The Association of Allergy-Related and Non-Allergy-Related Olfactory Impairment with Cognitive Function in Older Adults: Two Cross- Sectional Studies.

BACKGROUND: Evidence on the association of Olfactory Impairment (OI) with age-related cognitive decline is inconclusive, and the potential influence of allergy remains unclear. OBJECTIVE: We aimed to evaluate the cross-sectional associations of allergy-related and non-allergy- related OI to cognitive function. METHODS: We included 2,499 participants from the Health and Retirement Study (HRS)-Harmonized Cognitive Assessment Protocol (HCAP) sub-study and 1,086 participants from the English Longitudinal Study of Ageing (ELSA)-HCAP. The Olfactory Function Field Exam (OFFE) using Sniffin' Stick odor pens was used to objectively assess olfactory function and an olfactory score <6/11 indicated OI. Mini-Mental Status Examination (MMSE) was used to assess global cognitive function and define cognitive impairment (<24/30). A neuropsychologic battery was used to assess five cognitive domains. RESULTS: Compared to non-OI participants, individuals with OI had lower MMSE z-score [ßHRS = -0.33, 95% Confidence Interval (CI): -0.41 to -0.24; ßELSA = -0.31, -0.43 to -0.18] and higher prevalence of cognitive impairment (Prevalence Ratio (PR)HRS = 1.46, 1.06 to 2.01; PRELSA = 1.63, 1.26 to 2.11). The associations were stronger for non-allergy-related OI (ßHRS = -0.36; ßELSA = -0.34) than for allergy-related OI (ßHRS = -0.26; ßELSA = 0.13). Similar associations were observed with domain- specific cognitive function measures. CONCLUSION: OI, particularly non-allergy-related OI, was related to poorer cognitive function in older adults. Although the current cross-sectional study is subject to several limitations, such as reverse causality and residual confounding, the findings will provide insights into the OI-cognition association and enlighten future attention to non-allergy-related OI for the prevention of potential cognitive impairment.

Workplace bullying and sexual harassment among general surgery residents in Colombia / Acoso laboral y sexual en residentes de cirugía general en Colombia

INTRODUCTION: Workplace bullying and sexual harassment are concerns among general surgery residents in Colombia. OBJETIVE: To explore the prevalence and impact of workplace bullying and sexual harassment incidents among general surgery residents in Colombia. MATERIALS AND METHODS: This nationwide study was conducted in 2020. Residents selfrated their exposure to workplace bullying and to sexual harassment in the forms of gender harassment, unwanted sexual attention, and sexual coercion. We analyzed demographic variables, perpetrator's characteristics, and differences between victims and non-victims. RESULTS: The study included 302 residents. It found that 49% of general surgery residents in Colombia suffered from workplace bullying and 14.9% experienced sexual harassment. The main forms of sexual harassment were gender harassment (47%) and unwanted sexual attention (47%). Women reported significantly higher rates of being sexually harassed. Surgeons were the main perpetrators of sexual harassment. CONCLUSIONS: Workplace bullying and sexual harassment are frequent events in general surgery residency in Colombia. These findings suggest the need for interventions to improve the educational culture of surgical departments and decrease the prevalence of these behaviors.

Introducción: El acoso laboral y el acoso sexual son preocupaciones en la formación quirúrgica. Objetivo: Exploramos la magnitud de estos problemas entre los residentes de cirugía general en Colombia. Materiales y métodos: se realizó un estudio nacional en junio de 2020. Los residentes autoevaluaron su exposición a la intimidación y el acoso sexual en forma de acoso de género, atención sexual no deseada y coerción sexual. Se analizaron variables demográficas y perpetradores entre víctimas y no víctimas. Resultados: Se incluyeron un total de 302 residentes. Las tasas de acoso laboral y sexual fueron del 49% y 14,9%, respectivamente. Las principales formas de acoso sexual correspondieron al acoso de género (47%) y la atención sexual no deseada (47%). El acoso sexual fue significativamente mayor entre las mujeres. Los cirujanos fueron los principales perpetradores. Conclusiones: El acoso laboral y el acoso sexual son frecuentes en la formación quirúrgica en Colombia. Estos hallazgos conducen a intervenciones para mejorar la cultura educativa de los departamentos quirúrgicos para disminuir la prevalencia de estos comportamientos.

Workplace bullying and sexual harassment among general surgery residents in Colombia / Acoso laboral y sexual en residentes de cirugía general en Colombia

Introduction. Workplace bullying and sexual harassment are concerns among general surgery residents in Colombia. Objective. To explore the prevalence and impact of workplace bullying and sexual harassment incidents among general surgery residents in Colombia. Materials and methods. This nationwide study was conducted in 2020. Residents selfrated their exposure to workplace bullying and to sexual harassment in the forms of gender harassment, unwanted sexual attention, and sexual coercion. We analyzed demographic variables, perpetrator's characteristics, and differences between victims and non-victims. Results. The study included 302 residents. It found that 49% of general surgery residents in Colombia suffered from workplace bullying and 14.9% experienced sexual harassment. The main forms of sexual harassment were gender harassment (47%) and unwanted sexual attention (47%). Women reported significantly higher rates of being sexually harassed. Surgeons were the main perpetrators of sexual harassment. Conclusions. Workplace bullying and sexual harassment are frequent events in general surgery residency in Colombia. These findings suggest the need for interventions to improve the educational culture of surgical departments and decrease the prevalence of these behaviors.

