Made available in DSpace on 2014-08-20T13:57:56Z (GMT). No. of bitstreams: 1 Dissertacao_Everton_Jose_Fantinel.pdf: 361570 bytes, checksum: 358e3247ab150dabf9b0250dfc706290 (MD5) Previous issue date: 2010-10-18 / Insomnia is the most common sleep disorder. It affects millions of people constituting a public health problem with social and individual consequences. This study aimed to evaluate the prevalence of insomnia and its association with sociodemographic, behavioral and drug use. We used a cross-sectional population-based sample of 2732 adults aged 20 years or more living in Pelotas, Brazil. The outcome was operationalized by Insomnia Severity Index. Analysis was adjusted by Poisson regression. The prevalence of insomnia was 28.2% (95% CI: 26.2 to 30.3), with an increased likelihood in women, younger, poorer and do not work people. There was an apparent increase in the prevalence of insomnia in the city over the past ten years, with a marked change in age, becoming more prevalent in young than old. / A insônia é o mais frequente dos problemas relacionados ao sono. Afeta milhões de pessoas constituindo-se em um problema de saúde pública com consequências sociais e individuais. Este estudo teve por objetivo avaliar a prevalência de insônia e sua associação com variáveis sociodemográficas, comportamentais e de uso de medicamentos. Utilizou-se o delineamento transversal de base populacional, com amostra de 2732 indivíduos de 20 anos de idade ou mais, residentes em Pelotas, RS. O desfecho foi operacionalizado através do Insomnia Severity Index. A análise foi ajustada por regressão de Poisson. A prevalência de insônia foi de 28,2% (IC95%: 26,2 30,3), com uma probabilidade aumentada em mulheres, pessoas mais jovens, mais pobres e que não trabalham. Houve um aparente incremento da prevalência de insônia na cidade nos últimos dez anos, com uma marcante mudança de faixa etária, passando a ser mais prevalente em jovens do que em idosos.

Made available in DSpace on 2014-08-20T13:57:56Z (GMT). No. of bitstreams: 1 Dissertacao_Arnildo_Agostinho_Hackenhaar.pdf: 306557 bytes, checksum: e4cfcd2b150bbe8aa2e680ef206162bc (MD5) Previous issue date: 2005-02-25 / Objective: This study aims to determinate the prevalence and factors associated to women living in Pelotas, Southern Brazil, RS, who have undergone Pap smear within the 20- 59 age range. Methods: A population-based cross-sectional study was carried out from October to December, 2003. 144 census tracts were sampled through a multiple-stage clustered method. Socio-demographic variables were investigated, as well as wommen s undergoing Pap smear exam. Results: Among 1404 women who are the polulation included in the prophylactic program of the cervix uterine cancer, 83% had Pap smear exam in the previous three years before the study. Variables statistically associated (p<0.05) to women not undergonig the exam in the previos three years were: ages range of 20- 29 years and 50-59 compared with 40-49 years-old women, lower schooling level, worst social level, mixed races and black skined, not seeing a gynecologist in the previous 12 months. Conclusions: Although this study presents a high coverage regarding women undergoing Pap smear exam, women that present higher risk factors for this kind of cancer had fewer exams. Compared to a previous similar study carried out in the same setting a decade ago, an increase in the number of women undergoing the exam has been verified, regardless the skin color, monthly family income and whether they are living with a partner or not. / Objetivo: Determinar a prevalência e fatores associados a não realização de exame citopatológico do colo uterino em mulheres com idade entre 20 e 59 anos residentes na cidade de Pelotas, RS. Métodos: Entre outubro e dezembro de 2003 foi realizado um estudo transversal de base populacional. Através de amostragem por conglomerados foram sorteados 144 setores censitários em múltiplos estágios. Foram investigadas variáveis sociodemográficas e a realização de exame citopatológico do colo uterino. Resultados: Dentre as 1404 mulheres que constituem a população-alvo dos programas de prevenção do câncer do colo uterino, 83,0% realizaram o exame citopatológico do colo uterino nos três anos antecedentes a este estudo. Mostraram-se significativamente associadas (P<0,05) a não realização deste tipo de exame nos últimos três anos as seguintes variáveis: faixas etárias de 20 a 29 anos e 50 a 59 anos em relação às mulheres de 40 a 49 anos de idade, menor escolaridade, menor quintil de pontos obtidos para construção do nível socioeconômico segundo a Associação Nacional de Empresas de Pesquisa (ANEP), cor da pele mulata ou preta e não consultar com ginecologista nos últimos 12 meses. Conclusões: Apesar de este estudo mostrar alta cobertura na realização de citopatológico do colo uterino nos três anos antecedentes a entrevista, as mulheres com maior número de fatores de risco ao câncer de colo uterino apresentaram menor índice de realização deste exame. Em relação ao estudo similar realizado na mesma localidade em 1992, verificou-se aumento na realização deste exame independentemente da cor da pele, renda familiar mensal e viver ou não com companheiro.

