Greater within- and between-day instability is associated with worse anxiety and depression symptoms.

BACKGROUND: Depression and anxiety affect hundreds of millions of people worldwide, and their prevalence increased during the COVID-19 pandemic as social schedules were disrupted. This study explores the associations between anxiety and depression and within- and between-day instability of affective, somatic, and cognitive symptoms during the early pandemic stages. METHODS: Participants (n = 153, ages 18-77, 72 % female) reported daily levels of affective (anxiety/sadness), somatic (appetite/sleepiness), and cognitive (concentration/energy) symptoms for 14-44 days at five timepoints: 0, 3, 6, 9, and 12 h after awakening. At the end of the study, participants completed validated scales for anxiety (GAD-7) and depression (PHQ-9). Symptom instability was assessed using the Absolute Real Variability (ARV) index. Regression models examined within-day instability (WD-I) and between-day instability (BD-I) with GAD-7 and PHQ-9 scores as outcomes. RESULTS: Greater instability (both WD-I and BD-I) of affective symptoms correlated with elevated GAD-7 and PHQ-9 scores. For somatic and cognitive symptoms, greater BD-I was associated with higher scores. LIMITATIONS: The study used retrospective daily data, which could benefit from real-time assessments for improved accuracy. CONCLUSIONS: This study provides empirical evidence of a connection between greater anxiety and depression severity and increased instability in daily mood and physiological symptoms. The findings underscore the importance of consistent symptom monitoring to understand overall mental health trajectories. Additionally, it highlights the role of daily routines in stabilizing the circadian system, potentially regulating physiological and psychological processes and reducing symptom instability.

The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study.

BACKGROUND: The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use. METHODS: This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery. RESULTS: We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%-90.3%) and specificity of 93.5% (91.5-95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity. CONCLUSIONS: These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.

Psychometric properties of the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in healthcare professionals.

INTRODUCTION: Burnout syndrome (BS) in healthcare professionals (HCP) has been a major concern, and even more so during the coronavirus disease 2019 (COVID-19) pandemic. The need for adequate tools to assess BS is urgent. The objective of this study was to validate the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in HCP. METHODS: The sample comprised 1,054 Brazilian HCP. Data were collected for 1 month (May-2020 to June-2020) using an online self-administered questionnaire. RESULTS: All three CBI dimensions demonstrated optimal reliability. All consistency measures attained values > 0.90. Split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: personal burnout (PB) and work-related burnout (WB) items were associated with factor 1, and client-related burnout (CB) items were associated with factor 2. CONCLUSION: Our study corroborates the validity of the Brazilian Portuguese version of the CBI, pointing to a close relation between PB and WB in HCP. A public domain tool with evidence quality to ensure sufficient content validity can aid in burnout evaluation and encourage both expansion of the research field and accurate detection and treatment of this syndrome in Brazilian HCP.

Psychometric properties of the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in healthcare professionals

Abstract Introduction Burnout syndrome (BS) in healthcare professionals (HCP) has been a major concern, and even more so during the coronavirus disease 2019 (COVID-19) pandemic. The need for adequate tools to assess BS is urgent. The objective of this study was to validate the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in HCP. Methods The sample comprised 1,054 Brazilian HCP. Data were collected for 1 month (May-2020 to June-2020) using an online self-administered questionnaire. Results All three CBI dimensions demonstrated optimal reliability. All consistency measures attained values > 0.90. Split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: personal burnout (PB) and work-related burnout (WB) items were associated with factor 1, and client-related burnout (CB) items were associated with factor 2. Conclusion Our study corroborates the validity of the Brazilian Portuguese version of the CBI, pointing to a close relation between PB and WB in HCP. A public domain tool with evidence quality to ensure sufficient content validity can aid in burnout evaluation and encourage both expansion of the research field and accurate detection and treatment of this syndrome in Brazilian HCP.

Self-reported questionnaire on periodontal condition validated for use in Brazil.

