Caracterización sobre los pacientes operados de cáncer colorrectal tratados con quimioterapia adyuvante en Camagüey

Introducción: El cáncer colorrectal es un problema de salud creciente en el mundo, el aumento en la expectativa de vida de las poblaciones, el continuo mejoramiento de las técnicas de tamizaje y la búsqueda activa de casos, son las razones por las cuales cada año se informa un aumento en el número global de casos diagnosticados con cáncer. Objetivo: Caracterizar a los pacientes operados de cáncer colorrectal tratados con quimioterapia. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal, en pacientes atendidos en la consulta multidisciplinaria de cáncer colorrectal. El universo lo conformaron todos los pacientes que acudieron a consulta en ese período, la muestra a criterio de los autores la conformaron 55 pacientes tratados con quimioterapia adyuvantes por cáncer colorrectal. La fuente primaria de la investigación estuvo dada por la historia clínica. Resultados: En cuanto a la relación sexo y edad, se observó una mayor frecuencia del grupo de 70-79 años y en el sexo femenino. Según la localización topográfica existió predominio en colon sigmoides con 33 pacientes para un 60 % de la muestra estudiada. La variante histológica adenocarcinoma moderadamente diferenciado fue la de mayor presentación. Predominaron los pacientes en estadio IIIa de la enfermedad. El esquema de quimioterapia usado con mayor frecuencia fue el Folfox. Conclusiones: En la muestra, la mayoría de los pacientes estuvieron incluidos en el grupo etáreo entre 70-79 años de edad. La localización topográfica más frecuente fue el colon sigmoide y el tipo histológico, el adenocarcinoma moderadamente diferenciado. Predominaron los pacientes en el estadio IIIa y el tratamiento con quimioterapia adyuvante más utilizado fue el esquema de Folfox.

Introduction: Colorectal cancer is a growing health problem in the world, the increase in the life expectancy of populations, the continuous improvement of screening techniques and the active search for cases, are the reasons why an increase in the global number of cases diagnosed with cancer is reported each year. Objective: To characterize the patients operated on for colorectal cancer treated with adjuvant chemotherapy. Methods: An observational, descriptive, cross-sectional study was carried out in patients seen at the multidisciplinary colorectal cancer clinic. The universe was made up of all the patients who attended the consultation in that period, the sample at the authors' criteria was made up of 55 patients treated with adjuvant chemotherapy for colorectal cancer. The primary source of the investigation was given by the clinical history. Results: Regarding the relationship between sex and age, a higher frequency was observed in the group of 70-79 years and in the female sex. Regarding the topographic location, there was a predominance in the sigmoid colon with 33 patients for 60% of the sample studied. The moderately differentiated adenocarcinoma histological variant was the one with the highest presentation. Patients in stage IIIa of the disease were more frequent. The most frequently used chemotherapy regimen was Folfox. Conclusions: In the sample, most of the patients were included in the age group between 70-79 years of age. The most frequent topographic location was the sigmoid colon and the histological type was moderately differentiated adenocarcinoma. Patients in stage IIIa predominated and the most widely used adjuvant chemotherapy treatment was the Folfox regimen.

Development in methods and application of healthy life expectancy / 上海预防医学

With the development of social economy and improvement of people's health condition， life expectancy continues to extend and people are more concerned about the quality of life. Nowadays people's attention has shifted from living longer lives to living healthier lives. Life expectancy can only reflect the length of life， but not the health condition and quality of life. Meanwhile， healthy life expectancy contains death and disability information， which comprehensively reflects the length and quality of life and evaluates the health status of the population comprehensively. Through literature search and review， the article summarized the research on healthy life expectancy in recent years， including the concept proposal， index development， calculation， and application progress of health life expectancy. The research methods of healthy life expectancy are summarized in order to provide academic reference for further research.

El envejecimiento de la población chilena y los desafíos para la salud y el bienestar de las personas mayores / The aging of the chilean population and the challenges for health and wellbeing of older people

El envejecimiento de la población es un fenómeno global. El proceso ha adquirido mayor velocidad en países en desarrollo que la que tuvo en países desarrollados, los que enfrentan el proceso en un contexto de desarrollo socio-económico muy inferior. Chile es el país que ha aumentado más rápidamente la expectativa de vida al nacer (EVN) en la región, constituyéndose en el país con la mayor expectativa de vida de Sudamérica, con 79,5 años. Los logros económicos y socio-sanitarios alcanzados colocan a Chile entre los países de altos ingresos, sin embargo, persisten importantes desigualdades en la distribución del ingreso, lo que impacta negativamente en los indicadores de salud de los adultos mayores. En el estudio Alexandros se observó que, si bien la expectativa de vida es superior en las mujeres que en los hombres, la diferencia corresponde a expectativa de vida con discapacidad. El seguimiento de la cohorte SABE Chile mostró además importantes diferencias en la prevalencia e incidencia de limitación funcional entre los niveles socioeconómicos alto, medio y bajo en desmedro de estos últimos CONCLUSIONES Chile enfrenta un rápido envejecimiento poblacional en un contexto de profunda desigualdad socioeconómica, de género y urbano-rural en los adultos mayores, lo que plantea a la sociedad múltiples desafíos que deben ser enfrentados a la brevedad. La disminución de la brecha entre expectativa de vida total y expectativa de vida saludable, es posible a través de estilos de vida saludable y participación social sumado a un cuidado de la salud integrado y centrado en la persona.

The aging of the population is a global phenomenon. The process has gained greater speed in developing countries than it had in developed countries, which face the process in a much lower socio-economic development context. In the regional context, Chile is the country that has most rapidly increased life expectancy at birth (LEB), becoming the country with the highest life expectancy in South America, which currently reaches 79,5 years. The economic and socio-sanitary achievements of the country place Chile among the high-income countries, however important inequalities persist in the distribution of income, which negatively impacts the health indicators of older adults. In the Alexandros study, it was observed that although LE is higher in women than in men, life expectancy with disabilities is higher in women than in men. The follow-up of the SABE Chile cohort also showed important differences in the prevalence and incidence of functional limitation between high, medium and low socioeconomic levels at the expense of the latter CONCLUSIONS Chile faces rapid population aging in a context of profound socioeconomic, gender and urban-rural inequality in older people, which poses to society multiple challenges that must be addressed shortly. The reduction of the gap between total life expectancy and healthy life expectancy is possible promoting healthy lifestyles and social participation and providing a people centred, integrated health care.

Application and development of healthy life expectancy index / 公共卫生与预防医学

As the life expectancy of the population increases and traditional indexes are flawed in reflecting the health level, the concept of the healthy life expectancy has emerged, which integrates the length of the life and quality, more comprehensively reflects the health level of the population. This article has summarized the emergence and development of health life expectancy, classification of indexes, and commonly used measurement methods, as well as domestic and international application examples, and domestic research status. It proposes to establish a unified national measurement method, and make full use of big data resources in health care to comprehensively assess the health life expectancy of the population.

Expectativa de vida livre de fatores de risco relacionados ao estilo de vida na população brasileira / Life expectancy free of lifestyle-related risk factors in the Brazilian population

Com o aumento da expectativa de vida no Brasil, faz-se essencial conhecer a saúde e a qualidade dos anos vividos por essa população mais longeva. Nesse cenário, as Doenças Crônicas Não Transmissíveis (DCNT) apontam como principais causas de limitações, incapacidades e morbimortalidade. Mensurar os fatores de risco relacionados ao estilo de vida para DCNT é premissa indispensável para atender a esta demanda por meio de políticas públicas eficazes. Os objetivos deste trabalho foram: (1) identificar perfis multidimensionais de fatores de risco relacionados ao estilo de vida, descrevendo as prevalências dos perfis e características sociodemográficas e de autopercepção de saúde associadas; (2) estimar a expectativa de vida livre de fatores de risco relacionados ao estilo de vida na população brasileira. Foram utilizados dados da Pesquisa Nacional de Saúde (PNS) 2013. Para a identificação dos perfis de estilo de vida foi utilizado o método Grade of Membership (GoM), com dados de 45.881 indivíduos acima de 30 anos, a partir de 12 variáveis relacionadas a estilo de vida. A análise de características associadas a estes perfis foi realizada por meio do teste Quiquadrado de Pearson e Regressão logística incondicional. As prevalências do perfil saudável e as tábuas de vida da população brasileira para o ano de 2013 foram utilizadas, no método de Sullivan, para o cálculo da expectativa de vida livre de fatores de risco relacionados ao estilo de vida, nesta etapa foram selecionados os indivíduos com idade entre 30 e 69 anos, totalizando 40.942. Foram identificados dois perfis: um perfil denominado de "perfil saudável" (61,6%; IC95% 61,1 ­ 62,2), caracterizado pelo consumo adequado de frutas e vegetais, peixes, e consumo não regular de refrigerante, carne com gordura e feijão, pelo excesso de peso e atividade física recomendada no lazer. E outro perfil intitulado de "perfil de risco" (38,4%; IC95% 37,8 ­ 38,9), caracterizado pelo não consumo de marcadores saudáveis, exceto o consumo de feijão, pelo consumo de todos os marcadores não saudáveis de alimentação, substituir refeições por lanches, consumo de álcool, uso de tabaco, por não serem fisicamente ativos no lazer e por serem eutróficos. O perfil saudável se associou ao sexo feminino, idosos, brancos, residentes no Norte e Nordeste, viúvos, casados, com maior escolaridade e melhor autoavaliação de saúde. Já o perfil de risco se associou ao sexo masculino, adultos jovens, residentes no Centro-oeste e Sul, solteiros, com menor escolaridade e pior autoavaliação de saúde. O tempo estimado a ser vivido pelos brasileiros livre de fatores de risco relacionados ao estilo de vida, aos 30 anos de idade, foi de 33,5 anos para as mulheres e 25,5 anos para os homens. O sexo feminino apresentou maior expectativa de vida livre de fatores de risco em todas as idades. Os achados do presente estudo evidenciam a associação do estilo de vida às características sociodemográficas e contribuem para a discussão sobre desigualdades de gênero existente na morbimortalidade. Os homens brasileiros vivem menos tempo livre de fatores de risco relacionados ao estilo de vida, o que pode contribuir com as elevadas taxas de mortalidade prematura (AU).

The increase in life expectancy in Brazil makes it essential to know the health and the quality of the years lived by the country's longest-lived population. In this context, Chronic Non-communicable Diseases (NCDs) point out as the main causes of limitations, disabilities and morbimortality. Measuring of lifestyle-related modifiable risk factors for NCDs is an indispensable premise for meeting this emerging demand through effective public policy. The objectives of this study were: (1) to identify multidimensional profiles of lifestyle-related risk factors, describing the prevalence of the sociodemographic and self-perceived health profiles and their characteristics; (2) to estimate life expectancy free from lifestyle-related risk factors in the Brazilian population. This study based on data from the National Health Survey (Pesquisa Nacional de Saude, PNS) published in 2013. Grade of Membership (GoM) method was used to identify lifestyle profiles, with data from 45,881 individuals over 30 years by applying the inclusion of 12 lifestyle-related variables. The analysis of the characteristics associated with these profiles was done through Pearson's chi-square test and unconditional logistic regression. The prevalence of the healthy profile and the Brazilian population's life table for 2013 were used in the Sullivan's method to calculate life expectancy free of lifestyle-related risk factors. In this stage, individuals aged between 30 and 69 years were selected, totalling 40,942. Two profiles were identified: a profile called "healthy profile" (61.6%; 95% CI 61.1 - 62.2), characterized by adequate consumption of fruits and vegetables, fish, and non-regular consumption of soda, meat with fat and beans. The profile was also characterized by overweight and for meeting the recommendations for physical activity at leisure time. The second profile was entitled "risk profile" (38.4%; 95% CI 37.8 - 38.9), characterized by non-consumption of healthy markers, except bean consumption, by the consumption of all unhealthy markers of eating, replacing meals with snacks, alcohol consumption and tobacco use. The second profile was also characterized for not being physically active at leisure and for being eutrophic. The healthy profile was associated with females, elderlies, white populations, residents of the North and Northeast regions of Brazil, widowed, married, high-educated populations and individuals who evaluate their health habits positively. The risk profile was associated with males, young adults, residents of the Midwest and South regions of Brazil, singles, less educated populations and individuals who evaluate their health habits negatively. The estimated lifetime for Brazilians free of lifestylerelated risk factors at age 30 was 33.5 years for women and 25.5 years for men. Females had a higher life expectancy free of risk factors at all ages in relation to males. The findings of the present study show the association of lifestyle-related risk factors with sociodemographic characteristics and contribute to the discussion of gender inequalities when it comes to morbimortality. Brazilian men live less time free of lifestyle-related risk factors, which may contribute to the high rates of premature mortality among them (AU).

Osteoporose e Expectativa de Vida Saudável: estimativas para o Brasil em 2008 / Osteoporosis and Healthy Life Expectancy: estimates for Brazil in 2008

Resumo Introdução Estimar a expectativa de vida com osteoporose (EVCO) e a expectativa de vida livre de osteoporose (EVLH) ao nascer e aos 20, 40, 60 e 80 anos, no Brasil, em 2008. Método Empregou-se o método de Sullivan, combinando a tábua de vida e as prevalências de osteoporose. Foram utilizadas as tábuas de vida publicadas pelo Instituto Brasileiro de Geografia e Estatística para 2008 e as prevalências de osteoporose do inquérito Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) do mesmo ano. Resultados Em 2008, ao nascer, um homem poderia esperar viver, em média, 69,1 anos e, desses, 1,3 ano seria vivido com osteoporose. No caso das mulheres, a esperança de vida seria maior (76,7 anos), assim como a expectativa de vida com osteoporose (7,9 anos). Ao alcançar a idade de 60 anos, as mulheres poderiam esperar viver, em média, por mais 22,7 anos, sendo 7,0 desses anos (31,0%) com osteoporose. Já para os homens, na mesma idade, apenas 1,3 ano (6,6%) dos 19,5 anos remanescentes seriam vividos com osteoporose. Conclusão Os resultados chamam atenção para a necessidade de considerar as diferenças entre os sexos em relação à demanda por cuidado.

Abstract Objective Estimate osteoporosis life expectancy and osteoporosis-free life expectancy for Brazilians in 2008 at birth and at 20, 40, 60 and 80 years. Method The Sullivan method is used to combine the period life tables from the Brazilian Institute of Geography and Statistics and the prevalence of osteoporosis according to the Protective and Risk Factors for Chronic Diseases by Telephone Survey (Vigitel Brazil 2008). Results The main results of the study indicate that at birth, a man could expect to live, on average, 69.1 years and of these, 1.3 years would be with osteoporosis. For women, life expectancy was higher (76.7 years), as was osteoporosis life expectancy (7.9 years). Upon reaching the age of 60, women could expect to live another 22.7 years on average, 7.0 of those (31.0%) with osteoporosis. As for men the same age, only 1.3 years (6.6%) of the remaining 19.5 years would be spent with osteoporosis. Conclusion The results call attention to the need to consider the differences between the sexes in relation to the demand for care.

Universal health coverage and the health Sustainable Development Goal: achievements and challenges for Sri Lanka.

With state-funded health care that is free at the point of delivery, a sound primary health-care policy and widespread health-care services, Sri Lanka seems a good example of universal health coverage. Yet, health transition and disparities in provision and financing threaten this situation. Sri Lanka did well on the Millennium Development Goal health indicators, but the Sustainable Development Goal (SDG) for health has a wider purview, which is to “ensure healthy lives and promote wellbeing for all at all ages”. The gender gap in life expectancy and the gap between life expectancy and healthy life expectancy make achievement of the health SDG more challenging. Although women and children do well overall, the comparative health disadvantage for men in Sri Lanka is a cause for concern. From a financing perspective, high out-of-pocket expenditure and high utilization of the private sector, even by those in the lowest income quintile, are concerns, as is the emerging “third tier”, where some individuals accessing state health care that is free at the point of delivery actually bear some of the costs of drugs, investigations and surgery. This cost sharing is resulting in catastrophic health expenditure for individuals, and delays in and non-compliance with treatment. These concerns about provision and financing must be addressed, as health transition will intensify the morbidity burden and loss of well-being, and could derail plans to achieve the health SDG.

Estimativas de expectativa de vida com doenças crônicas de coluna no Brasil / Estimates of life expectancy for individuals with chronic spinal diseases in Brazil

As doenças crônicas de coluna, entre elas as deformidades e as dores musculares, são importantes causas de morbidade entre adultos e idosos. O objetivo deste estudo foi estimar a expectativa de vida de brasileiros com doenças crônicas de coluna, por sexo e idade, nos anos de 2003 e 2008. Empregou-se o método de Sullivan, combinando a tábua de vida e as prevalências de doen ças crônicas de coluna. Foram utilizadas as tá buas de vida publicadas pelo Instituto Brasileiro de Geografia e Estatística e as prevalências de enfermidades crônicas de coluna da Pesquisa Nacio nal por Amostra Domiciliar (PNAD), dos anos selecionados. Os principais resultados indicam que, no Brasil, ao nascer em 2008, um homem poderia esperar viver 69,1 anos, 15% dos quais com doenças crônicas de coluna. Já as mulheres que nasceram neste mesmo ano, apresentavam uma expectativa de vida de 76,7 anos e espera riam viver um quinto de sua vida com problemas crônicos de coluna. No período analisado, concomitantemente aos ganhos na expectativa de vida, ocorreu um crescimento na expectativa de vida saudável, ou seja, nos anos de vida livre de doenças crônicas da coluna, tanto em termos absolutos como relativos.

Chronic spinal diseases, including deformities and muscular pain, are significant causes of morbidity among adults and the elderly. The scope of this study is to assess the life expectancy of Brazilians with chronic spinal diseases by sex and age between 2003 and 2008. The Sullivan method was used, combining the mortality/actuarial table with the prevalence of chronic spinal diseases. The mortality/actuarial tables published by the Brazilian Institute of Geography and Statistics (IBGE) were used and the prevalence of chronic spinal diseases was taken from the Brazilian Household Sample Survey (PNAD) for the years under scrutiny. The main results indicate that a man born in Brazil in 2008 could expect to live for 69.1 years, of which 15% with chronic spinal diseases. However, women born in the same year had a life expectancy of 76.7 years and could expect to live a fifth of their lives with chronic spinal diseases. Over the period under analysis, concurrently with gains in life expectancy, there was an increase in healthy life expectancy, or length of life lived without chronic spinal diseases, both in absolute and relative terms.

Esperanza de vida saludable asociada a la diabetes en Cuba: años 1990 y 2003 / A healthy life expectancy associated with diabetes in Cuba: years 1990 and 2003

OBJETIVO: identificar posibles diferencias en la carga integral (combinando mortalidad y morbilidad) de la diabetes entre grupos de edad, provincias y sexos; así como evaluar su comportamiento en el tiempo (años 1990 y 2003). MÉTODOS: se utilizó el indicador esperanza de vida saludable, en particular una alternativa que considera la mortalidad y morbilidad por enfermedades específicas (en este caso la diabetes). Para el cálculo del indicador se obtuvo la esperanza de vida usual (no ajustada) a partir de la tabla de vida, considerando solo la mortalidad por diabetes. La esperanza de vida así obtenida se ajustó a partir de la morbilidad (prevalencia y severidad) por esta condición. Se calculó el indicador por sexos, grupos de edades, provincias, y para 1990 y 2003. Se llevó a cabo un análisis de conglomerado con el propósito de resumir e integrar los resultados por provincias. RESULTADOS: la mayoría de los resultados son consistentes para Cuba y la casi totalidad de las provincias para ambos años. Se observó una mayor afectación del sexo femenino (ej. Cuba, 2003, grupo de menos de 1 año, esperanza de vida saludable de 99,17 en hombres vs. 98,67 en mujeres), incremento del aporte de la morbilidad con la edad que alcanza las mayores cifras en el grupo de 60 a 64 años. La evolución de 1990 a 2003 es ascendente para la esperanza de vida y el aporte de la morbilidad, y descendente para la esperanza de vida saludable (ej: Cuba, mujeres, grupo de menos de 1 año, de 99,59 a 99,76; de 0,7 a 1,09 por ciento; y 98,89 a 98,76, respectivamente). Se identificaron provincias con un mayor impacto en términos de esperanza de vida saludable, estas resultaron: Ciudad de La Habana, La Habana, Matanzas (en 1990) y Camagüey (en 2003). CONCLUSIONES: la afectación por diabetes en términos de esperanza de vida saludable se incrementó en el período de estudio en el país, a pesar de la disminución del aporte de la mortalidad(AU)

OBJECTIVE: to identify the possible differences in integral burden (combining mortality and morbidity) of diabetes among the age groups, provinces, sexes, as well as to assesses its behavior in the time (years 1990 and 2003). METHODS: authors used a healthy life expectancy indicator, particularly, an alternative considering the mortality and the morbidity as specific diseases (in this case, diabetes). To estimate the indicator we achieved a common life expectancy (no-adjusted) from a life table, considering only the diabetes mortality. The life expectancy thus obtained was adjusted from morbidity (prevalence and severity) due this condition. We estimated the indicator by sex, age groups, and provinces and also for 1990 and 2003. A cluster analysis was made to resume and to integrate the results by provinces. RESULTS: most of results are consistent for Cuba and almost as the whole of provinces for both years. There was a higher affectation of female sex (e.g.: Cuba, 2003, group aged under one, healthy life expectancy of 99,17 in men versus 98.67 in women), increase of mortality contribution with the age achieving the higher figures in 60-64 age group. The course of 1990 to 2003 is rising for life expectancy and mortality contribution and descending for a healthy life expectancy (e.g. Cuba: women aged under one from 99.59 to 99.76; from 0.7 to 1.09 percent, and from 98.89 to 98.76, respectively). We identified provinces with a higher impact in terms of healthy life expectancy including: Ciudad de La Habana, La Habana, Matanzas (in 1990) and Camaguey (in 2003). CONCLUSIONS: affectation due to diabetes in terms of a healthy life expectancy increased during national study period, despite the decrease of mortality contribution(AU)

Densidade de médicos e expectativa de vida saudável na América Latina e no Caribe / Physician's density and healthy life expectancy in Latin America and Caribbean

Objetivo. Este estudo visa a mostrar a importância do médico como indicador de saúde e como variável relevante na qualidade de vida da população da América Latina e do Caribe. Método. Foram analisados os dados mais recentes disponíveis do arquivo de dados WHO Statistical Information System (WHOSIS) da Organização Mundial da Saúde referentes a trinta países da América Latina e do Caribe. As variáveis coletadas foram: densidade de médicos (número de médicos por dez mil habitantes), expectativa de vida saudável ao nascimento e idade média da população. Os métodos estatísticos aplicados foram correlação de Pearson e regressão logarítmica. A significância estatística considerada foi p < 0,05. Resultados. A densidade média de médicos nos países da América Latina e do Caribe foi 15 ± 13 médicos por dez mil habitantes; a média de idade da população foi 26 ± 4,3 anos; a expectativa de vida saudável ao nascimento média foi 61 ± 4,8 anos. As variáveis expectativa de vida saudável e a média de idade mostraram correlação positiva com a densidade de médicos. A regressão logarítmica mostra aumento progressivo da expectativa de vida pelo aumento da densidade de médicos. Conclusão. O estudo permitiu sugerir relação entre a quantidade de médicos de um país e a expectativa de vida saudável em sua população. Os dados apontam para a necessidade de novos estudos que se aprofundem no tema, dando continuidade à busca constante pela qualidade de vida e pelo perfil de saúde elevado nas populações.

Objective. This study aims to show the importance of the physician as a health indicator and as an important variable in the quality of life of the Latin America and Caribbean population.Method. We analyzed the most recent data available from the WHO Statistical Information System (WHOSIS) World Health Organization (WHO) database for thirty countries of Latin America and Caribbean. The variables studied were: density of physicians (number of doctors per 10.000 inhabitants), healthy life expectancy at birth and mean population age. The statistical methods used were Pearson's correlation and logarithmic regression. The statistical significance was p < 0.05.Results. The average density of doctors in Latin America and Caribbean was 15 ± 13 doctors per 10.000 inhabitants, the mean population age was 26 ± 4.3 years, and the healthy life expectancy at birth averaged 61 ± 4.8 years old. The variables healthy life expectancy at birth and mean age showed a positive correlation with physician's density. The logarithmic regression showed a progressive increase in life expectancy along with anincreasing physician's density. Conclusion. This study suggests a link between the number of physicians in a due country and its healthy lifeexpectancy and furthermore confirms the physician's role as an important health promoting factor. The results also point to the necessity of further research to better define the health profile and characteristics of these populations.