Made available in DSpace on 2014-08-20T13:57:58Z (GMT). No. of bitstreams: 1 Dissertacao_Raquel_Siqueira_Barcelos.pdf: 1041764 bytes, checksum: 13725e8c323a6880506d7a7f9441cce3 (MD5) Previous issue date: 2012-12-17 / To assess the prevalence of menstrual disturbances and their distribution according to parity and demographic, social and behavioral characteristics among 1.078 women aged 15-54 years, a cross-sectional population-based study was carried out in Pelotas, Brazil. The menstrual disturbances investigated included heavy menstrual bleeding, inter-menstrual bleeding, short cycle, long cycle, and prolonged menses. Prevalence rates and 95% confidence intervals were calculated. Global prevalence of menstrual disturbances was 46.4% (95%CI 43.3-49.4). The most prevalent disturbance was heavy menstrual bleeding (23.2%; 20.5-25.8), followed-up by short cycle (19.2%; 16.6-21.8), long cycle (14.8%; 12.7-16.9), inter-menstrual bleeding (11.1%; 9.1-13.2), and prolonged menses (7.9%; 6.3-9.4). Menstrual disturbances are frequent at the population and are more prevalent among women with 35 years or older, with low level of formal education, high parity, with tubal ligation, and smokers. / Para avaliar a prevalência de distúrbios menstruais e sua distribuição conforme paridade e características demográficas, sociais e comportamentais, entre 15-54 anos de idade, realizou-se estudo transversal de base populacional, em Pelotas, RS, com 1.078 mulheres. Foram investigados sangramento menstrual excessivo, sangramento intermenstrual, ciclo menstrual curto, ciclo menstrual longo e menstruação prolongada. Foram calculadas as taxas de prevalência, com intervalos de confiança de 95%. A prevalência global de distúrbios menstruais foi 46,4% (IC95% 43,4-49,4). O mais prevalente foi sangramento menstrual excessivo (23,2%; 20,5-25,8), seguido de ciclo menstrual curto (19,2%; 16,6-21,8), ciclo menstrual longo (14,8%; 12,7-16,9), sangramento intermenstrual (11,1%; 9,1-13,2) e menstruação prolongada (7,9%; 6,3-9,4). Os distúrbios menstruais são frequentes na população, estando associados à idade maior que 34 anos, escolaridade menor que cinco anos, maior paridade, laqueadura tubária e tabagismo.