There is a current expectation of instruments for periodontal condition surveillance worldwide. The present study aimed to validate the Oral Health Questions Set B (OHQB) for the Brazilian Portuguese and evaluate its temporal stability. This is a sequential mixed-method investigation. After the forward-backward translation process to the Brazilian Portuguese, the OHQB Brazil (OHQB-Br) was applied to 156 participants (39.5 ± 14.14 years; 51.9% males). In sequence, through a full-mouth six-sites/teeth examination and in accordance with the original instrument, the periodontal diagnosis was obtained (March 2020). In January 2021, the OHB-BR was reapplied (n = 71). Ordinal alpha and McDonald's omega tested the internal consistency of the OHQB-Br. Temporal stability was investigated [Spearman correlation, intraclass correlation coefficient (ICC), and the Bland-Altman]. The concurrent validity was also verified, considering the periodontal clinical diagnosis (Kruskal Wallis). The ordinal alpha (0.69) and McDonald's omega (0.73) coefficients showed an adequate internal consistency of the OHQB-Br. The OHQB-Br temporal stability was high, as demonstrated by the Spearman coefficient (0.80) and ICC (0.79) and by the Bland-Altman plot. A concurrent validity showed a direct relationship between the OHQB-Br and the clinical condition of no periodontitis, mild, moderate, and severe periodontitis (p < 0.05). Because the OHQB-Br shows internal validity, temporal stability, and adequately identifies periodontal health and moderate/severe periodontitis, the instrument might represent an important tool, at the public level or other settings, for periodontal surveillance in Brazil.

Prevalence of chronic respiratory diseases and medication use among children and adolescents in Brazil - a population based cross-sectional study / Prevalência de doenças respiratórias crônicas e uso de medicamentos entre crianças e adolescentes no Brasil - um estudo transversal de base populacional

Abstract Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil),a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting β2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population.

Resumo Objetivos: descrever a prevalência de doenças respiratórias crônicas e seu manejo farmacológico em crianças e adolescentes no Brasil. Métodos: foram analisados os dados da Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), um estudo transversal de base populacional. As pesquisas domiciliares foram realizadas entre setembro de 2013 e fevereiro de 2014. Incluímos a população com menos de 20 anos de idade com doenças respiratórias crônicas. Foi avaliada a prevalência de doença, indicação de tratamento farmacológico e seu uso. Resultados: a prevalência de doenças respiratórias crônicas em menores de 6 anos foi de 6,1% (IC95%= 5,0-7,4), 4,7% (IC95%= 3,4-6,4) naqueles 6-12 anos e 3,9% (IC95%= 2,8-5,4) em crianças com 13 anos ou mais. Crianças menores de 6 anos apresentaram uma maior prevalência de indicação de tratamento farmacológico (74,6%; IC95%= 66,0-81,7), assim como uso de medicamentos (72,6%; IC95%= 62,8-80,7). Dos usuários de inaladores, 56,6% relataram o uso com espaçador. As classes farmacológicas mais frequentemente relatadas foram β2 agonistas de curta ação (19,0%), seguidos por anti-histamínicos (17,2%). Conclusão: crianças e adolescentes que relatam doenças respiratórias crônicas residentes em áreas urbanas no Brasil parecem ser subtratados para suas condições crônicas. O tratamento farmacológico, mesmo quando indicado, não foi utilizado em sua totalidade, um achado importante para a tomada de decisão nessa população.

PSS Health: como calcular tamanho de amostra para testes de comparação de médias de dois grupos / PSS Health: how to calculate sample sizes for mean comparison tests between two groups

Dando continuidade à série de artigos que pretendem orientar o usuário na utilização da ferramenta PSS Health para o planejamento de uma pesquisa, esta edição apresenta um passo a passo de como realizar o cálculo e de quais informações são necessárias para comparar médias: de dois grupos dependentes ou independentes, de dois grupos independentes com duas medidas repetidas (deltas), e com duas ou mais medidas repetidas. Todos os exemplos também são ilustrados e disponibilizados em vídeos no canal da Unidade de Bioestatística.

Following the series of articles aiming to guide users in using the PSS Health tool for research planning, this issue presents a step-by-step guide on how to calculate and what information is needed to compare means between 2 dependent or independent groups, 2 independent groups with 2 repeated measures (deltas), and 2 independent groups with 2 or more repeated measures. All examples are accompanied by figures and available in video on the Biostatistics Unit's channel.

