A systematic review

Background: Multimorbidity is the co-occurrence of two or more diseases in the same individual. One method to identify this condition at an early stage is the use of specific markers for various combinations of morbidities. Nonetheless, evidence related to physiological markers in multimorbidity is limited. Objective: The aim was to perform a systematic review to identify physiological markers associated with multimorbidity. Design: Articles available on PubMed, Register of Controlled Trials, Academic Search Premier, CINAHL, Scopus, SocINDEX, Web of Science, LILACS, and SciELO, from their inception to May 2018, were systematically searched and reviewed. The project was registered in PROSPERO under the number CRD42017055522. Results: The systematic search identified 922 papers. After evaluation, 18 articles were included in the full review reporting at least one physiological marker in coexisting diseases or which are strongly associated with the presence of multimorbidity in the future. Only five of these studies examined multimorbidity in general, identifying five physiological markers associated with multimorbidity, namely, dehydroepiandrosterone sulfate (DHEAS), interleukin 6 (IL-6), C-reactive protein (CRP), lipoprotein (Lp), and cystatin C (Cyst-C). Conclusions: There is a paucity of studies related to physiological markers in multimorbidity. DHEAS, IL-6, CRP, Lp, and Cyst-C could be the initial focus for further investigation of physiological markers related to multimorbidity.info:eu-repo/semantics/publishedVersio

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 and complex multimorbidity in Brazilians with severe obesity

To investigate the prevalence of multimorbidity and complex multimorbidity and their association with sociodemographic and health variables in individuals with severe obesity. This is a baseline data analysis of 150 individuals with severe obesity (body mass index ≥ 35.0 kg/m2) aged 18-65 years. The outcomes were multimorbidity and complex multimorbidity. Sociodemographic, lifestyle, anthropometric and self-perceived health data were collected. Poisson multiple regression was conducted to identify multimorbidity risk factors. The frequency of two or more morbidities was 90.7%, three or more morbidities was 76.7%, and complex multimorbidity was 72.0%. Living with four or more household residents was associated with ≥ 3 morbidities and complex multimorbidity. Fair and very poor self-perceived health was associated with ≥ 2 morbidities, ≥ 3 morbidities and complex multimorbidity. A higher BMI range (45.0-65.0 kg/m2) was associated with ≥ 2 morbidities and ≥ 3 morbidities. Anxiety (82.7%), varicose veins of lower limbs (58.7%), hypertension (56.0%) were the most frequent morbidities, as well as the pairs and triads including them. The prevalence of multimorbidity and complex multimorbidity in individuals with severe obesity was higher and the risk for multimorbidity and complex multimorbidity increased in individuals living in households of four or more residents, with fair or poor/very poor self-perceived health and with a higher BMI

Educação Química no Projeto Escolar “Quixaba”: Alfabetização Científica com Enfoque CTSA no Ensino Fundamental a Partir de Temas Sociocientíficos

The objective of this study was to analyze the pedagogical aspects of teaching chemistry in a “Quixaba” school project developed with students of Science of last year of basic school (corresponding to the third cycle), focusing CTSA. The project dealt with the articulation of socio-scientific issues with content of Chemistry, focusing on some industry sectors of Espírito Santo State, such as food, construction and steel. This is a case study, qualitative, based on direct observations, technical visits and focus group interviews. The results led us to conclude that the teaching practices carried out during the “Quixaba” project provided scientific literacy focusing CTSA. DOI: http://dx.doi.org/10.17807/orbital.v7i1.68

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

Da vibração ao encontro com o outro: psicanálise, música e autismo

El estudio investigó los efectos de un taller musical como formador de lazos entre los niños autistas y sus semejantes. Se supone que el ritmo impregna la estructura psíquica. Formaran parte del taller, con reuniones semanales, niños de dos a cuatro años. Los interventores fueron: psicólogos, psicoanalistas, un profesor de música, un terapeuta del habla y estudiantes de psicología de la Universidad Ceuma. Los resultados fueron presentados en un estudio de caso analizado desde la teoria psicoanálitica. Llegamos a la conclusión de que el lenguaje musical puede ayudar a formar una unión que no sea amenazadora y intrusiva. O estudo, partindo do princípio de que o ritmo permeia a estruturação psíquica, investigou os efeitos de um ateliê musical como formador de laço entre crianças autistas e seus semelhantes. O ateliê, com encontros semanais, era formado por crianças de dois a quatro anos. Foram interventores: psicólogas, psicanalistas, uma professora de música, uma fonoaudióloga e estudantes de psicologia da Universidade Ceuma. Os resultados foram descritos por meio de um estudo de caso, discutido sob o referencial da psicanálise. Conclui-se que a linguagem musical pode auxiliar no estabelecimento de vínculos, sendo esta linguagem não ameaçadora e intrusiva. The study investigated the effects of a musical atelier as in instrument to create bond between autistic children with pairs. It was assumed that rhythm permeates psychic structuring. The atelier, which happened once a week, was composed by children aged two to four. The interventors were: one speech therapist, psychologists and students of the Psychology at Ceuma University. The results were described through a case study, done with a three year old child and discussed under the theoretical reference of psychoanalysis. It concluded that the musical language can help in the establishment of bond with autistic children, since this language is not threatening and intrusive.

