15 research outputs found
Alcoolistas e usuårios disfuncionais de outras substùncias psicoativas: identificação de comorbidade, adesão ao tratamento e prognóstico
-INTRODUĂĂO: Tomando a adesĂŁo ao tratamento como variĂĄvel dependente, este estudo utilizou a regressĂŁo logĂstica para aprofundar anĂĄlises
anteriormente realizadas e testar a influĂȘncia sobre a adesĂŁo de variĂĄveis que abrangem diferentes dimensĂ”es utilizadas na avaliação de alcoolistas:
sĂłcio-demogrĂĄficas, sintomatolĂłgicas, crenças, sentimentos, comportamentos e padrĂŁo de consumo, diagnĂłstico e tratamento â anterior e atual â
dos pacientes. Utilizou-se adesão por tratar-se de uma medida pråtica de avaliação de resultado de tratamento.
MĂTODO: Partiu-se de estudo observacional e foram incluĂdos 300 pacientes alcoolistas que concluĂram a fase de avaliação do programa.
Inicialmente, foi testada a associação de todas as mais de 1000 variåveis do banco de dados com a adesão, utilizando o Teste do Qui-quadrado de
Pearson (p< 0,1). Posteriormente, foi realizada regressĂŁo logĂstica das variĂĄveis, inicialmente em cada dimensĂŁo avaliadas, selecionando-se as que
seriam incluĂdas na anĂĄlise multidimensional (modelo final). O protocolo do trabalho em questĂŁo obteve aprovação pelos ComitĂȘs de Ătica em
Pesquisa (CEP) do HU-UFJF (Protocolo 099-23/2000-Grupo III) e CEP da UFJF (Protocolo CEP-UFJF 1071.117.2007). O requerimento do
consentimento livre e esclarecido foi dispensado pelos CEP.
RESULTADOS: ApĂłs a realização dos procedimentos de regressĂŁo logĂstica para cada dimensĂŁo estudada, procedeu-se Ă anĂĄlise do conjunto das
variĂĄveis mantidas nos modelos unidimensionais. Dois modelos finais se destacaram. No mais parcimonioso, seis variĂĄveis se mostraram fortemente
associadas Ă adesĂŁo â Tempo de uniĂŁo acima da mĂ©dia do grupo; Receber mais que um salĂĄrio mĂnimo; Ter apresentado dor abdominal nos 30
dias que precederam a avaliação; Apresentar tremores se não bebia no horårio habitual; Apresentar pressão arterial sistólica d 130mmHg ; Beber
sozinho na Ă©poca da avaliação â, com razĂ”es de chance que variaram entre 2,993 (para aqueles que afirmaram beber sozinhos Ă Ă©poca da
avaliação) e 5,127 para os referiram apresentar tremores se não bebiam no horårio habitual. Outro modelo a ser considerado é o que, além das seis
anteriores inclui tambĂ©m a variĂĄvel âjĂĄ ter procurado, alguma vez, tratamento para alcoolismoâ: apesar do p-valor indicar apenas significĂąncia
marginal (0,065), sujeitos que afirmaram jĂĄ haver, anteriormente, procurado tratamento para alcoolismo, tiveram uma probabilidade 120% maior de
âadesĂŁo superiorâ.
CONCLUSĂO: Uma vez que a adesĂŁo ao tratamento de alcoolismo vem sendo considerada uma medida adequada para a monitorização de
tratamentos, a identificação de caracterĂsticas dos pacientes que se associam ao seu tempo de adesĂŁo ao tratamento deverĂĄ contribuir para o
desenvolvimento de estratĂ©gias de avaliação destes grupos de pacientes que costumam responder mal Ă s terapĂȘuticas de rotina. O foco na
modificação ou reforço de tais caracterĂsticas poderĂĄ gerar resultados mais favorĂĄveis no tratamento de alcoolistas
Factors associated with adherence in a alcoholic program
OBJECTIVE: The evaluation of adherence to treatment has been considered an objective and versatile alternative to alcoholism treatment result assessment. The purpose of this study is to identify factors associated with adherence to an outpatient alcoholism treatment program. METHOD: This study included 300 alcoholic patients that concluded the program assessment stage. Crosstabs were performed to verify the association of adherence to treatment on all other (more than 1,000) variables in the data bank. Statistical significance was given by Pearson's Qui-square test (p < 0.1).
RESULTS: Among variables with a positive association to adherence were: to have children and stable matrimonial relationship; affirm psychological problems; lately noticed forgetfulness and weakness; felt irritability when drunk, consuming it alone; present a psychiatric comorbidity; had already looked for alcoholism treatment, got help from AA, psychiatric treatment and made use of antidepressants; etc. Negative associations were: reduced consumption due to family influence; felt self-sufficiency, expansive and unsatisfied while sober; self-sufficient or resigned when under alcohol; first consumptions above group's average age; involved in physical aggression with friends; etc. CONCLUSIONS: These findings suggest the need of developing particular therapeutic strategies to address specific groups of patients and also contribute to the simplification of alcoholism assessment routines.OBJETIVO: A medida da adesão tem sido considerada alternativa objetiva e versåtil para avaliação do resultado do tratamento de alcoolistas. Este estudo avaliou fatores associados à adesão de alcoolistas atendidos em um programa ambulatorial.