Self-reported questionnaire on periodontal condition validated for use in Brazil

Abstract: There is a current expectation of instruments for periodontal condition surveillance worldwide. The present study aimed to validate the Oral Health Questions Set B (OHQB) for the Brazilian Portuguese and evaluate its temporal stability. This is a sequential mixed-method investigation. After the forward-backward translation process to the Brazilian Portuguese, the OHQB Brazil (OHQB-Br) was applied to 156 participants (39.5 ± 14.14 years; 51.9% males). In sequence, through a full-mouth six-sites/teeth examination and in accordance with the original instrument, the periodontal diagnosis was obtained (March 2020). In January 2021, the OHB-BR was reapplied (n = 71). Ordinal alpha and McDonald's omega tested the internal consistency of the OHQB-Br. Temporal stability was investigated [Spearman correlation, intraclass correlation coefficient (ICC), and the Bland-Altman]. The concurrent validity was also verified, considering the periodontal clinical diagnosis (Kruskal Wallis). The ordinal alpha (0.69) and McDonald's omega (0.73) coefficients showed an adequate internal consistency of the OHQB-Br. The OHQB-Br temporal stability was high, as demonstrated by the Spearman coefficient (0.80) and ICC (0.79) and by the Bland-Altman plot. A concurrent validity showed a direct relationship between the OHQB-Br and the clinical condition of no periodontitis, mild, moderate, and severe periodontitis (p < 0.05). Because the OHQB-Br shows internal validity, temporal stability, and adequately identifies periodontal health and moderate/severe periodontitis, the instrument might represent an important tool, at the public level or other settings, for periodontal surveillance in Brazil.

PSS Health: como calcular tamanho de amostra para testar relações de variáveis com um desfecho binário / PSS Health: how to calculate the sample size to test variables relationships with a binary outcome

Dando continuidade à série de artigos que pretendem orientar o usuário na utilização da ferramenta PSS Health para o planejamento de uma pesquisa, esta edição apresenta um passo a passo de como realizar o cálculo para tamanho de amostra e de quais informações são necessárias para testar relações estatísticas entre variáveis e um desfecho binário: comparação de proporções entre grupos independentes (dois ou mais), comparação de duas proporções dependentes e regressão logística. Todos os exemplos também são ilustrados e disponibilizados em vídeos no canal da Unidade de Bioestatística.

Following the series of articles that aim to guide the user in using the PSS Health tool for planning research, this issue presents a step-by-step guide on how to perform the sample size calculation and what information is needed to test statistical relationships between variables and a binary outcome: comparison of proportions between independent groups (two or more), comparison of two dependent proportions, and logistic regression. All examples are also illustrated and available in videos on the Biostatistics Unit's channel.

[Analysis of records for women that have undergone legally authorized abortions in Porto Alegre, Rio Grande do Sul State, Brazil]. / Análise dos registros de atendimentos de mulheres que realizaram aborto previsto em lei em Porto Alegre, Rio Grande do Sul, Brasil.

Abortion as allowed by law in Brazil is a right that is rarely enforced, due to the multiple barriers to access. Another troublesome issue related to the health system's organization is the difficulty in obtaining reliable and easily accessible records to back monitoring and evaluation of legally authorized abortion. The current study thus aimed to analyze the patient records of women that had undergone legal abortion in the city of Porto Alegre, Rio Grande do Sul State, from 2013 to 2018 and to identify the procedure's prevalence in the Hospital Information System (SIH). The study analyzed on site the patient files for legally permitted abortions performed in the four referral services in the city. The authors cross-analyzed the data with the database of the SIH under the Brazilian Unified National Health System (SUS). Prevalence ratio was estimated with a Poisson regression model with robust variance. Examination of the patient files identified 236 cases of legal abortion, of which 95 (40.3%) were recorded in the SIH. The cases in which the patient files contained ICD O04 (medical abortion) identified in their internal records had 3.02 times higher prevalence (95%CI: 1.83-4.98) of being recorded in the SIH than those without the ICD code. The number of records of legal abortions in the SIH differed according to the hospital. However, independently of the hospital, the fact that the internal record listed ICD O04 increased the prevalence of records in the SIH. In conclusion, the lack of standardization and under-recording hindered the collection of trustworthy information in the national database of the SUS, further increasing the invisibility of legal abortion in Brazil.

O aborto permitido por lei no Brasil é um direito pouco garantido devido a múltiplas barreiras de acesso. A dificuldade em obter-se registros confiáveis e de fácil acesso, que subsidiem ações de monitoramento e avaliação pertinentes a essa temática, é outra questão preocupante relacionada à organização do sistema de saúde. Assim, esta pesquisa teve como objetivo analisar os registros de atendimentos a mulheres que realizaram aborto legal no Município de Porto Alegre, Rio Grande do Sul, no período de 2013 a 2018 e identificar sua prevalência no Sistema de Informações Hospitalares (SIH). Para isso, os prontuários dos casos de aborto previstos em lei, realizados nos quatro serviços de referência foram avaliados in loco. Os dados obtidos foram cruzados com o banco do SIH do Sistema Único de Saúde (SUS). A razão de prevalência foi estimada por meio do modelo de regressão Poisson, com variância robusta. Foram identificados, nos prontuários, 236 casos de aborto legal, dos quais 95 (40,3%) estavam registrados no SIH. Os casos cujos prontuários tinham o CID O04 (aborto por razões médicas) identificado em seus registros internos tiveram uma prevalência de 3,02 (IC95%: 1,83-4,98) vezes de constarem no SIH do que aqueles que não identificaram. Foi observado que o número de registros de aborto legal no SIH diferia dependendo do hospital; no entanto, verificou-se que, independentemente do hospital, o fato do registro interno descrever o CID O04 aumenta a prevalência de registros no SIH. Conclui-se que a falta de padronização e o sub-registro dificultam a obtenção de informações fidedignas na base de dados nacionais do SUS, aumentando a invisibilidade do aborto legal.