Introducción. El acoso laboral y el acoso sexual son preocupaciones en la formación quirúrgica. Objetivo. Exploramos la magnitud de estos problemas entre los residentes de cirugía general en Colombia. Materiales y métodos. Se realizó un estudio nacional en junio de 2020. Los residentes autoevaluaron su exposición a la intimidación y el acoso sexual en forma de acoso de género, atención sexual no deseada y coerción sexual. Se analizaron variables demográficas y perpetradores entre víctimas y no víctimas. Resultados. Se incluyeron un total de 302 residentes. Las tasas de acoso laboral y sexual fueron del 49% y 14,9%, respectivamente. Las principales formas de acoso sexual correspondieron al acoso de género (47%) y la atención sexual no deseada (47%). El acoso sexual fue significativamente mayor entre las mujeres. Los cirujanos fueron los principales perpetradores. Conclusiones. El acoso laboral y el acoso sexual son frecuentes en la formación quirúrgica en Colombia. Estos hallazgos conducen a intervenciones para mejorar la cultura educativa de los departamentos quirúrgicos para disminuir la prevalencia de estos comportamientos.

Epidemiologia e custos hospitalares de internações de pacientes com infecções de origem odontogênica em um hospital público de Belo Horizonte / Epidemiology and hospital costs of admissions of patients with infections of origin dentistry in a public hospital in Belo Horizonte

Introdução: A Infecção Odontogênica (IO) possui a sua origem no tecido dental e de suporte, que que em uma eventual situação, pode evoluir para os espaços fasciais subjacentes. O processo infeccioso pode evoluir de uma infecção odontogênica localizada simples para uma infecção maxilofacial grave, levando a sérias complicações. A epidemiologia das IO é importante para o desenvolvimento de estratégias de prevenção, evitando assim a progressão para complicações graves e hospitalização. As implicações resultantes de IO continuam a ser uma preocupação significativa para a saúde pública e isso não se deve apenas ao seu potencial prejudicial para a saúde, mas também à considerável carga financeira hospitalar ligada ao tratamento dessas situações. Objetivos: Analisar casos de infecção de origem odontogênica em pacientes internados pelo Setor de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Metropolitano Odilon Behrens (HMOB), em Belo Horizonte, Minas Gerais, Brasil. Materiais e métodos: Estudo transversal, analítico, realizado por meio da coleta de dados secundários. Foram analisados 530 prontuários de pacientes internados devido a infecção odontogênica no HMOB, entre janeiro de 2018 e dezembro de 2022. As variáveis independentes foram idade, sexo, presença de comorbidade, município de residência, ano, lado da face, etiologia da infecção, dente acometido e arcada dentária. A variável dependente foi constituída por um escore de gravidade construído a partir das variáveis de conduta clínica e de complicações na internação. Além disso, foram coletadas informações sobre o número de dias de internação e custo das internações. Foram realizadas análises estáticas descritivas. Testes bivariados foram realizados e aqueles que tiveram um p<0.05 foram incluídos na análise de regressão de Poisson com variância robusta. Resultados: Pode-se observar que aproximadamente, 60.6% dos pacientes fizeram uso de pelo menos uma das opções de dreno intraoral ou extraoral. A angina de Ludwig foi identificada em 7.4% da amostra. O ano com maior número de internações foi o ano de 2022 (24.2%), no qual aconteceram, em sua maioria, no primeiro trimestre (28.9%), causadas por infecções que acometiam o lado direito (42.3%), a etiologia da maioria dos casos foi a cárie (56.4%), o dente mais acometido o molar inferior permanente (55.3%) e na mandíbula (88.7%). O tempo médio de internação foi de 6,9 dias e foi possível verificar aumento no tempo médio das internações ao longo dos anos. O número médio de antibióticos administrados aos pacientes foi de 2,2 e o custo médio total das internações no período de janeiro de 2018 a dezembro de 2022 foi de R$991,65. Pessoas com mais de 60 anos apresentaram gravidade 19% maior que aquelas de 1 a 19 anos. Em relação ao ano de internação, as que foram internadas em 2022, tiveram quadro 13% mais grave que os pacientes internados em 2018 e foi possível observar indícios de gradiente dose-resposta quando ano e gravidade foram relacionados. Os casos em que o acometimento foi bilateral foram 38% mais graves que quando o acometimento foi em um lado da face; e os casos que acometeram a mandíbula foram 17% mais graves que quando o acometimento se deu na maxila. Foi realizado georreferenciamento de Belo Horizonte, a partir do endereço de domicílio dos pacientes do município. A distribuição de casos decorrentes de infecção de origem odontogênica foi homogênea no município. Ao analisar a renda mensal per capita dos domicílios com 2 salários-mínimos, observou-se a formação de aglomerados de alta densidade nos bairros Aparecida e Santa Mônica. Conclusão: Conclui-se que a maioria dos casos de internação por infecção odontogênica foram de pacientes que residem no município de Belo Horizonte, a principal causa foi a cárie, os dentes mais acometidos os molares inferiores permanentes e acometimento da mandíbula. A adoção de estratégias preventivas e a intervenção precoce emergem como abordagens de destaque.