Orientador: Herling Gregorio Aguilar Alonzo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T19:45:31Z (GMT). No. of bitstreams: 1 Germano_LucasCoraca_M.pdf: 2927353 bytes, checksum: 0acf11b60ff7d23a33ff0ac8280c2046 (MD5) Previous issue date: 2015 / Resumo: As intoxicações constituem um problema de saúde pública global, com crescente número de ocorrências e óbitos. No Brasil, os dados deste agravo decorrem principalmente dos atendimentos de hospitais, que notificam ao Sistema de Informação de Agravos de Notificação (SINAN) ou solicitam auxílio dos Centros de Informação e Assistência Toxicológica (CIAT) no tratamento. Estes centros, por sua vez, enviam dados de seus atendimentos ao Sistema Nacional de Informações Tóxico-farmacológicas (SINITOX), entretanto, mesmo com ambos os sistemas de informação, grande parcela das ocorrências é ainda desconhecida. O objetivo do trabalho foi analisar os atendimentos por exposição, intoxicação ou envenenamento em um município do Estado de São Paulo, no período entre um de janeiro e 31 de dezembro de 2012, quanto às características de exposição, assistência, desfecho e de notificação. Foram revisadas as fichas de todos os atendimentos ocorridos na Unidade de Urgência e Emergência (UUE) e selecionados os decorrentes de exposição, intoxicação ou envenenamento, das quais foram coletadas variáveis de ocorrência e assistência, e analisadas com auxílio de software estatístico. Dos 95.923 atendimentos ocorridos, 3.184 (3,3%) decorreram dos eventos toxicológicos, destes, 68,6% eram do gênero masculino com mediana de idade de 38 anos, ao feminino corresponderam 31,4% e mediana de 30 anos, ambos com predomínio das faixas etárias entre 20 e 59 anos (74,5%). A taxa da prevalência foi de 46,4 atendimentos/mil habitantes. Predominaram as exposições agudas (48,5%) e crônicas (31,9%), e os principais agentes foram as drogas de abuso (58,1%), animais peçonhentos (15,8%) e medicamentos (10,0%). Em 71,0% dos atendimentos foram adotadas medidas de suporte. Foram notificados ao SINAN apenas acidentes por animais peçonhentos e o contato ao CIAT ocorreu em 10 atendimentos (0,3%), o que correspondeu a 3,1 notificações a CIATs para cada mil ocorrências toxicológicas atendidas. Em 1,7% a internação foi necessária e 4,8% receberam alta com orientação de acompanhamento em outros serviços. Em 30,8% dos expostos a drogas de abuso foram solicitadas internações em instituição de tratamento para dependência química. Em 16,7% foram identificados agravos/doenças com ou sem associação a exposição química. Ocorreram oito (0,2%) óbitos, a maioria associados a outros agravos ou doenças. O perfil apresentado dos atendimentos foi parcialmente semelhante ao apresentado em outros estudos, porém, é grande a variação entre diferentes países e regiões do mundo, inclusive no Brasil. Foi elevada a proporção de atendimentos dentre o total de urgências médicas e isso se deu ao ampliado critério de inclusão adotado, o que proporcionou uma alta representatividade das ocorrências em uma UUE. A alta subnotificação ao SINAN e SINITOX, bem como as diferenças observadas quanto aos dados destes sistemas, apontam para a necessidade de reformulação/qualificação dos dados sobre intoxicações no País, uma vez que sua representatividade pode estar comprometida. Discussões e ações devem ser tomadas para estruturação e qualificação da atenção ao exposto/intoxicado no SUS, com vistas ao conhecimento, redução e resolutividade das ocorrências / Abstract: Poisoning is a global public health problem, with an increasing number of cases and deaths. In Brazil, the data of this problem stem mainly from hospital care, which notify the National Information System of Diseases Notification (NISDN) or request assistance of Information and Toxicological Care Centers (ITCC) in the treatment. These centers, send data from your calls to the National System of Toxic-Pharmacological Information (NSTI), however, even with both information systems, large portion of cases is still unknown. The objective of this study was to analyze consultations for chemical exposures and poisonings in a municipality of San Paul State, Brazil, in the period between January 1 and December 31, 2012, for the chemical exposure characteristics, received medical care, and outcomes reporting to national systems of health information. All chart records of medical assistances occurred in Emergency Department (ED) were reviewed and selected those arising