El aborto está permitido por ley en Brasil, aunque es un derecho poco garantizado, debido a múltiples barreras de acceso. La dificultad de conseguir registros confiables y de fácil acceso, que apoyen acciones de supervisión y evaluación pertinentes para esta temática, es otra cuestión preocupante relacionada con la organización del sistema de salud. De este modo, el objetivo de esta investigación fue analizar los registros de atención a mujeres, que abortaron legalmente en el Municipio de Porto Alegre, Rio Grande do Sul, durante el período de 2013 a 2018 e identificar su prevalencia en el Sistema de Informaciones Hospitalarias (SIH). Para tal fin, se evaluaron in loco los historiales de los casos de aborto previstos en ley, efectuados en cuatro servicios de referencia. Los datos obtenidos se cruzaron con el banco de datos del SIH del Sistema Único de Salud (SUS). La razón de prevalencia se estimó mediante el modelo de regresión Poisson con variancia robusta. Se identificaron en los registros médicos, 236 casos de aborto legal, de los cuales 95 (40,3%) estaban registrados en el SIH. Los casos cuyos historiales tenían el CIE O04 (aborto por razones médicas), identificado en sus registros internos, contaron con una prevalencia de 3,02 veces (IC95%: 1,83-4,98) respecto a constar en el SIH, en relación con aquellos que no se identificaron. Se observó que el número de registros de aborto legal en el SIH difería dependiendo del hospital; no obstante, se verificó que, independientemente del hospital, el hecho de que el registro interno describa el CIE O04 aumenta la prevalencia de registros en el SIH. Se concluye que la falta de estandarización y el subregistro dificultan la obtención de información fidedigna en la base de datos nacionales del SUS, aumentando la invisibilidad del aborto legal.

PSS Health: como calcular tamanho de amostra para estimar média, proporção e correlação / PSS Health: how to calculate a sample size to estimate means, proportions, and correlations

A ferramenta PSS Health (Power and Sample Size for Health Researchers) foi desenvolvida com o propósito de facilitar o cálculo do tamanho amostral e do poder de testes de hipóteses para diferentes objetivos de estudo, usando interface amigável e terminologia comum à área da saúde. Este é o primeiro de uma série de artigos que pretendem orientar o usuário na utilização da ferramenta PSS Health para o planejamento de uma pesquisa. Neste artigo, se ensina como utilizar o PSS Health quando o objetivo principal do estudo é estimar uma média, estimar uma proporção (prevalência ou incidência) ou estimar uma correlação. São disponibilizados vídeos demonstrando o uso da ferramenta em cada um dos contextos citados. (AU)

The PSS Health (Power and Sample Size for Health Researchers) tool was developed with the purpose of facilitating the calculation of sample size and power of hypothesis tests for different study objectives, based on a user-friendly interface and common health care terminology. This is the first in a series of articles intending to guide the user in how to use the PSS Health tool for planning a research project. This article teaches how to use PSS Health when the main objective of the study is to estimate means, proportions (prevalence or incidence), or correlations. Videos showing how to use the tool in each of the mentioned contexts are available. (AU)

Análise dos registros de atendimentos de mulheres que realizaram aborto previsto em lei em Porto Alegre, Rio Grande do Sul, Brasil / Analysis of records for women that have undergone legally authorized abortions in Porto Alegre, Rio Grande do Sul State, Brazil / Análisis de los registros de atención a mujeres que abortaron según lo previsto en la ley en Porto Alegre, Río Grande do Sul, Brasil