Introduction: Odontogenic Infection (IO) has its origin in the dental and supporting tissue, which in an eventual situation, can evolve into the underlying fascial spaces. The infectious process can evolve from a simple localized odontogenic infection to a severe maxillofacial infection, leading to serious complications. The epidemiology of OI is important for the development of prevention strategies, thus avoiding progression to serious complications and hospitalization. The resulting implications of OI continue to be a significant public health concern and this is not only due to its harmful potential for health, but also the considerable hospital financial burden linked to the treatment of these situations. Objectives: To analyze cases of infection of odontogenic origin in patients admitted to the Oral and Maxillofacial Surgery and Traumatology Sector of the Hospital Metropolitano Odilon Behrens (HMOB), in Belo Horizonte, Minas Gerais, Brazil. Materials and methods: Cross-sectional, analytical study, carried out through the collection of secondary data. A total of 530 medical records of patients hospitalized due to odontogenic infection at the HMOB between January 2018 and December 2022 were analyzed. The independent variables were age, gender, presence of comorbidity, municipality of residence, year, side of the face, etiology of infection, tooth affected and dental arch. The dependent variables consisted of a severity score constructed from the clinical management and hospitalization complications variables. In addition, information was collected on the number of days of hospitalization and the cost of hospitalizations. Descriptive static analyzes were performed and those that had a p<0.05 were included in the Poisson regression analysis with robust variance. Results: It can be seen that approximately 60.6% of the patients used at least one of the options for intraoral or extraoral drain. Ludwig's Angina was identified in 7.4% of the sample. The year with the highest number of hospitalizations was 2022 (24.2%), in which they mostly occurred in the first quarter (28.9%), caused by infections that affected the right side (42.3%), the etiology of the majority of cases was caries (56.4%), the most affected tooth was the lower permanent molar (55.3%) and the mandible (88.7%). The mean length of stay was 6.9 days, and it was possible to see an increase in the mean length of stay over the years. The average number of antibiotics administered to patients was 2.2 and the total average cost of hospitalizations in the period between January 2018 and December 2022 was R$991.65. People aged over 60 years had a 19% greater severity than those aged 1 to 19 years. Regarding the year of hospitalization, those who were hospitalized in 2022 had a 13% more severe condition than patients hospitalized in 2018 and it was possible to observe evidence of a dose-response gradient When year and severity were related. Cases in which the involvement was bilateral were 38% more severe than when the involvement was on one side of the face; and the cases that affected the mandible were 17% more severe than when the maxilla was affected. Belo Horizonte was georeferenced based on the home addresses of patients in the city. The distribution of cases resulting from infection of odontogenic origin was homogeneous in the municipality. When analyzing the per capita Monthly income of households earning 2 minimum wages, the formation of highdensity clusters was observed in the Aparecida and Santa Mônica neighborhoods. Conclusion: It is concluded that most cases of hospitalization due to odontogenic infection were patients residing in the city of Belo Horizonte, the main cause was caries, the most affected teeth were permanent lower molars and involvement of the mandible. The adoption of preventive strategies and early intervention emerge as prominent approaches.

Predicción de caídas y caídas recurrentes en adultos mayores que viven en el domicilio / Prediction of falls and recurrent falls in older adults living at home

Objetivos: Determinar la predicción de las caídas y caídasrecurrentes asociadas a factores de riesgo en el adulto mayor quevive en el domicilio. Metodología: Estudio cuantitativo y transversalrealizado en La Libertad, Perú. La muestra fue de 1.110 adultosmayores que viven en el domicilio y se utilizó instrumentos como perfilsocial, enfermedades y medicamentos autorreferidos, caídas, estadocognitivo, síntomas depresivos, actividad básica e instrumental de lavida diaria, y equilibrio estático y dinámico. Se analizó con estadísticadescriptiva, curvas ROC y el área bajo la curva para evaluar los valorespredictivos y la regresión logística. Resultados: La mayoría era mujer,de entre 60 y 79 años, con compañero, viven acompañados y trabajan.La prevalencia de caídas fue del 30,5% y de caídas recurrentes del14%. Hubo predominio de aquellos sin déficit cognitivo, necesitabanayuda para las actividades instrumentales e independientes para lasbásicas, sin síntomas depresivos y con equilibrio estático y dinámicopreservado. En la regresión hubo relación entre caídas con ser mujer,vivir solo, número de enfermedades y medicamentos y dependenciapara las actividades básicas. Para caídas recurrentes hubo asociacióncon vivir solo, uso de medicamentos y dependencia para las actividadesinstrumentales. Conclusiones: La caída está asociada a diferentesfactores y su identificación precoz es importante para la creación deplanes de cuidados por el equipo multiprofesional evitando problemasfísicos y psicológicos en el adulto mayor. (AU)

Objectives: To determine the prediction of falls and recurrentfalls associated with risk factors in the elderly living at home.Methodology: Quantitative and cross-sectional study carried out inLa Libertad, Peru. The sample consisted of 1,110 older adults livingat home and instruments such as social profile, self-reported illnessesand medications, falls, cognitive status, depressive symptoms, basicand instrumental activity of daily life, static and dynamic balance wereused. It was analyzed with descriptive statistics, ROC curves and areaunder the curve to evaluate predictive values and logistic regression.Results: The majority were women, between 60 and 79 years old,with a partner, living with someone and working. The prevalence offalls was 30.5% and recurrent falls 14%. There was a predominanceof those without cognitive deficit, they need help for instrumentaland independent activities for the basic ones, without depressivesymptoms and with preserved static and dynamic balance. In theregression, there was a relationship between falls with being a woman,living alone, number of illnesses and medications, and dependencefor basic activities. For recurrent falls, there was an association withliving alone, use of medications, and dependence for instrumentalactivities. Conclusions: the fall is associated with different factors andits early identification is important for the creation of care plans by themultiprofessional team, avoiding physical and psychological problemsin the elderly. (AU)

Chagas disease and social welfare: characterization of the disease in the Brazilian social security and social assistance, 2004-2016 / Enfermedad de Chagas y bienestar social: caracterización de la enfermedad en el sistema de seguridad y asistencia social brasileño, 2004-2016 / Doença de Chagas e a seguridade social: caracterização da doença no sistema previdenciário e assistencial brasileiro, 2004-2016

Objective: To characterize the sociodemographic profile of beneficiaries of Brazilian social security affected by Chagas disease and identify factors associated with the granting of assistance benefits, 2004 to 2016. Methods: Cross-sectional study based onsecondary data from the Ministry of Labor and Social Security. Logistical regression was performed to estimate crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI). Results: 36,023 benefits were granted; 62.5% were to male; 67.0% to residents of urban areas; 46.7% to residents of Southeast region; 56.7% to people with chronic cardiac form; and 42.7% to the 50-59 age group. Residents of urban areas (OR=134.9 ­ 95%CI 78.0;233.2), Northeast macro-region (OR=2.9 ­ 95%CI 2.5;3.1), female (OR=2.0­ 95%CI 1.8;2.1) and age group 60 years or older (OR=1.6 ­ 95%CI 1,3;1,7) were factors associated with assistance benefits. Conclusion: Factors related to the area of residence, macro-region, sex and age group increased the chance of granting assistance benefits.