from chemical exposures and poisonings, in addition the occurrence characteristics and support variables were collected and analyzed with the statistical software. Of the 95,923 visits to ED, 3,184 (3.3%) arose from chemical exposures and poisonings, of these, 68.6% were male with a median age of 38 years, and 31.4% were female with median age of 30 years, both with predominance of age groups between 20 and 59 years (74.5%). The rate of prevalence was 46.4 ED visits / thousand inhabitants. The acute (48.5%) and chronic (31.9%) were the predominant exposures, and major toxic agents were drugs of abuse (including tobacco and alcohol) (58.1%), venomous animals (15.8%) and drugs (10.0%). Support measures were adopted in 71.0% of cases and were reported to NISDN only envenomations by venomous animals contact. ITCC consultations occurred in 10 ED visits (0.3%) corresponding to 3.1 notifications to ITCC per thousand toxicological occurrences met. 1.7% hospitalization was required and 4.8% were discharged with accompanying guidance in other services. In 30.8% of exposed to drug abuse were requested admission to the institution of treatment for chemical dependency. In 16.7% cases were identified diseases / disorders with or without associated chemical exposure. There were eight (0.2%) deaths, most associated with other health problems or diseases. The presented profile of the visits was partially similar to that shown in other studies and there is great variation between different countries and regions worldwide, including others Brazilian municipalities. The proportion of visits among the total number of medical emergencies and it took the extended inclusion criteria, which proportional representation of high occurrences in a UUE. The high underreporting to NISDN and NSTI as well as the differences on the data from these systems point to the need to reformulate / qualification of data on poisoning in the country, since their representation may be compromised. Discussion and action must be taken to structure and improve care of the intoxicated in Brazilian Universal Health System, with the objective to know, prevent, reduce and resolve all toxicologic events / Mestrado / Epidemiologia / Mestre em Saude Coletiva

INTRODUÇÃO: A adolescência é uma fase da vida marcada por transformações corpóreas intensas, especialmente nos pés resultando em mudanças no apoio estático e dinâmico. Dentre as metodologias de avaliação desse segmento destaca-se o Índice da Postura do Pé (IPP-6) por ser válido, confiável e multidimensional para verificar possíveis alterações posturais. OBJETIVOS: Caracterizar e relacionar o índice da postura do pé (IPP-6) em adolescentes de acordo com o sexo, faixa etária, índice de massa corpórea (IMC) e lateralidade. MÉTODOS: Foram avaliados 1.400 adolescentes escolares de Amparo e Pedreira em São Paulo, Brasil. Para avaliação eles permaneceram descalços numa base de madeira tendo entre os pés um retângulo de etil vinil acetato (EVA) para padronização da base de apoio. Cada pé foi avaliado pelo IPP- 6 em posição estática, no qual foi classificado entre supinado, normal e pronado através da somatória de seis critérios anatômicos. Cada critério foi graduado entre -2 a +2, sendo que valores negativos indicam supinação, positivos pronação e zero postura neutra. RESULTADOS: Os adolescentes, independentemente do sexo, apresentaram em sua maioria, os pés classificados como normais (lado direito: 78%, esquerdo: 73%). O sexo masculino (0,29, p= 0,04) e o pé esquerdo (0,73, p < 0,001) foram relacionados ao IPP-6, ou seja, em ambas as condições esperam-se que o escore total atribuído a essas variáveis sejam mais elevados (pé direito masculino: 3,09±2,84, esquerdo: 3,76 ± 2,80; pé direito feminino: 2,28 ± 2,61, esquerdo: 3,45±2,66; lateralidade esquerda: 3,55 ± 2,71, direita: 2,82 ± 2,7). Por outro lado, o coeficiente de correlação para o IMC foi negativo (- 0,08, p= < 0,001), o que significa que quanto maior for o IMC menor será o escore atribuído ao IPP-6. CONCLUSÃO: O IPP-6 em adolescentes de 10 a 14 anos está relacionado ao sexo masculino e pé esquerdo, isto é, em ambas as condições o escore predito é maior, logo os pés tendem a se apresentar com maior tendência a pronação. Por outro lado, em relação ao IMC, observa-se uma relação negativa, ou seja, o escore atribuído ao IPP-6 no adolescente classificado com sobrepeso e obesidade é menor. Porém, independentemente do sexo e IMC do adolescente