MĂTODO: Foram estudados 300 alcoolistas que concluĂram a fase de avaliação do programa e avaliada a associação da adesĂŁo dos pacientes ao tratamento a todas as mais de mil variĂĄveis do banco de dados do programa, utilizando o teste qui-quadrado de Pearson (p < 0,1). RESULTADOS: Entre as variĂĄveis que se associaram positivamente Ă adesĂŁo foram identificadas: ter filhos; relação conjugal estĂĄvel; afirmar problemas psicolĂłgicos; ter sofrido esquecimento ou fraqueza recentemente; sentir-se irritado quando alcoolizado; beber sozinho; apresentar comorbidade psiquiĂĄtrica; jĂĄ ter procurado tratamento para alcoolismo, tratamento em psiquiatria; uso anterior de antidepressivos etc. Associaram-se negativamente: reduzir consumo por influĂȘncia familiar; sentir-se auto-suficiente, expansivo, insatisfeito quando sĂłbrio; sentir-se auto-suficiente ou conformado quando alcoolizado; inĂcio do consumo com idade acima da mĂ©dia do grupo; ter-se envolvido em agressĂŁo fĂsica com amigos etc.
CONCLUSĂO: Os resultados sugerem a necessidade de desenvolvimento de estratĂ©gias diferenciadas para o cuidado de determinados grupos de pacientes e contribuem para a simplificação das rotinas de avaliação de alcoolistas
Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants
Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5â19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9â10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changesâgaining too little height, too much weight for their height compared with children in other countries, or bothâoccurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprungâs disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprungâs disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36â39) and median bodyweight at presentation was 2·8 kg (2·3â3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
pâ€0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88â4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59â2·79], p<0·0001), sepsis at presentation (1·20
[1·04â1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4â5 vs ASA 1â2, 1·82 [1·40â2·35], p<0·0001; ASA 3 vs ASA 1â2, 1·58, [1·30â1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02â1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41â2·71], p=0·0001; parenteral nutrition 1·35, [1·05â1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47â0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50â0·86], p=0·0024) or percutaneous central line (0·69 [0·48â1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions
CaracterĂsticas demogrĂĄficas e sociais associadas Ă adesĂŁo a um programa de tratamento de alcoolistas
Diante da complexidade da avaliação de resultados de tratamento de alcoolistas a partir de variĂĄveis relacionadas Ă ingestĂŁo de ĂĄlcool, a medida adesĂŁo ao tratamento tem sido proposta como uma opção simples e prĂĄtica. Este estudoavaliou fatores sĂłcio-demogrĂĄficos possivelmente associados a adesĂŁo de alcoolistas atendidos em um programa ambulatorial. MĂ©todo: Estudo observacional utilizando dados de 300 alcoolistas que concluĂram a fase de avaliação do programa ambulatorial. Avaliou-se a associação de todas as 18 variĂĄveis estudadas com adesĂŁo ao tratamento. Todas as variĂĄveis cuja associação resultou em um p-valor (dado pelo Teste do Qui-quadrado de Pearson) menor que 0,1 foram, entĂŁo, incluĂdas em procedimentos de regressĂŁo logĂstica. Resultados: Na analise bivariada, as variĂĄveis associadas positivamente a adesĂŁo foram: ter filhos; ter relação conjugal estĂĄvel; ter tempo de uniĂŁo acima da media do grupo; estar trabalhando; e receber mais que um salĂĄrio mĂnimo; ser autĂŽnomo associou-se negativamente a adesĂŁo. Apos a analise multivariada, tempo de uniĂŁo permaneceu como Ășnica caracterĂstica sĂłcio-demogrĂĄfica significativamente relacionada a adesĂŁo ao tratamento. ConclusĂŁo: Os resultados contribuem para o processo de avaliação de alcoolistas e enfatizam a necessidade do desenvolvimento de estratĂ©gias especificamente desenhadas para a abordagem de determinados grupos destes pacientes
Identificação de fatores associados Ă adesĂŁo a um programa ambulatorial de tratamento de alcoolistas por meio de regressĂŁo logĂstica
Adherence is a practical measure of treatment results assessment. This study aimed to identify patientâs characteristics associated to adherence to an outpatient treatment program for alcoholics. This study included 300 alcoholics that concluded the programÂŽs assessment stage. Firstly, crosstabs were used to verify possible association of adherence to treatment to all other (more than 1,000) variables in the data bank, using PearsonÂŽs Qui-square test (p < 0.1). Later, logistic regression was performed; initially within each dimension of characteristics, and then using the selected variables in a multidimensional model. In the final model, variables significantly associated to adherence were: stable matrimonial relationship; to perceive more than one Brazilian minimum wage; abdominal pain on the last 30 days before evaluation; to tremble if did not drink at regular timing; systolic blood pressure †130mmHg; solitary consumption. The identification of characteristics associated to greater adherence is expected to contribute to the development of strategies of care of patients that are usually poor