Objetivo: Caracterizar el perfil sociodemográfico de los beneficiarios de la seguridad social brasileña con enfermedad de Chagas e identificar los factores asociados a la concesión de beneficios asistenciales, de 2004 a 2016. Métodos: Estudio transversal con datos del Ministerio de Trabajo y Seguridad Social. Se utilizó regresión logística para estimar las razones de probabilidad (OR) crudas y ajustadas. Resultados: Se otorgaron 36.023 beneficios; 62,5% para el sexo masculino; 67,0% para residentes en áreas urbanas; 46,7% residentes del Sudeste; 56,7% para personas con la forma cardiaca crónica; y 42,7% para personas de 50-59 años. Residir en áreas urbanas (OR=134,9 ­ IC95% 78,0;233,2), en el Noreste (OR=2,9 ­ IC95% 2,5;3,1), sexo femenino (OR=2,0 ­ IC95% 1,8;2,1) y grupo de edad de 60 años o más (OR=1,6 ­ IC95% 1,3;1,7) fueron factores asociados a las prestaciones asistenciales. Conclusión: Los factores relacionados con el local de residencia, sexo y grupo de edad aumentaron la posibilidad de otorgar beneficios asistenciales.

Objetivo: Caracterizar o perfil sociodemográfico de beneficiários da seguridade social brasileira com doença de Chagas e identificar fatores associados à concessão de benefícios assistenciais, 2004-2016. Métodos: Estudo transversal, com dados secundários do Ministério do Trabalho e Previdência Social. Empregou-se regressão logística para estimar razões de chances (OR: odds ratios), brutas e ajustadas, e intervalo de confiança de 95% (IC95%). Resultados: Foram concedidos 36.023 benefícios: 62,5% a pessoas do sexo masculino; 67,0% para residentes de áreas urbanas; 46,7% para moradores da macrorregião Sudeste; 56,7% para pessoas com forma cardíaca crônica; e 42,7% para a faixa etária de 50-59 anos. Residir em áreas urbanas (OR=134,9 ­ IC95% 78,0;233,2), no Nordeste (OR=2,9 ­ IC95% 2,5;3,1), sexo feminino (OR=2,0 ­ IC95% 1,8;2,1) e idade de 60 anos ou mais (OR=1,6 ­ IC95% 1,3;1,7) estiveram associados aos benefícios assistenciais. Conclusão: Fatores relacionados a zona de residência, macrorregião, sexo e faixa etária aumentaram a chance de concessão de benefícios bassistenciais.

Impact of the COVID-19 pandemic on the timing of dental care in Peruvian children.

BACKGROUND: Due to the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), governments adopted preventive measures, such as social distancing and obligatory social immobilization, which negatively affected access to health services, including oral health services. Similarly, dental care restraint arose in this context, with the aim of reducing the possibility of cross-infection caused by aerosols, which notably restricted dental care activity. OBJECTIVES: The aim of the study was to determine the impact of the COVID-19 pandemic on the timing of dental care in Peruvian children. MATERIAL AND METHODS: A cross-sectional study with a population of 42,115 respondents for 2019 and 20,510 for 2020 was conducted. The participants were children aged 0-11 years. The records of those who responded to the question on the time since their last dental care were considered, extracting a total of 22,166 (69.03%) subjects for 2019 and 9,945 (30.97%) subjects for 2020. The dependent variable consisted of the time since the last dental care measured in years; the variables of health, geographic and sociodemographic characteristics were grouped within 3 dimensions. Descriptive bivariate and multivariate analyses were applied by means of multiple linear regression in order to analyze the variables. RESULTS: The time since the last dental care during 2019 was 5.25 ±4.30 years, and it increased to 6.64 ±4.90 years in 2020. Within the multivariate analysis, the dimensions and their variables were ordered hierarchically for 2019 and 2020 separately, and as a whole. Each model was not significant when observed independently (p > 0.05); however, when evaluated as a whole, validity was observed only in model 1 of the year (p = 0.018), with R2 = 2.90, a constant equal to 3.852, the non-standardized regression coefficient (ß) of 1.653, and a 95% confidence interval (CI) of 0.289-3.018. CONCLUSIONS: The 2020 COVID-19 pandemic year had a negative impact on the timing of dental care in Peruvian children, increasing it by 1.39 years as compared to 2019.

Coordinación de un servicio de Salud Mental con profesionales de Atención Primaria / Coordination of a Mental Health Service with Primary Care professionals

Objetivo: evaluar la opinión de los profesionales de Atención Primaria (AP) en relación con la coordinación y el funcionamiento de los servicios de Salud Mental ofrecidos por el Centro de Salud Mental Miraflores de Alcobendas (Madrid). Así mismo, se buscó determinar su formación autopercibida, el manejo del seguimiento y la derivación de casos y su valoración de las herramientas de coordinación. Método: estudio descriptivo transversal. Se incluyó a médicos y enfermeras de AP vinculados al Hospital Universitario Infanta Sofía de la Comunidad de Madrid (N= 344). Mediante cuestionario diseñado ad hoc se recogieron variables de formación, de relación terapéutica, de manejo de casos en AP y de relación con el servicio de Salud Mental medidas con escalas tipo Likert de 1 (mín.) a 5 puntos (máx.), sociodemográficas y laborales. Se realizaron índices de estadística descriptiva. Resultados: participaron 29 profesionales (25 médicos). Refirieron un 31% de consultas relacionadas con SM. Consideraron su formación como suficiente ( = 3,17/5) y que la derivación de casos a Salud Mental estaba condicionada por la ideación suicida ( =4,9/5) y la sintomatología grave ( =4,7/5). Los casos leves eran los más idóneos para atender en AP. Puntuaron la existencia de coordinación en 3,0/5. La herramienta considerada más útil fue la interconsulta por correo electrónico ( = 4,31/5) y las sesiones clínicas sobre casos solicitados por AP. Conclusión: la coordinación obtuvo una valoración positiva. Se detectaron condicionantes de la derivación sobre los que no se puede actuar directamente, pero otros susceptibles de abordarse con interconsultas o sesiones, herramientas bien valoradas por los profesionales.(AU)

Objective: to assess the opinion by Primary Care (PC) professionals regarding the coordination and functioning of the Mental Health services offered by the “Miraflores” Mental Health Centre in Alcobendas (Madrid). Also, to determine their self-perceived training, the management of follow-up and referral of cases, and their assessment of coordination tools. Method: a cross-sectional descriptive study, including PC doctors and nurses attached to the Hospital Universitario Infanta Sofía of the Community of Madrid (N= 344). Through a questionnaire designed ad hoc, the following variables were collected: training, therapeutic relationship, management of cases at PC and relationship with the Mental Health (MH) service measured through Likert-type scales from 1 (minimum) to 5 scores (maximum), as well as sociodemographic and occupational variables. Descriptive statistical indexes were conducted. Results: the study included 29 professionals (25 doctors), who referred 31% of consultations associated with MH. They considered their training as sufficient ( = 3.17/5), and referral to cases to MH was determined by suicidal ideation ( =4.9/5) and severe symptomatology ( = 4.7/5). Mild cases were the most adequate to be managed at PC. They gave a score of 3.0/5 to the current coordination. The tool considered most useful was consultation between professionals by email ( = 4,31/5), as well as clinical sessions about cases requested by PC. Conclusion: coordination achieved a positive evaluation. Some factors determining referral on which no direct action is possible were detected; but there are others that can be potentially addressed through consultations or sessions, which are tools positively valued by professionals.(AU)

Acceptance Model of a Mandatory Health Information System in Indonesia.

OBJECTIVES: The purpose of this study was to develop a model of acceptance of the Mother and Child Health Information System in the Ngawi Regency Health Office, Indonesia based on the technology acceptance model, by integrating organizational support and personal characteristics as external variables and enjoyment as an intervening variable. METHODS: The design of this study was cross-sectional. The subjects of this study were 217 village midwives who had operated the Maternal and Child Health Information System in the Ngawi Regency Health Office, Indonesia. The variables studied were perceived organizational support, personal characteristics, perceived ease of use, perceived usefulness, perceived enjoyment, behavioral intention, and actual system use. Data were collected through questionnaires, and then analyzed using structural equation modeling. RESULTS: In terms of the total effect, the most meaningful factor affecting actual system use was perceived organizational support (0.766), followed in descending order by behavioral intention to use (0.344), perceived enjoyment (0.238), personal characteristics (0.118), perceived usefulness (0.054), and perceived ease of use (0.048). CONCLUSIONS: In the acceptance model of the Mother and Child Health Information System in Ngawi Regency, perceived organizational support was the main determinant of actual system use, while enjoyment was the main intermediate determinant of the indirect effects of perceived organizational support and personal characteristics on actual system use.

Associated factors with user embracement by the Primary Health Care teams in Brazil, 2012: a cross-sectional study / Factores asociados a la realización de acogimiento por los equipos de Atención Primaria de Salud en Brasil, 2012: un estudio transversal / Fatores associados à realização de acolhimento pelas equipes da Atenção Básica à Saúde no Brasil, 2012: um estudo transversal

Objective. Evaluate the prevalence and factors associated with user embracement by primary health care teams in Brazil. Methods. This is a cross-sectional study that included teams that joined PMAQ-AB 2012 (Cycle I). The outcome used was the user embracement by the health team. The independent variables were macroregion, municipal profile, Gini index and Family Health Strategy population coverage, team meeting, study of spontaneous demand, consideration of user opinion and existence of permanent education. Multilevel Poisson regression analysis was performed to obtain the results. Results. The sample consisted of 13,751 teams. The prevalence of user embracement was 78.3% (95%CI 77.6;79.1). In the hierarchical analysis, the highest prevalence of user embracement was among the teams from the southern region (PR=1.37 ­ 95%CI 1.27;1.48) compared to the northeast region. Conclusion. There is an uneven distribution of primary care teams that do user embracement in Brazil, possibly associated with regional inequalities.

Objetivo. Avaliar a prevalência e os fatores associados à realização de acolhimento pelas equipes da Atenção Básica à Saúde no Brasil. Métodos. Estudo transversal, realizado com equipes que aderiram ao PMAQ-AB 2012 (Ciclo I). O desfecho utilizado foi o 'acolhimento pela equipe de saúde'; as variáveis independentes foram macrorregião, perfil municipal, índice de Gini e cobertura populacional da Estratégia Saúde da Família, reunião de equipe, estudo da demanda espontânea, consideração da opinião do usuário e existência de educação permanente. Realizou-se análise multinível, por regressão de Poisson. Resultados. A amostra foi composta por 13.751 equipes. Aprevalência de acolhimento foi de 78,3% (IC95% 77,6;79,1). Na análise hierárquica, a maior prevalência de acolhimento foi entre as equipes pertencentes à região Sul (RP=1,37 ­ IC95% 1,27;1,48), tendo por referência a região Nordeste. Conclusão. Háuma distribuição desigual de equipes da Atenção Básica que realizam o acolhimento no país, possivelmente associada às iniquidades regionais.