e do pé em que a avaliação seja realizada espera-se que a postura seja classificada como normal / INTRODUCTION: Adolescence is a phase of life marked by intense bodily transformations. This is especially true in the feet, where changes occur in static and dynamic support. Among the evaluation methodologies of this segment, the foot posture index (FPI-6) stands out because it is valid, reliable, and multidimensional to verify possible postural changes. OBJECTIVES: To characterize and relate the FPI-6 in adolescents according to sex, age, body mass index (BMI) and laterality. METHODS: A total of 1,400 schoolchildren from Amparo and Pedreira in São Paulo, Brazil, were evaluated. For evaluation, they remained barefoot on a wooden base, with a rectangle of ethylene- vinyl acetate (EVA) between their feet for standardization of the support base. The FPI-6 was used to evaluate each foot in a static position, in which each foot was classified as either supinated, normal, or pronated after a summation of six anatomical criteria. Each criterion was graded between -2 and +2, with negative values indicating supination, positive values indicating pronation, and zero indicating neutral posture. RESULTS: Adolescents, regardless of their sex had their feet classified as normal (right side: 78%, left side: 73%). The male sex (0.29, p = 0.04) and the left foot (0.73, p < 0.001) were related to the FPI-6--that is, in both conditions, the total score attributed to these variables was higher (male right foot: 3.09 ± 2.84, male left foot: 3.76 ± 2.80; female right foot: 2.28 ± 2.61, female left foot: 3.45 ± 2.66; laterality for left foot: 3.55 ± 2.71, laterality for right foot: 2.82 ± 2.7). On the other hand, the correlation coefficient for the BMI was negative (-0.08, p = < 0.001), which means that the higher the BMI, the lower the score attributed to the FPI-6. CONCLUSION: The FPI-6 in adolescents aged 10 to 14 years is related to the male sex and the left foot--that is, in both conditions, the predicted score is higher, so the feet tend to present with a tendency to pronation. In relation to BMI, however, a negative relation is observed--that is, the score attributed to the FPI-6 in the adolescents who are classified as overweight and obese is lower. However, regardless of the sex and BMI of the adolescent and the foot in which the evaluation is performed, the foot posture is expected to be classified as normal

Objetivo: A hipertensão arterial constitui o principal fator de risco modificável para as doenças cardiovasculares e a maioria dos hipertensos necessitará de medicamento para controlar a pressão. Este estudo analisa a prevalência da hipertensão arterial referida e a utilização de anti-hipertensivos por adultos do município de São Paulo de acordo com variáveis socioeconômicas e demográficas. Métodos: Análise de dados do Inquérito de Saúde no Município de São Paulo – ISA Capital, estudo transversal, de base populacional conduzido em 2003 que possui 1668 adultos com 20 anos ou mais. Para investigar a distribuição das principais classes de anti-hipertensivos, utilização de genérico, forma de obtenção e custeio utilizou-se de um recordatório de três dias. Resultados: A prevalência de hipertensão referida foi de 16,9%, sendo maior nos indivíduos com idade mais avançada, menor escolaridade e sem ocupação. Entre os que referiam hipertensão, a prevalência do consumo de anti-hipertensivo nos três dias que antecederam a entrevista foi de 73,1%. Dos indivíduos que consumiram anti-hipertensivos 38,3% obtiveram o medicamento através do SUS e 35,3% utilizaram genéricos. As principais classes consumidas em monoterapia foram: inibidores da enzima conversora de angiotensina – IECA (41,9%) e diuréticos (24,6%). As principais associações foram: IECA + diurético (36,0%) e diurético + betabloqueador (22,3%). Conclusões: A hipertensão arterial referida se distribui de maneira desigual entre diferentes subgrupos da população. No acesso a medicamento anti-hipertensivo o SUS consegue promover equidade no fornecimento dessas drogas para a população mais desfavorecida. As classes consumidas não estão totalmente de acordo com as diretrizes de hipertensão. / Objective: Hypertension is the major modifiable risk factor for cardiovascular diseases and most of hypertensive patients will require medication for the control of blood pressure. This study analyses the prevalence of self-reported hypertension and the utilization