responders to regular approaches. A focus on the changing or reinforcement of these characteristics may contribute to improve results in the treatment of alcoholics.Key-words: Alcoholism; Evaluation, DiagnosisAdesĂŁo Ă© uma medida prĂĄtica de avaliação de resultado de tratamento. Buscou-se identificar caracterĂsticas dos pacientes, associadas Ă adesĂŁo a um programa ambulatorial de tratamento de alcoolistas. O estudo foi de coorte naturalĂstico, no qual foram incluĂdos todos os 300 pacientes alcoolistas, que concluĂram a fase de avaliação do programa. Inicialmente, foi testada a associação de variĂĄveis relativas a aspectos sociodemogrĂĄficos, econĂŽmicos, crenças, sentimentos, comportamentos, sintomas e tratamentos, incluĂdas no protocolo de avaliação dos pacientes com a variĂĄvel adesĂŁo, utilizando o Teste do Qui-quadrado de Pearson (p< 0,1). Posteriormente, foi realizada regressĂŁo logĂstica das variĂĄveis, primeiro, dentro de cada dimensĂŁo de caracterĂsticas, selecionando-se as que seriam incluĂdas numa anĂĄlise multidimensional. No modelo final, as variĂĄveis que se associaram significativamente Ă adesĂŁo superior foram: tempo de uniĂŁo acima da mĂ©dia do grupo; receber mais que um salĂĄrio mĂnimo; ter apresentado dor abdominal nos 30 dias antes da avaliação; apresentar tremores se nĂŁo bebia no horĂĄrio habitual; apresentar pressĂŁo arterial sistĂłlica †130mmHg; costumar beber sozinho Ă avaliação. Espera-se que a identificação de caracterĂsticas associadas Ă adesĂŁo ao tratamento contribua para o desenvolvimento de estratĂ©gias de abordagem de pacientes que respondem mal Ă prĂĄtica habitual. O foco na modificação ou reforço destas caracterĂsticas poderĂĄ contribuir para resultados mais favorĂĄveis no tratamento de alcoolistas
Aplicabilidade da classificação de alcoolismo tipo A/tipo B Aplicability of the type A/type B classification of alcoholics
OBJETIVOS: Avaliar a aplicabilidade da tipologia e caracterizar os subtipos identificados. MĂTODOS: CaracterĂsticas de 300 homens alcoolistas atendidos em um programa ambulatorial foram submetidas Ă anĂĄlise de cluster para separĂĄ-los em dois subgrupos de acordo com a tipologia de Babor et al. Efetivaram-se cruzamentos de dados (significĂąncia avaliada pelo Teste do qui-quadrado de Pearson) para se verificar a associação dos clusters com variĂĄveis clĂnicas e demogrĂĄficas. RESULTADOS: Comparado ao outro grupo e pacientes, um dos clusters identificados foi caracterizado por um perfil de maior gravidade clĂnica. Pacientes do subtipo menos grave foram mais frequentemente (65,3%) encaminhados a tratamentos simbĂłlicos, enquanto pacientes do subtipo mais grave foram atendidos predominantemente (58,5%) por abordagem exclusivamente farmacolĂłgica e aderiram mais ao tratamento proposto. CONCLUSĂES: Como os resultados identificaram subtipos de alcoolistas com distintas caracterĂsticas, este estudo evidenciou a aplicabilidade clĂnica da tipologia de Babor et al. em nosso meio socioculturalÂč. TambĂ©m aponta para a relevĂąncia de estudos tipolĂłgicos que possam contribuir para uma mais ampla compreensĂŁo dos aspectos etiolĂłgicos, preventivos e terapĂȘuticos do alcoolismo.<br>OBJECTIVE: To test the applicability of this typology and to characterize the identified subtypes. METHODS: Characteristics of 300 alcoholic men attending an out-treatment program were submitted to cluster analysis for identification of two subgroups (clusters), according to the original classification. Cross-tabulations were then performed to test for possible association of identified clusters to demographic and clinical features. Statistical significance was given by Pearson chi-square tests. RESULTS: Compared to the other group, one of the identified clusters was characterized by a more severe clinical profile. Patients of the mild subtype were principally (65,3%) referred to symbolic treatments while patients of the severe subtype were mainly assisted (58,5%) exclusively through a pharmacological approach and remained in treatment for longer periods of time. CONCLUSIONS: As the results identified subtypes of alcoholics with differential features, this study brought forth the clinical applicability of Babor et al. typology in our social-cultural contextÂč. Results also point to the relevance of typological studies that may contribute to a more adequate understanding of etiological, preventive and therapeutic aspects of alcoholism
Outcomes from elective colorectal cancer surgery during the SARSâCoVâ2 pandemic
Aim
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.
Method
This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data.
Results
From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58â14.06), postoperative SARS-CoV-2 (16.90, 7.86â36.38), male sex (2.46, 1.01â5.93), age >70 years (2.87, 1.32â6.20) and advanced cancer stage (3.43, 1.16â10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%).
Conclusion
Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks
The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study
AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4âweeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4âweeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, PÂ =Â 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, PâConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease