, K., Hanna, J., Gee, A., Chyka, P., Polypharmacy in the elderly: Clinical challenges in emergency practice: Part 1 overview, etiology, and drug interactions (2002) Emerg Med Rep, 23, pp. 145-153Rozenfeld, S., Fonseca, M.J.M., Acurcio, F.A., Drug utilization and polypharmacy among the elderly: A survey in Rio de Janeiro City, Brazil (2008) Pan Am J Public Health, 23, pp. 34-43Lebrão, M.L., Duarte, Y.A.O., (2003) SABE-Saúde, Bem Estar e envelhecimento-O projeto SABE no município de São Paulo:Uma abordagem inicial [livro na internet], , http://www.opas.org.br/sistema/arquivos/l_saber.pdf, Brasília: Athalaia Bureau;,. Disponível em, [Acessado em 20 de fevereiro de 2006](2006) Anatomical therapeutic chemical (ATC) classification index with defined daily doses (DDDs), , http://www.whocc.no/atcddd/index, World Health Organization, [homepage na Internet]. Genevac2007. Disponível em, [atualizado em 16 de dezembro de, e acessado em 16 de março de 2007]Rao, J.N.K., Scott, A.J., On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data (1984) Annals of Statistics, 12, pp. 46-60(2009) Stata Statistical Software: Release 11, , StataCorp, College Station. Texas: StataCorp LPRollason, V., Vogt, N., Reduction of polypharmacy in the elderly. A systematic review of the role of the pharmacist (2003) Drugs Aging, 20, pp. 817-832Rochon, P.A., Gurwitz, J.H., Optimising drug treatment for elderly people: The prescribing cascade (1997) BMJ, 315, pp. 1096-1099Gurwitz, J.H., Polypharmacy: A new paradigm for quality drug therapy in the elderly? (2004) Arch Int Med, 164, pp. 1957-1959Loyola Filho, A.I., Uchoa, E., Lima-Costa, M.F., A population-based study on use of medication by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil (2006) Cad Saude Publica, 22, pp. 2657-2667Linjakumpu, T., Hartikainen, S., Klaukka, T., Veijola, J., Kivelä, S.L., Isoaho, R., Use of medications and polypharmacy are increasing among the elderly (2002) J Clin Epidemiol, 55, pp. 809-817Jörgensen, T., Johansson, S., Kennerfalk, A., Wallander, M.A., Svärdsudd, K., Prescription drug use, diagnoses, and healthcare utilization among the elderly (2001) Ann Pharmacother, 35, pp. 1004-1009Loyola Filho, A.I., Uchoa, E., Firmo, J.O., Lima-Costa, M.F., A population-based study on use of medications by elderly Brazilians: The Bambuí Health and Aging Study (BHAS) (2005) Cad Saúde Pública, 21, pp. 545-553Loyola Filho, A.I., Uchoa, E., Firmo, J.O., Lima-Costa, M.F., Influence of income on the association between cognitive impairment and polypharmacy: Bambuí Project (2008) Rev Saúde Pública, 42, pp. 89-99Rosholm, J.U., Christensen, K., Relationship between drug use and self-reported health in elderly Danes (1997) Eur J Clin Pharmacol, 53, pp. 179-183Parente, F., Cucino, C., Gallus, S., Bargiggia, S., Greco, S., Pastore, L., Bianchi Porro, G., Hospital use of acid-suppressive medications and its fall-out on prescribing in general practice: A 1-month survey (2003) Aliment Pharmacol Ther, 17, pp. 1503-1506Alves, L.C., Rodrigues, R.N., Determinantes da autopercepção de saúde entre idosos do Município de São Paulo, Brasil (2005) Rev Panam Salud Publica, 17 (5-6), pp. 333-341Woodward, M.C., Deprescribing: Achieving better health outcomes for older people through reducing medications (2003) J Pharm Pract Res, 33, pp. 323-328Stein, C., Moritz, I., (1999) A life course perspective of maintaining independence in older age, , http://whqlibdoc.who.int/hq/1999/WHO_HSC_AHE_99.2_life.pdf, Geneva: WHO.,. Disponível em, [Acessado em 20 de fevereiro de 2006](2006) Dispõe sobre o salário mínimo a partir de 1o de abril de, , http://www010.dataprev.gov.br/sislex/paginas/42/2006/11321.htm, BRASIL, Lei no 11.321, de 7 de julho de 2006, Disponível em, [Acessado em 23 de outubro de 2011