Associação entre características sociodemográficas e de saúde e o grau de dificuldade de locomoção dos idosos / Association between sociodemographic and health characteristics and the level of difficulty of locomotion of elderly / Asociación entre características sociodemograficas y de salud y el grado de dificultad de locomoción de ancianos

Objetivo: O presente artigo tem como objetivo analisar a associação entre características sociodemográficas e de saúde e o grau de dificuldade de locomoção dos idosos, no Brasil. Método: Foi utilizado o modelo de chances proporcionais parciais e os dados da Pesquisa Nacional de Saúde 2013. Resultados: Na análise ajustada, observou-se maior grau de dificuldade de locomoção entre idosos mais velhos, não casados (OR=1/0,759=1,318;p-valor<0,001), sem instrução (OR=1,433;p-valor=0,026), residentes na região Sul (OR=1,448;p-valor=0,019) e que reportaram piores níveis de saúde geral. Além disso, idosos com diagnóstico de doença crônica, física ou mental apresentaram maior chance de reportar dificuldade de locomoção (OR=1,645;p-valor<0,001). Conclusão: Devido à natureza dos fatores associados, destaca-se a necessidade de ações de promoção e educação em saúde a fim de reduzir as complicações e danos à saúde dos idosos que comprometam a sua capacidade funcional, especialmente na região Sul do Brasil

Objective: this article aims to analyze the association between sociodemographic and health characteristics and the degree of locomotion difficulty of the elderly in Brazil. Methods: the partial proportional odds model and data from the National Health Survey 2013 were used. Results: in the adjusted analysis, a greater degree of locomotion difficulty was observed among older, unmarried elderly (OR=1/0.759=1.318; p-valor<0,001), without education level (OR=1.433, p-value=0.026), who were in the southern region (OR=1.448, p-value=0.019) and reported worse overall health. In addition, the elderly with a diagnosis of chronic, physical or mental illness had a greater odds of reporting difficulty in locomotion (OR=1.645; p-value<0.001). Conclusion: due to the types of factors associated, health promotion and education actions are necessary to reduce the complications and damages to the health of the elderly that compromise their functional capacity, especially in the Southern region of Brazil

Objetivo: el presente artículo tiene como objetivo analizar la asociación entre características sociodemográficas y de salud y el grado de dificultad de locomoción de los ancianos en Brasil. Métodos: se utilizó el modelo de odds proporcionales parciales y los datos de la Encuesta Nacional de Salud 2013. Resultados: en el análisis ajustado, se observó mayor grado de dificultad de locomoción entre ancianos mayores, no casados (OR =1/0,759=1,318; p-valor r<0,001). sin instrucción (OR=1,433; p-valor=0,026), residentes en la región Sur (OR=1,448; p-valor=0,019) y que reportaron peor salud general. Además, ancianos con diagnóstico de enfermedad crónica, física o mental presentaron mayor odds de reportar dificultad de locomoción (OR =1,645;p-valor<0,001). Conclusión: debido a la naturaleza de los factores asociados, se destaca la necesidad de acciones de promoción y educación en salud para reducir las complicaciones y daños a la salud de los ancianos que comprometen su capacidad funcional, especialmente en la región Sur de Brasil

Queda em idosos: estudo de base populacional / Falls in the elderly: a population-based study

OBJETIVO: Avaliar a prevalência de quedas em idosos e possíveis fatores associados. MÉTODOS: Estudo transversal de base populacional realizado por meio da aplicação de questionário domiciliar a todos os idosos com 60 anos ou mais residentes nas zonas urbana e rural do município de Arroio Trinta (SC), em 2013. Realizou-se análise bivariada, buscando medir o nível de associação entre as variáveis independentes com o desfecho "presença de quedas". Para a comparação entre proporções, foi utilizado o teste qui quadrado. RESULTADOS: Do total de 568 idosos, 552 participaram do estudo. A prevalência de quedas foi de 28,3%; a prevalência de três ou mais quedas (38,5%) foi ligeiramente superior a de uma única (35,9%), sendo o próprio lar (49,3%) o local de maior ocorrência. Em 13,5% das quedas, ocorreram fraturas. O aumento da idade mostrou-se associado às quedas nos idosos (p=0,04). CONCLUSÃO: A prevalência encontrada, mesmo dentro dos padrões brasileiros, é elevada, considerando que se trata de um desfecho evitável. A idade avançada foi a única variável associada ao desfecho neste estudo. As quedas em idosos são multifatoriais e de complexa análise, sendo necessários mais estudos para se definirem os fatores associados, bem como comparar as diferentes realidades brasileiras.(AU)

OBJECTIVE: To evaluate the prevalence of falls in the elderly, as well as the possible associated factors. METHODS: Crosssectional, population-based study performed through the application of a household questionnaire to every person of 60 years of age or older living in the urban and rural areas of the city of Arroio Trinta (state of Santa Catarina) in 2013. A bivariate analysis was performed to evaluate the association level among independent variables and the outcome (occurrence of falls). The Chi-square test was performed for proportion comparison. RESULTS: There were 568 elderly people, of whom 552 participated in the study. The prevalence of falls was 28.3%;the prevalence of three or more falls (38.5%) was slightly above that of one single fall (35.9%), with the own home (49.3%) being the place of greatest occurrence of falls. Fractures occur in 13.5% of falls. Age increase was associated with falls (p=0.04). CONCLUSION: The prevalence found, even though within Brazilian standards, is high because it is a preventable outcome. The advanced age was the only variable associated with the outcome in this study. Falls in the elderly are multifactorial and of complex analysis; therefore, more studies are necessary to define the associated factors, as well as to compare the different realities in Brazil.(AU)