Resumo: O aborto permitido por lei no Brasil é um direito pouco garantido devido a múltiplas barreiras de acesso. A dificuldade em obter-se registros confiáveis e de fácil acesso, que subsidiem ações de monitoramento e avaliação pertinentes a essa temática, é outra questão preocupante relacionada à organização do sistema de saúde. Assim, esta pesquisa teve como objetivo analisar os registros de atendimentos a mulheres que realizaram aborto legal no Município de Porto Alegre, Rio Grande do Sul, no período de 2013 a 2018 e identificar sua prevalência no Sistema de Informações Hospitalares (SIH). Para isso, os prontuários dos casos de aborto previstos em lei, realizados nos quatro serviços de referência foram avaliados in loco. Os dados obtidos foram cruzados com o banco do SIH do Sistema Único de Saúde (SUS). A razão de prevalência foi estimada por meio do modelo de regressão Poisson, com variância robusta. Foram identificados, nos prontuários, 236 casos de aborto legal, dos quais 95 (40,3%) estavam registrados no SIH. Os casos cujos prontuários tinham o CID O04 (aborto por razões médicas) identificado em seus registros internos tiveram uma prevalência de 3,02 (IC95%: 1,83-4,98) vezes de constarem no SIH do que aqueles que não identificaram. Foi observado que o número de registros de aborto legal no SIH diferia dependendo do hospital; no entanto, verificou-se que, independentemente do hospital, o fato do registro interno descrever o CID O04 aumenta a prevalência de registros no SIH. Conclui-se que a falta de padronização e o sub-registro dificultam a obtenção de informações fidedignas na base de dados nacionais do SUS, aumentando a invisibilidade do aborto legal.

Abstract: Abortion as allowed by law in Brazil is a right that is rarely enforced, due to the multiple barriers to access. Another troublesome issue related to the health system's organization is the difficulty in obtaining reliable and easily accessible records to back monitoring and evaluation of legally authorized abortion. The current study thus aimed to analyze the patient records of women that had undergone legal abortion in the city of Porto Alegre, Rio Grande do Sul State, from 2013 to 2018 and to identify the procedure's prevalence in the Hospital Information System (SIH). The study analyzed on site the patient files for legally permitted abortions performed in the four referral services in the city. The authors cross-analyzed the data with the database of the SIH under the Brazilian Unified National Health System (SUS). Prevalence ratio was estimated with a Poisson regression model with robust variance. Examination of the patient files identified 236 cases of legal abortion, of which 95 (40.3%) were recorded in the SIH. The cases in which the patient files contained ICD O04 (medical abortion) identified in their internal records had 3.02 times higher prevalence (95%CI: 1.83-4.98) of being recorded in the SIH than those without the ICD code. The number of records of legal abortions in the SIH differed according to the hospital. However, independently of the hospital, the fact that the internal record listed ICD O04 increased the prevalence of records in the SIH. In conclusion, the lack of standardization and under-recording hindered the collection of trustworthy information in the national database of the SUS, further increasing the invisibility of legal abortion in Brazil.

Resumen: El aborto está permitido por ley en Brasil, aunque es un derecho poco garantizado, debido a múltiples barreras de acceso. La dificultad de conseguir registros confiables y de fácil acceso, que apoyen acciones de supervisión y evaluación pertinentes para esta temática, es otra cuestión preocupante relacionada con la organización del sistema de salud. De este modo, el objetivo de esta investigación fue analizar los registros de atención a mujeres, que abortaron legalmente en el Municipio de Porto Alegre, Rio Grande do Sul, durante el período de 2013 a 2018 e identificar su prevalencia en el Sistema de Informaciones Hospitalarias (SIH). Para tal fin, se evaluaron in loco los historiales de los casos de aborto previstos en ley, efectuados en cuatro servicios de referencia. Los datos obtenidos se cruzaron con el banco de datos del SIH del Sistema Único de Salud (SUS). La razón de prevalencia se estimó mediante el modelo de regresión Poisson con variancia robusta. Se identificaron en los registros médicos, 236 casos de aborto legal, de los cuales 95 (40,3%) estaban registrados en el SIH. Los casos cuyos historiales tenían el CIE O04 (aborto por razones médicas), identificado en sus registros internos, contaron con una prevalencia de 3,02 veces (IC95%: 1,83-4,98) respecto a constar en el SIH, en relación con aquellos que no se identificaron. Se observó que el número de registros de aborto legal en el SIH difería dependiendo del hospital; no obstante, se verificó que, independientemente del hospital, el hecho de que el registro interno describa el CIE O04 aumenta la prevalencia de registros en el SIH. Se concluye que la falta de estandarización y el subregistro dificultan la obtención de información fidedigna en la base de datos nacionales del SUS, aumentando la invisibilidad del aborto legal.

Use and sources of psychotropic drugs by Brazilian adults and seniors. / Uso e fontes de obtenção de psicotrópicos em adultos e idosos brasileiros.

The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic classes and sources of acquisition. Data from the Brazilian National Survey on Access, Use and Promotion of the Rational Use of Medicines (2013-2014) were analyzed. The prevalence of use of at least one psychotropic drug in the overall sample (adults and seniors) was 8.7%. In the adjusted analyses, positive associations were found between the use of psychotropic drugs and the female sex, poorer self-rated health and chronic diseases (p < 0.05). The most frequently used therapeutic classes were antidepressants (55.3%) by the adults and anxiolytics (59.3%) by the seniors. Approximately 23.0% of psychotropic drugs were obtained exclusively from pharmacies of the public healthcare system and 77.0% were acquired from other sources. The findings reveal a low proportion of attaining psychotropic drugs through the Brazilian public healthcare system as well as the need for public policies that encourage the rational use of prescriptions and treatments to promote a better quality of life and ensure the population's right to health.

O objetivo do presente estudo foi verificar a prevalência do uso de psicotrópicos nos adultos e idosos e os fatores associados, classes terapêuticas de medicamentos e fontes de obtenção. Foram analisados dados da Pesquisa Nacional sobre o Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM/2013-2014). A prevalência do uso de ao menos um psicotrópico para o conjunto de adultos brasileiros foi de 8,7%. Nas análises ajustadas para adultos e idosos, observaram-se associações positivas entre uso de psicotrópicos e sexo feminino, pior autoavaliação de saúde e presença de doenças crônicas (p < 0,05). As classes terapêuticas mais utilizadas foram os antidepressivos (55,3%) por adultos e os ansiolíticos (59,3%) por idosos. Cerca de 23,0% dos psicotrópicos foram obtidos exclusivamente nas farmácias do SUS e os outros 77,0% por outras fontes. Os resultados mostraram baixa proporção de obtenção dos psicotrópicos no SUS e a necessidade de políticas que incentivem a prescrição e tratamentos com mais racionalidade, promovendo melhor qualidade de vida e garantia do direito à saúde a população.

Uso e fontes de obtenção de psicotrópicos em adultos e idosos brasileiros / Use and sources of psychotropic drugs by Brazilian adults and seniors

Resumo O objetivo do presente estudo foi verificar a prevalência do uso de psicotrópicos nos adultos e idosos e os fatores associados, classes terapêuticas de medicamentos e fontes de obtenção. Foram analisados dados da Pesquisa Nacional sobre o Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM/2013-2014). A prevalência do uso de ao menos um psicotrópico para o conjunto de adultos brasileiros foi de 8,7%. Nas análises ajustadas para adultos e idosos, observaram-se associações positivas entre uso de psicotrópicos e sexo feminino, pior autoavaliação de saúde e presença de doenças crônicas (p < 0,05). As classes terapêuticas mais utilizadas foram os antidepressivos (55,3%) por adultos e os ansiolíticos (59,3%) por idosos. Cerca de 23,0% dos psicotrópicos foram obtidos exclusivamente nas farmácias do SUS e os outros 77,0% por outras fontes. Os resultados mostraram baixa proporção de obtenção dos psicotrópicos no SUS e a necessidade de políticas que incentivem a prescrição e tratamentos com mais racionalidade, promovendo melhor qualidade de vida e garantia do direito à saúde a população.

Abstract The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic classes and sources of acquisition. Data from the Brazilian National Survey on Access, Use and Promotion of the Rational Use of Medicines (2013-2014) were analyzed. The prevalence of use of at least one psychotropic drug in the overall sample (adults and seniors) was 8.7%. In the adjusted analyses, positive associations were found between the use of psychotropic drugs and the female sex, poorer self-rated health and chronic diseases (p < 0.05). The most frequently used therapeutic classes were antidepressants (55.3%) by the adults and anxiolytics (59.3%) by the seniors. Approximately 23.0% of psychotropic drugs were obtained exclusively from pharmacies of the public healthcare system and 77.0% were acquired from other sources. The findings reveal a low proportion of attaining psychotropic drugs through the Brazilian public healthcare system as well as the need for public policies that encourage the rational use of prescriptions and treatments to promote a better quality of life and ensure the population's right to health.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines.

Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval - 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

Epidemiology and burden of chronic respiratory diseases in Brazil from 1990 to 2017: analysis for the Global Burden of Disease 2017 Study.

INTRODUCTION: In Brazil, little is known about the trends of chronic respiratory diseases, which was estimated as the third leading cause of deaths in 2017 worldwide. METHODS: We analyzed Global Burden of Disease (GBD) 2017 estimates for prevalence, incidence, mortality, disability-adjusted life years (DALY), a summary measure of years of life lost (YLLs) and years lived with disability (YLDs), and risk factors attributable to chronic respiratory diseases in Brazil from 1990 to 2017. RESULTS: The overall estimates have decreased for all ages and both sexes, and for age-standardized rates. For age-adjusted prevalence, there was a 21% reduction, and nearly 16% reduction for incidence. There was a 42% reduction in mortality for both sexes, though the rate of deaths for men was 30% greater than the rate in women. The increase in the number of DALY was essentially due to the population growth and population ageing. We observed a 34% increase in the absolute number of DALY in Brazil over the study period. The majority of the DALY rates were due to Chronic Obstructive Pulmonary Disease (COPD). For all ages and both sexes, smoking was the main attributable risk factor. CONCLUSION: In Brazil, although mortality, prevalence and incidence for chronic respiratory diseases have decreased over the years, attention should be taken to the DALYs increase. Smoking remained as the main risk factor, despite the significant decrease of tobacco use, reinforcing the need for maintenance of policies and programs directed at its cessation.

Equívocos estatísticos: perguntas que você sempre quis fazer, mas nunca teve coragem / Statistical misconceptions: questions you've always wanted to ask, but never dared

Este artigo visa elucidar algumas dúvidas enfrentadas ou equívocos estatísticos cometidos por pesquisadores de diversas áreas. São explanados os temas: "tradução não é validação", "análise fatorial exploratória ou confirmatória", "nem todo estudo com dois grupos tem delineamento caso-controle", "teste ou ajuste de Bonferroni", "tamanho de amostra para teste de hipóteses e/ou para intervalo de confiança", e "testes ou dados paramétricos". A abordagem é realizada em uma linguagem acessível ao público leigo, utilizando exemplos e sugerindo referências para aprofundar o conhecimento.(AU)

This article aims to answer some questions and elucidate statistical misconceptions of researchers from different fields. The following topics are addressed: "translation is not validation", "exploratory or confirmatory factor analysis", "not every study with two groups is a case-control study", "Bonferroni test or adjustment", "sample size for testing hypotheses and/or for confidence intervals", and "parametric data or tests". The topics are explained in lay terms, using examples and suggesting references to advance knowledge.(AU)

Epidemiology and burden of chronic respiratory diseases in Brazil from 1990 to 2017: analysis for the Global Burden of Disease 2017 Study / Epidemiologia e carga das doenças respiratórias crônicas no Brasil de 1990 a 2017: análise do Estudo Global Burden of Disease 2017

ABSTRACT: Introduction: In Brazil, little is known about the trends of chronic respiratory diseases, which was estimated as the third leading cause of deaths in 2017 worldwide. Methods: We analyzed Global Burden of Disease (GBD) 2017 estimates for prevalence, incidence, mortality, disability-adjusted life years (DALY), a summary measure of years of life lost (YLLs) and years lived with disability (YLDs), and risk factors attributable to chronic respiratory diseases in Brazil from 1990 to 2017. Results: The overall estimates have decreased for all ages and both sexes, and for age-standardized rates. For age-adjusted prevalence, there was a 21% reduction, and nearly 16% reduction for incidence. There was a 42% reduction in mortality for both sexes, though the rate of deaths for men was 30% greater than the rate in women. The increase in the number of DALY was essentially due to the population growth and population ageing. We observed a 34% increase in the absolute number of DALY in Brazil over the study period. The majority of the DALY rates were due to Chronic Obstructive Pulmonary Disease (COPD). For all ages and both sexes, smoking was the main attributable risk factor. Conclusion: In Brazil, although mortality, prevalence and incidence for chronic respiratory diseases have decreased over the years, attention should be taken to the DALYs increase. Smoking remained as the main risk factor, despite the significant decrease of tobacco use, reinforcing the need for maintenance of policies and programs directed at its cessation.

RESUMO: Introdução: No Brasil, pouco se sabe sobre as tendências das doenças respiratórias crônicas, que foram estimadas como a terceira principal causa de mortes em 2017 em todo o mundo. Métodos: Analisamos as estimativas do Global Burden of Disease (GBD) 2017 para prevalência, incidência, mortalidade, anos de vida ajustados por incapacidade (DALY), uma medida resumida de anos de vida perdidos (YLL) e anos vividos com deficiência (YLD), e fatores de risco atribuíveis a doenças respiratórias crônicas no Brasil, de 1990 a 2017. Resultados: As estimativas gerais diminuíram para todas as idades e ambos os sexos, assim como para as taxas padronizadas por idade. Para a prevalência ajustada pela idade, houve uma redução de 21% e, aproximadamente, 16% para a incidência. Houve uma redução de 42% na mortalidade para ambos os sexos, embora a taxa de mortes para homens tenha sido 30% maior do que a taxa para mulheres. O aumento no número de DALY deveu-se ao crescimento e envelhecimento da população. Observamos um aumento de 34% no número absoluto de DALYs no Brasil durante o período do estudo. A maioria das taxas de DALY foi devido a Doença Pulmonar Obstrutiva Crônica (DPOC). Para todas as idades e ambos os sexos, tabagismo foi o principal fator de risco atribuível. Conclusão: No Brasil, embora a mortalidade, a prevalência e a incidência de doenças respiratórias crônicas tenham diminuído ao longo dos anos, maior atenção deve ser dada ao aumento dos DALYs. O tabagismo permaneceu como principal fator de risco, apesar da redução significativa do seu uso, reforçando a necessidade de manutenção de políticas e programas direcionados à sua cessação.

Power and sample size for health researchers: uma ferramenta para cálculo de tamanho amostral e poder do teste voltado a pesquisadores da área da saúde / Power and sample size for health researchers: a tool for calculating sample size and statistical power designed for health researchers

Nas próximas edições da seção de Bioestatística da revistaClinical & Biomedical Researchuma nova série de artigos será publicada abordando um assunto de grande importância ao planejar uma pesquisa: o tamanho de amostra mínimo necessário para atingir os objetivos do estudo. Nessa série será apresentado como calcular o tamanho de uma amostra usando a ferramenta PSSHealth(Power and Sample Size for Health Researchers), construído em linguagem R por meio do pacote Shiny, para diferentes tipos e objetivos de estudo, direcionado à pesquisadores da área da saúde, utilizando termos e conceitos comumente utilizados nesta área. Além disso, o pacote fornece uma sugestão de texto com as informações consideradas no cálculo, e como devem ser descritas, com a finalidade de minimizar problemas de interpretação por parte dos pesquisadores. Neste primeiro artigo será apresentada essa ferramenta desenvolvida pela Unidade de Bioestatística do Grupo de Pesquisa e Pós-Graduação do Hospital de Clínicas de Porto Alegre, que permite calcular não apenas o tamanho de amostra, mas também o poder de um teste de hipóteses. (AU)

In the next issues ofClinical and Biomedical Research, the Biostatistics section will introduce a new series of articles addressing a very important subject for research planning: the minimum sample size to achieve the aim of a study. This series will show how to calculate sample size using PSS Health (Power and Sample Size for Health Researchers). This tool was built using R language through the Shiny package. It can be used for different types of study and is designed for health researchers by using terms and concepts commonly used in this area. PSS Health also suggests a text with information considered in the calculation to minimize problems of interpretation by the researchers. In this first article, a general overview of PSS Health will be presented. This tool, which was developed by the Research and Graduate Group Biostatistics Unit of the Hospital de Clínicas de Porto Alegre, is useful not only to calculate sample size but also to determine power of a hypothesis test. (AU)

Modelagem estatística: perguntas que você sempre quis fazer, mas nunca teve coragem / Statistical modeling: questions you have always wanted to ask but never had the courage to

Dando continuidade aos artigos da série "Perguntas que você sempre quis fazer, mas nunca teve coragem", que tem como objetivo responder e sugerir referências para o melhor entendimento das principais dúvidas dos pesquisadores do Hospital de Clínicas de Porto Alegre sobre estatística, este quarto artigo se propõe a responder às principais dúvidas levantadas sobre modelagem estatística. São discutidas questões referentes à classificação de variáveis em independentes e dependentes, diferenças entre correlação, associação e regressão, os principais tipos de regressão e quais etapas são necessárias na construção de modelos. Os conceitos são abordados numa linguagem acessível ao público leigo e diversas referências são sugeridas para os curiosos em relação ao tema. (AU)

Continuing the series of articles "Questions you have always wanted to ask but never had the courage to," which aims to answer the most common questions of researchers at Hospital de Clínicas de Porto Alegre regarding statistics and to suggest references for a better understanding, this forth article addresses the topic of statistical modeling. Questions about classification of variables as dependent or independent, differences between correlation, association and regression, types of regression and steps for statistical modeling are discussed. The concepts are explained in plain language for lay readers and several references are suggested for those curious about the topic. (AU)