Hospitalizações por condições cardiovasculares sensíveis à atenção primária em municípios goianos

OBJETIVO: Analisar taxas de hospitalização por condições cardiovasculares sensíveis à atenção primária. MÉTODOS: Estudo ecológico com 237 municípios do Estado de Goiás, de 2000 a 2008, utilizando dados do Sistema de Informação Hospitalar e Sistema de Informação da Atenção Básica. As taxas de hospitalização foram calculadas pela proporção entre o número de hospitalizações por condições cardiovasculares e a população acima de 40 anos. Foram avaliadas em triênios: A (2000-2002), B (2003-2005) e C (2006-2008), segundo sexo, faixa etária, porte populacional, pertencimento à região metropolitana, macrorregião de saúde, distância da capital, Índice de Condições de Vida e Saúde e cobertura de Estratégia Saúde da Família. A cobertura populacional potencial da Saúde da Família foi calculada conforme diretrizes do Ministério da Saúde. A variabilidade das taxas foi avaliada segundo teste t e ANOVA. RESULTADOS: Ocorreram 253.254 internações (17,2% do total) por condições cardiovasculares sensíveis à atenção primária. As taxas de hospitalização diminuíram entre os triênios: A (213,5, dp = 104,6), B (199,7, dp = 96,3) e C (150,2, dp = 76,1), com diferença entre os períodos A-C e B-C (p < 0,001). Porte populacional municipal não influenciou o comportamento das taxas. Municípios próximos à capital e aqueles da região metropolitana apresentaram maiores taxas (p < 0,001). Em todos os percentis do Índice de Condições de Vida e Saúde, houve redução das taxas (p < 0,001), exceto no percentil 1. Redução foi também observada em todas as macrorregiões, exceto na região nordeste do estado. A redução das taxas ocorreu independentemente da cobertura da Saúde da Família. CONCLUSÕES: As taxas de hospitalização por condições cardiovasculares sensíveis à atenção primária diminuíram nesses municípios, independentemente da cobertura da Saúde da Família.OBJECTIVE: To analyze rates of hospitalization due to primary care-sensitive cardiovascular conditions. METHODS: This ecological study on 237 municipalities in the state of Goiás, Central-West Brazil, between 2000 and 2008, used data from the Hospital Information System and the Primary Care Information System. The hospitalization rates were calculated as the ratio between the number of hospitalizations due to cardiovascular conditions and the population over the age of 40 years. The data were evaluated over the three-year periods A (2000-2002), B (2003-2005) and C (2006-2008), according to sex, age group, population size, whether the individual belonged to the metropolitan region, healthcare macroregion, distance from the state capital, living conditions index and coverage within the Family Health Strategy. The potential population coverage of the Family Health Strategy was calculated in accordance with Ministry of Health guidelines. The variability of the rates was evaluated using the t test and ANOVA. RESULTS: A total of 253,254 hospitalizations (17.2%) occurred due to primary care-sensitive cardiovascular conditions. The hospitalization rates diminished between the three-year periods: A (213.5, SD = 104.6), B (199.7, SD = 96.3) and C (150.2, SD = 76.1), with differences from A to C and from B to C (p < 0.001). Municipal population size did not influence the behavior of the rates. Municipalities near the state capital and those in the metropolitan area presented higher rates (p < 0.001). At all percentiles of the Life and Health Conditions Index, there were decreases in the rates (p < 0.001), except at percentile 1. Decreases were also observed in all the macroregions except for the northeastern region of the state. The reduction in rates was independent of the Family Health Strategy coverage. CONCLUSION: The rates of hospitalization due to primary care-sensitive cardiovascular conditions decreased in these municipalities, independent of the Family Health Strategy coverage.OBJETIVO: Analizar tasas de hospitalización por condiciones cardiovasculares sensibles de atención primaria. MÉTODOS: Estudio ecológico con 237 municipios del estado de Goias (centro-oeste de Brasil) de 2000 a 2008, utilizando datos del Sistema de Información Hospitalario y Sistema de Información de Atención Básica. Las tasas de hospitalización fueron calculadas por la proporción entre el número de hospitalizaciones por condiciones cardiovasculares y la población con más de 40 años. Las tasas fueron evaluadas en trienios: A (2000-2002), B (2003-2005) y C (2006-2008), según sexo, grupo etáreo, porte poblacional, pertenencia a la región metropolitana, macro región de salud, distancia a la capital, índice de Condiciones de Vida y Salud y cobertura de Estrategia Salud de la Familia. La cobertura poblacional potencial de la Salud de la Familia fue calculada conforme a las directrices del Ministerio de la Salud. La variabilidad de las tasas fue evaluada según la prueba de t y ANOVA. RESULTADOS: Ocurrieron 253.254 internaciones (17,2% del total) por condiciones cardiovasculares sensibles de la atención primaria. Las tasas de hospitalización disminuyeron entre los trienios: A (213,5, de=104,6); B (199,7, de=96,3) y C (150,2, de=76,1), con diferencia entre los períodos A-C y B-C (

Educação Química no Projeto Escolar “Quixaba”: Alfabetização Científica com Enfoque CTSA no Ensino Fundamental a Partir de Temas Sociocientíficos

The objective of this study was to analyze the pedagogical aspects of teaching chemistry in a “Quixaba” school project developed with students of Science of last year of basic school (corresponding to the third cycle), focusing CTSA. The project dealt with the articulation of socio-scientific issues with content of Chemistry, focusing on some industry sectors of Espírito Santo State, such as food, construction and steel. This is a case study, qualitative, based on direct observations, technical visits and focus group interviews. The results led us to conclude that the teaching practices carried out during the “Quixaba” project provided scientific literacy focusing CTSA. DOI: http://dx.doi.org/10.17807/orbital.v7i1.68