Misoprostol como método de interrupción del embarazo, una alternativa clínica económica / Misoprostol as a method of pregnancy interruption, a clinical and economical alternative

Fundamento: el aborto es la expulsión del producto de la concepción cuando todavía no es capaz de sobrevivir fuera del seno materno. Objetivo: comparar clínica y económicamente la efectividad del misoprostol como método de interrupción del embarazo con el método tradicional. Método: se realizó un estudio transversal descriptivo en el Hospital Universitario Manuel Piti Fajardo, Florida Camagüey, desde de enero hasta diciembre de 2010. El universo estuvo formado por 600 pacientes que acudieron a consulta de planificación familiar, la muestra quedó constituida por 450 embarazadas que cumplían los criterios de inclusión. Los datos fueron recogidos y procesados de forma computarizada, como medidas estadísticas números y por cientos. Resultados: el método se consideró efectivo ya que provocó el aborto completo sin requerir procedimiento quirúrgico. El aborto completo ocurrió en 409 pacientes, en el primer ciclo se presentaron 41 fallos, a 19 pacientes se les aplicó una segunda dosis y a las 22 restantes se les aplicó método quirúrgico, se logró mayor efectividad con el primer ciclo en 390 pacientes. Con la aplicación del método no quirúrgico existió un ahorro en el presupuesto de $16793.54. Conclusiones: los efectos secundarios más frecuentes después de aplicado el método fueron escalofríos, náuseas y dolores pélvicos, el mayor número de pacientes logró el aborto completo con la utilización del misoprostol vaginal en el primer ciclo donde fue poco representativo el número de fallos. Con la aplicación del método farmacológico existió un ahorro en el presupuesto de $16793.54 comparándolo con el aborto quirúrgico.

Background: abortion is the expulsion of a human fetus when it is not yet able to survive outside the womb. Objective: to compare clinical and economic effectiveness of misoprostol as a method of termination of pregnancy with the traditional method. Method: a descriptive, cross-sectional study was conducted at the University Hospital Manuel Piti Fajardo, Florida Camagüey, from January to December 2010. The universe was constituted by 600 patients who came to family planning consultation; the sample was made up 450 pregnants which met the inclusion criteria. Data were collected and processed in computerized form, as statistical measures, numbers and percents. Results: this method was considered effective because comprehensive abortion was achieved without requiring surgical procedure. Comprehensive abortion occurred at 409 patients, 41 failures were presented in the first cycle, 19 patients were applied a second dose and the 22 remaining surgical method was applied to them, the method was more effective with the first cycle in 390 patients. With the implementation of non-surgical method, there was a saving in the budget of $16793.54. Conclusions: the most common side effects after the use of this method were chills, nausea, and pelvic pain, the largest number of patients achieved comprehensive abortion with the use of vaginal misoprostol in the first cycle where the number of failures was unrepresentative. With the implementation of the pharmacological method, there was a saving in the budget compared to surgical abortion.

Perfil sociodemográfico e antropométrico de idosos de grupos de convivência / Sociodemographic and anthropometric profile of elderly people from coexistence groups

Objetivou-se neste estudo descrever e analisar o perfil sociodemográficoe antropométrico de idosos de grupos de convivência. Oestudo transversal foi formado por 181 idosos (98 mulheres e 83homens) de 18 diferentes grupos de Aracaju-SE. As variáveis sociodemográficasforam: idade, escolaridade, estado civil e renda.As antropométricas foram: massa corporal (MC), estatura, circunferênciada cintura (CC) e do quadril (CQ). Calculou-se o IMC e oRCQ. Empregou-se a estatística descritiva, teste “t” para amostrasindependentes e análise de variância, com comparações post-hocde Tukey, adotando um p<0,05. A maioria dos idosos tinha mais de70 anos (64%), eram do sexo feminino (54%), com no máximo ensinofundamental (73%), casados (68%) e com renda própria (60%). A MC e a estatura diminuíram com o passar da idade. Em média,o IMC foi superior aos recomendados em todas as faixas etárias.Mais mulheres do que homens apresentaram inadequação na CCe RCQ. (AU)

The aim of this study was to describe and analyze sociodemographicand anthropometric profile of elderly from coexistence groups. Thecross-sectional study was formed by 181 elderly people (98 womenand 83 men) of 18 different groups of Aracaju-SE. The sociodemographicvariables were: age, education, marital status and income.The anthropometric were: body mass (BM), height, waist circumference(WC) and hip (WH). The BMI and the WHR were calculates.It was applied the descriptive statistics, “t” test for independentsamples and analysis of variance, with post-hoc of Tukey, adopting p <0.05. Most elderly people had more than 70 years (64%), werefemale (54%), with at most elementary school (73%), married (68%),and with own income (60%). The BM and stature declined with theage passage. On average, BMI was higher than those recommendedfor all ages. More women than men showed inadequacy in the WCand WHR.(AU)

Perfil sociodemográfico e antropométrico de idosos de grupos de convivência / Sociodemographic and anthropometric profile of elderly people from coexistence groups

Objetivou-se neste estudo descrever e analisar o perfil sociodemográficoe antropométrico de idosos de grupos de convivência. Oestudo transversal foi formado por 181 idosos (98 mulheres e 83homens) de 18 diferentes grupos de Aracaju-SE. As variáveis sociodemográficasforam: idade, escolaridade, estado civil e renda.As antropométricas foram: massa corporal (MC), estatura, circunferênciada cintura (CC) e do quadril (CQ). Calculou-se o IMC e oRCQ. Empregou-se a estatística descritiva, teste “t” para amostrasindependentes e análise de variância, com comparações post-hocde Tukey, adotando um p<0,05. A maioria dos idosos tinha mais de70 anos (64%), eram do sexo feminino (54%), com no máximo ensinofundamental (73%), casados (68%) e com renda própria (60%). A MC e a estatura diminuíram com o passar da idade. Em média,o IMC foi superior aos recomendados em todas as faixas etárias.Mais mulheres do que homens apresentaram inadequação na CCe RCQ.

The aim of this study was to describe and analyze sociodemographicand anthropometric profile of elderly from coexistence groups. Thecross-sectional study was formed by 181 elderly people (98 womenand 83 men) of 18 different groups of Aracaju-SE. The sociodemographicvariables were: age, education, marital status and income.The anthropometric were: body mass (BM), height, waist circumference(WC) and hip (WH). The BMI and the WHR were calculates.It was applied the descriptive statistics, “t” test for independentsamples and analysis of variance, with post-hoc of Tukey, adopting p <0.05. Most elderly people had more than 70 years (64%), werefemale (54%), with at most elementary school (73%), married (68%),and with own income (60%). The BM and stature declined with theage passage. On average, BMI was higher than those recommendedfor all ages. More women than men showed inadequacy in the WCand WHR.

Fatores associados à não realização do exame de Papanicolau: estudo transversal de base populacional em duas capitais brasileiras

O câncer do colo do útero corresponde a cerca de 15% de todos os tipos de câncer em mulheres, no mundo. No Brasil, em 2002, o câncer de colo do útero foi responsável por 7,1% de todas as mortes por câncer em mulheres, ocupando a quarta posição entre os demais. Para o mesmo ano, a taxa de mortalidade por câncer do colo do útero ajustada por idade, pela população padrão mundial, foi de 5,03/100.000. Já as taxas de incidência ajustadas por idade variaram entre 14,3 por 100.000 mulheres em Salvador e 50,7 por 100.000 mulheres no Distrito Federal, para o período compreendido entre 1991 e 2001. O câncer do colo do útero inicia-se a partir de uma lesão pré-invasiva, curável em até 100% dos casos, que geralmente progride lentamente, por anos, antes de atingir o estágio invasor da doença, quando a cura se torna mais difícil, quando não impossível. A abordagem mais efetiva para o controle do câncer do colo do útero continua sendo o rastreamento por meio o exame preventivo de Papanicolaou. O objetivo deste estudo foi identificar fatores associados à não realização do exame de Papanicolaou em mulheres de 25 a 59 anos nos três anos anteriores à pesquisa, nos municípios de Fortaleza e Rio de Janeiro. Para cada localidade foi utilizado o delineamento transversal, de base populacional com amostragem por conglomerados com dois estágios de seleção e auto-ponderada. Os dados foram analisados por regressão de Poisson obedecendo a um modelo hierárquico previamente determinado. O percentual de mulheres não submetidas ao exame de Papanicolaou nos três nos anteriores à pesquisa, em Fortaleza e no Rio de Janeiro, foi de 19,1% (IC95%: 16,1- 22,1) e 16,5% (IC95%: 14,1-18,9), respectivamente. Mulheres de baixa escolaridade, de menor renda per capita, de maior idade, não casadas, não submetidas a mamografia, ao exame clínico das mamas, aos exames de glicemia e colesterolemia foram as que apresentaram as maiores de razões de prevalências para a não realização do exame de Papanicolaou, em ambas as localidades. As fumantes foram menos submetidas ao exame em relação às demais mulheres, sendo essa diferença estatisticamente significativa somente no Rio de Janeiro. Finalmente, as informações aqui apresentadas apontam para a necessidade de intervenção em um grupo específico de mulheres. Deve-se priorizar atividades de educação para o diagnóstico precoce e rastreamento em mulheres sintomáticas e assintomáticas, respectivamente, além da garantia de acesso aos métodos de diagnóstico e tratamento adequados.

Cervical cancer corresponds to about 15% of all cancer types in women, in the world. In Brazil, in 2002, the cervical cancer was responsible for 7.1% of all cancer deaths in women, occupying the fourth position. In the same year, the age standardized mortality rate for cervical cancer was of 5.03/100,000. The age standardized incidence rate varied from 14.3 per 100,000 women in Salvador to 50.7 per 100,000 women in Federal District, for the period between 1991 and 2001. Cervical cancer arises from a pre-invasive lesion, curable in up to 100% of the cases, that progresses usually slowly, per years, before reaching the invasive stage, when the cure becomes more difficult, if not impossible. The most effective approach for the control of cervical cancer continues to be screening through the Pap smear. The aim this study was to identify factors associated with failure of women from 25 to 59 years old to be submitted to the exam in the last three years, in Fortaleza and Rio de Janeiro. To each city we used a population-based cross-sectional study with self-weighting two-satage cluster sampling. Data analysis used Poisson regression according to a previously determined hierarchical framework. The women's percentage not submitted to the Pap smear three years previous to the survey, in Fortaleza and in Rio de Janeiro, was 19.1% (95%CI: 16.1-22.1) and 16.5% (95%CI: 14.1-18.9), respectively. Women of low education and per capita income, old age, not married, not submitted mammography, breast clinical examination, glycemia and cholesterolemia presented the largest prevalence ratios of failure to be submitted to the Pap Smear, in both places. The smokers were less submitted to the exam in relation to the other women, being that difference statistically significant only in Rio de Janeiro. Finally, the information presented points to the necessity of intervention in a specific group of women. Education activities must have priority for early diagnosis and screening in symptomatic and assymptomatic women, respectively, providing access to adequated methods of diagnosis and treatment..