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- ItemAcesso aberto (Open Access)Concordância para comportamentos de Saúde entre cônjuges de casais idosos: fatores relacionados, morbidade física e mortalidade(Universidade Federal de São Paulo (UNIFESP), 2014-09-30) Machado, Mayra Pires Alves [UNIFESP]; Ferri, Cleusa Pinheiro Ferri [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: The rate of population aging is increasing, especially in low and middle income countries. Chronic disease is one of the main causes of disability and mortality in older adults and is influenced by health behavior, making it important to understand the correlates of health behavior concordance among old couples and their association with cardiovascular disease (CVD), depression and mortality. Objectives: To estimate health behavior concordance and its correlates among old couples and their association with cardiovascular disease (CVD), depression and mortality. Methods This is a secondary analysis of the 10/66 Dementia Research Group population-based study, using data regarding alcohol consumption, smoking, physical activity, cardiovascular disease, depression and mortality (after 4 years of follow-up) collected from couples aged 65 and over from 5 low and middle income countries. Logistic regression models were used to estimate the factors associated with health behavior concordance and the association between concordance and chronic conditions. Cox regression models were used to estimate the association between concordance and mortality. Results: There was a high concordance in regard to alcohol (71.4%) and tobacco (83.2%) abstinence, and a smaller concordance for physical activity (46.9%). Increased age was associated with concordance among couples in respect of physical inactivity, alcohol and tobacco abstinence; being part of a wide social network was more common among physically active couples and having a narrow social network more common among alcohol abstinent couples. Physically inactive participants were more likely to have depression, independent of their spouse’s physical activity, but this association was stronger when they were married to an inactive spouse. Active participants married to inactive spouses had lower rates of CVD than those married to also active spouses (OR=0.70 ; 95%IC 0.52-0.94 for men and OR=0.61 ; 95%IC 0.45-0.81 for women). Inactive couples had higher rates of female mortality in comparison to active couples (HR=2.13 ; 95%CI 1.20-3.77); and there were lower rates of mortality in alcohol abstinent women married to at risk drinking husbands than for women from alcohol abstinent couples (HR=0.28 ; 95%CI 0.10-0.80). Conclusion: Older couples often share health behaviors which impact on their wellbeing but beyond this, spousal behavior can have distinct and sometimes unexpected health consequences, particularly for women. Interventions promoting changes in older people’s health behavior may be more effective if both spouses’ health behaviors and how they mutually affect each other’s health are considered.
- ItemAcesso aberto (Open Access)Fatores associados à adesão ao tratamento de crianças e adolescentes com doenças reumáticas crônicas(Sociedade Brasileira de Pediatria, 2012-12-01) Bugni, Vanessa Miotto [UNIFESP]; Ozaki, Luciana da Silva [UNIFESP]; Okamoto, Karine Yoshiye Kajiyama [UNIFESP]; Barbosa, Cassia Maria Passarelli Lupoli [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: There are several factors that contribute to poor adherence to treatment in children and adolescents with chronic rheumatic diseases, worsening their quality of life and prognosis. Our aim was to assess the rates of adherence to treatment and to identify the socioeconomic and clinical factors associated. METHODS: The sample included 99 patients with juvenile idiopathic arthritis, systemic erythematosus lupus, dermatomyositis or juvenile scleroderma. All patients were followed at the outpatient pediatric rheumatology for a minimum period of 6 months. To assess adherence, a questionnaire was administered to the providers, which included three blocks: 1) demographic, clinical and laboratory data; 2) medication adherence; and 3) attending follow-up appointments, examinations and use of orthoses. A value lower than or equal to 80% of the prescribed was considered poor adherence. RESULTS: A total of 53% of patients showed good overall adherence, observed when the caregiver lived in a stable union marital status (p = 0.006); 20 patients (20.2%) presented poor medication adherence, related to the use of three or more medications daily (p = 0.047). The causes of poor adherence were forgetfulness, refusal, incorrect dose or lack of medication, personal problems, and financial difficulties. CONCLUSIONS: We observed good overall treatment adherence in patients whose providers lived in stable union and poor adherence to medication in patients who used more than three types of medication daily. There was no association between the adherence rates and sex, age, time since diagnosis and disease activity.