Potentially inappropriate medication use among institutionalized elderly individuals in southeastern Brazil

In recent decades, the elderly population in Brazil has grown rapidly, as has concern for the health of this population. Institutionalization in nursing homes has appeared as an alternative form of health care for frail elderly that live alone. The present study evaluated the pharmacotherapy and inappropriate drug prescriptions for institutionalized elderly patients living in long-term institutions in southeastern Brazil. This research was conducted at five institutions with a total sample of 151 individuals aged at least 60 years. Databases were used to identify drug interactions, defined daily dose and inappropriate prescriptions. The prevalence of drug intake among the elderly was 95.36%, and there were an average of 3.31 ± 1.80 drug prescriptions per individual. Based on Beers criteria, the prevalence of inappropriate prescriptions was 25.83%. In addition, 70.2% of prescriptions were prescribed at a higher dosage than the defined daily dose (ATC/WHO). Potential drug interactions were identified for 54.11% of prescriptions; 81.42% of these were of moderate severity. The main inappropriate drugs were prescribed for cardiovascular and nervous system problems. Institutionalized elderly individuals presented a high consumption and misuse of medications, requiring professional intervention to monitor prescriptions and improve the quality of service for this population

Identification of inappropriate prescribing in a Brazilian nursing home using STOPP/START screening tools and the Beers' Criteria

The objective of this study was to determine the prevalence of Potentially Inappropriate Medication (PIM) use and associated factors, as well as the prevalence of Prescribing Omissions (PO). A cross-sectional study was conducted in a philanthropic Brazilian nursing home involving 46 individuals aged 60 years or older. The following information was collected from medical records and drug prescriptions: gender, age, health conditions and drugs used in the past thirty days. PIM and PO were identified according to the Beers' Criteria and the STOPP/START screening tools. Over one third (37%) of the population used at least one PIM according to the Beers' Criteria (n=17) and 60.9% according to the STOPP tool. A significant association was found between polypharmacy (use of five or more drugs) and use of PIM according to the Beers' Criteria, but not according to the STOPP. Eight residents (17.4%) were exposed to eight PO. This study allowed the diagnosis of a concerning drug utilization profile with use of a high number of PIMs. Thus, there is an evident need to implement strategies for improving geriatric prescription

Search for boosted diphoton resonances in the 10 to 70 GeV mass range using 138 fb−1 of 13 TeV pp collisions with the ATLAS detector

A search for diphoton resonances in the mass range between 10 and 70 GeV with the ATLAS experiment at the Large Hadron Collider (LHC) is presented. The analysis is based on pp collision data corresponding to an integrated luminosity of 138 fb−1 at a centre-of-mass energy of 13 TeV recorded from 2015 to 2018. Previous searches for diphoton resonances at the LHC have explored masses down to 65 GeV, finding no evidence of new particles. This search exploits the particular kinematics of events with pairs of closely spaced photons reconstructed in the detector, allowing examination of invariant masses down to 10 GeV. The presented strategy covers a region previously unexplored at hadron colliders because of the experimental challenges of recording low-energy photons and estimating the backgrounds. No significant excess is observed and the reported limits provide the strongest bound on promptly decaying axion-like particles coupling to gluons and photons for masses between 10 and 70 GeV

Evidence for the charge asymmetry in pp → tt¯ production at s√ = 13 TeV with the ATLAS detector

Inclusive and differential measurements of the top–antitop (tt¯) charge asymmetry Att¯C and the leptonic asymmetry Aℓℓ¯C are presented in proton–proton collisions at s√ = 13 TeV recorded by the ATLAS experiment at the CERN Large Hadron Collider. The measurement uses the complete Run 2 dataset, corresponding to an integrated luminosity of 139 fb−1, combines data in the single-lepton and dilepton channels, and employs reconstruction techniques adapted to both the resolved and boosted topologies. A Bayesian unfolding procedure is performed to correct for detector resolution and acceptance effects. The combined inclusive tt¯ charge asymmetry is measured to be Att¯C = 0.0068 ± 0.0015, which differs from zero by 4.7 standard deviations. Differential measurements are performed as a function of the invariant mass, transverse momentum and longitudinal boost of the tt¯ system. Both the inclusive and differential measurements are found to be compatible with the Standard Model predictions, at next-to-next-to-leading order in quantum chromodynamics perturbation theory with next-to-leading-order electroweak corrections. The measurements are interpreted in the framework of the Standard Model effective field theory, placing competitive bounds on several Wilson coefficients

Search for heavy resonances decaying into a Z or W boson and a Higgs boson in final states with leptons and b-jets in 139 fb−1 of pp collisions at s√ = 13 TeV with the ATLAS detector

This article presents a search for new resonances decaying into a Z or W boson and a 125 GeV Higgs boson h, and it targets the νν¯¯¯bb¯¯, ℓ+ℓ−bb¯¯, or ℓ±νbb¯¯ final states, where ℓ = e or μ, in proton-proton collisions at s√ = 13 TeV. The data used correspond to a total integrated luminosity of 139 fb−1 collected by the ATLAS detector during Run 2 of the LHC at CERN. The search is conducted by examining the reconstructed invariant or transverse mass distributions of Zh or Wh candidates for evidence of a localised excess in the mass range from 220 GeV to 5 TeV. No significant excess is observed and 95% confidence-level upper limits between 1.3 pb and 0.3 fb are placed on the production cross section times branching fraction of neutral and charged spin-1 resonances and CP-odd scalar bosons. These limits are converted into constraints on the parameter space of the Heavy Vector Triplet model and the two-Higgs-doublet model

The ATLAS trigger system for LHC Run 3 and trigger performance in 2022

The ATLAS trigger system is a crucial component of the ATLAS experiment at the LHC. It is responsible for selecting events in line with the ATLAS physics programme. This paper presents an overview of the changes to the trigger and data acquisition system during the second long shutdown of the LHC, and shows the performance of the trigger system and its components in the proton-proton collisions during the 2022 commissioning period as well as its expected performance in proton-proton and heavy-ion collisions for the remainder of the third LHC data-taking period (2022–2025)

Search for the Zγ decay mode of new high-mass resonances in pp collisions at √s = 13 TeV with the ATLAS detector

This letter presents a search for narrow, high-mass resonances in the Zγ final state with the Z boson decaying into a pair of electrons or muons. The √s = 13 TeV pp collision data were recorded by the ATLAS detector at the CERN Large Hadron Collider and have an integrated luminosity of 140 fb−1. The data are found to be in agreement with the Standard Model background expectation. Upper limits are set on the resonance production cross section times the decay branching ratio into Zγ. For spin-0 resonances produced via gluon–gluon fusion, the observed limits at 95% confidence level vary between 65.5 fb and 0.6 fb, while for spin-2 resonances produced via gluon–gluon fusion (or quark–antiquark initial states) limits vary between 77.4 (76.1) fb and 0.6 (0.5) fb, for the mass range from 220 GeV to 3400 GeV

Search for third-generation vector-like leptons in pp collisions at s√ = 13 TeV with the ATLAS detector

A search for vector-like leptons in multilepton (two, three, or four-or-more electrons plus muons) final states with zero or more hadronic τ-lepton decays is presented. The search is performed using a dataset corresponding to an integrated luminosity of 139 fb−1 of proton-proton collisions at a centre-of-mass energy of 13 TeV recorded by the ATLAS detector at the LHC. To maximize the separation of signal and background, a machine-learning classifier is used. No excess of events is observed beyond the Standard Model expectation. Using a doublet vector-like lepton model, vector-like leptons coupling to third-generation Standard Model leptons are excluded in the mass range from 130 GeV to 900 GeV at the 95% confidence level, while the highest excluded mass is expected to be 970 GeV

Search for heavy Higgs bosons with flavour-violating couplings in multi-lepton plus b-jets final states in pp collisions at 13 TeV with the ATLAS detector

A search for new heavy scalars with flavour-violating decays in final states with multiple leptons and b-tagged jets is presented. The results are interpreted in terms of a general two-Higgs-doublet model involving an additional scalar with couplings to the top-quark and the three up-type quarks (ρtt, ρtc, and ρtu). The targeted signals lead to final states with either a same-sign top-quark pair, three top-quarks, or four top-quarks. The search is based on a data sample of proton-proton collisions at √s = 13 TeV recorded with the ATLAS detector during Run 2 of the Large Hadron Collider, corresponding to an integrated luminosity of 139 fb−1. Events are categorised depending on the multiplicity of light charged leptons (electrons or muons), total lepton charge, and a deep-neural-network output to enhance the purity of each of the signals. Masses of an additional scalar boson mH between 200 − 630 GeV with couplings ρtt = 0.4, ρtc = 0.2, and ρtu = 0.2 are excluded at 95% confidence level. Additional interpretations are provided in models of R-parity violating supersymmetry, motivated by the recent flavour and (g − 2)μ anomalies