- ItemSomente MetadadadosRevolução tecnológica, inovação e seu impacto em pesquisa científica e saúde(Universidade Federal de São Paulo (UNIFESP), 2014-12-31) Capobianco, Dirce Maria [UNIFESP]; Prado, Gilmar Fernandes Do Prado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: we live in a Technological World, with exponential growth of information, population, life expectancy, and also chronic diseases. The Scientific Research and Health System must be adapted to the world changes/trends, learning to use giant databases, new technologies, new tools to streamline research and new systems of information, storage and use of data. General Objective: to describe the global context on Technology, Health (emphasis in Chronic Diseases) and Scientific Research, to generate future hypotheses/actions of intersection between these three areas (Technological Innovation, Health Care and Research Processes). Specific objectives were to analyze: 1). surgical treatment of Obstructive Sleep Apnea Syndrome (OSAS), on an American database; 2). the evolution of scientific research in bariatric surgery, as chronic disease model, and its popular perception; 3). the effective participation of researchers in data availability through publications of the New England Journal of Medicine (NEJM). Method: To address these goals, we held: Article 1 - the association between surgeon/hospital volume with the treatment outcomes of obstructive sleep apnea (OSA), a representative sample of the American Population. Article 2 - which used the technology of Text Mining (algorithm developed) for extraction of information from the PubMed database. Article 3 - the availability of scientific data in studies of NEJM, funded by the National Institutes of Health (NIH) since 2003, when the policy of data sharing emerged. Results: description of the global context of the aforementioned areas and the following results: Article 1. Validations of the hypothesis that surgeons and hospitals with lower volumes of patients have: higher mortality rates, longer hospital stays, higher rates of complications and higher hospital costs.Article 2. It demonstrates that: 2A). all types of classified study design have shown prevalence increase over the years; 2B). the prevalence of terms representing the Risk Factors of Chronic Diseases within PubMed database has increased over the years; 2C). searches of these terms, done by the general population through Google, declined over time. Article 3. It demonstrates low percentage (4.3%) of data availability, low adherence of the authors to the data sharing policy and, as a consequence, low reproducibility of research. Conclusion: Innovation is a reality of today's world and should be used for the benefit of Scientific Research and the Health Care. Text Mining Techniques, as exemplified in Article 2, are able to translate large amounts of scientific data into knowledge. In our study, despite the great advances of science in Bariatric Surgery, we have found that the popular perception of the risk factors for chronic diseases may be less than expected, raising an important alert about maximizing social value promoted by Science. Furthermore, we have identified in our sample (Article 3), low adherence to data sharing policy and low reproducibility of research. Added to this, we have raised the question of how the experience of a surgeon, and the hospital structure, may impact the results of their treatment (surgery for OSA, Article 1), a factor that may also alerts us about policy changes needed to improve the quality of Health Care.
- ItemAcesso aberto (Open Access)A transição de adolescentes com HIV/AIDS para a clínica de adultos: um novo desafio(Sociedade Brasileira de Pediatria, 2010-12-01) Machado, Daisy Maria [UNIFESP]; Succi, Regina Célia de Menezes [UNIFESP]; Turato, Egberto Ribeiro; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)OBJECTIVE: To review the literature on transition from pediatric to adult-oriented health care and discuss this issue in the specific context of chronic conditions. SOURCES: MEDLINE and LILACS were searched for relevant English and French-language articles published between 1990 and 2010. SUMMARY OF THE FINDINGS: The transition of adolescents with chronic diseases from pediatric care to adult-oriented services has been a growing concern among pediatric specialties. In recent years, young people living with HIV/AIDS have begun to reach adulthood, giving rise to several challenges. The studies reviewed herein discuss such relevant topics as: the difference between transfer, an isolated event, and transition, a gradual process; the transition models used in different services; the importance of transitioning in a planned and individualized manner; the need for comprehensive interaction between pediatric and adult-oriented care teams; the importance of joint participation of adolescents, their families, and health professionals in the process; barriers to and factors that promote successful transitions; and the special needs of adolescents with HIV/AIDS in this important period of life. CONCLUSIONS: Several authors agree that transitioning adolescents to adult-oriented health care should be a gradual process not determined by age alone. It requires a plan established with ample dialogue among adolescents, their families, and pediatric and adult care teams. However, there is little evidence to support any specific model of health care transition. This should prompt researchers to conduct more prospective studies on the theme, especially in more vulnerable groups such as adolescents living with HIV/AIDS.