of antihypertensive agents by adults in São Paulo City, Brazil, according to socioeconomic and demographic variables. Methods: Analysis of data from the Health Survey of São Paulo City – ISA Capital, a cross-sectional, population-based survey conducted in 2003 with 1668 adults aged 20 years or over. To investigate the distribution of the main antihypertensive drug classes, utilization of generic drugs and information about how the drugs were obtained, individuals who self-reported hypertension were asked about any drug use for high blood pressure in the previous three days. Results: The prevalence of self-reported hypertension was 16.9%. Advanced age, lower education and not having a job were independently associated with hypertension. The consumption of antihypertensive drugs was 73.1%. Among those who took antihypertensive drugs 38.3% and 35.3%, respectively, obtained the medication from the Brazilian Public Health System (SUS) and used generics. Angiotensin-converting enzyme inhibitors (ACEi) (41.9%) and diuretics (24.6%) were the most used drugs utilized as monotherapy and the most used combinations were ACEi + diuretics (36.0%) and diuretics + beta-blockers (22.3%). Conclusions: The distribution of self-reported hypertension is not equal among different subgroups of the population. The equity in the delivery of antihypertensive drugs is an important component of treatment and control of hypertension and the SUS could perform it to the less advantaged people. The classes consumed do not agree fully with the hypertension guidelines.

Introduction: Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives: To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods: A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results: We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions: We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19. / Introducción: La infección por coronavirus 2019 (SARS-CoV-2) en niños se presentó en Perú desde marzo del 2020. Desde entonces fue necesario internar pacientes pediátricos en el Hospital Nacional Edgardo Rebagliati Martins, en el área de hospitalización adaptada para dicho propósito. Al inicio, la demanda de hospitalización era baja y se fue incrementando progresivamente. Coincidiendo con los reportes internacionales, la mayoría presentó cuadros leves o moderados, pero también hubo casos graves e incluso mortales. Objetivos: Describir las características y el desenlace clínico de los pacientes pediátricos con COVID-19 hospitalizados en un hospital de referencia en Lima, Perú, entre marzo y agosto de 2020. Métodos: Se realizó un estudio transversal descriptivo e inferencial. La población incluyó a todos los pacientes que se hospitalizaron en el Departamento de Pediatría Clínica, con diagnósticos clínicos y quirúrgicos asociados a COVID-19. Resultados: Incluimos 100 pacientes, con edad promedio de 83,4 ± 54 meses, con predominio de varones (55%). Los pacientes hospitalizados fueron agrupados en cinco categorías: insuficiencia respiratoria (17%), síndrome inflamatorio multisistémico (31%), presentación neurológica (19%), abdomen agudo (20%) y pacientes con problemas oncológicos (13%). La mayoría de los pacientes (74%) tenían comorbilidades. Respecto a los síntomas de presentación, el dolor intestinal predominó en el grupo de apendicitis (90%, p < 0,001), la fiebre estuvo presente en la mayoría de los pacientes con falla respiratoria (64,7%), el síndrome inflamatorio multisistémico se registró en 90,3%, la sintomatología neurológica en 15,8%, el abdomen agudo 50% y oncológicos en 61,5% de los pacientes. Los síntomas de Kawasaki estuvieron presentes en 38,7% de los pacientes con síndrome inflamatorio multisistémico. La mortalidad fue de 4%. En 29,4% de problemas respiratorios y en 22,6% de síndrome inflamatorio multisistémico, se requirió de admisión en cuidados intensivos, lo que fue más frecuente que las otras presentaciones (p = 0,008). Conclusiones: Se concluye que la población pediátrica vulnerable es aquella con comorbilidades preexistentes. La división de pacientes en nuestro estudio fue definida por la presentación, diagnóstico y complicaciones predominantemente con problemas respiratorios, y en pacientes oncológicos con COVID-19. / Revisión por pares

En hälsosam kosthållning minskar risken för kardiovaskulär sjukdom och bidrar till en minskad risk för akut koronart syndrom. De nordiska näringsrekommendationerna innehåller riktlinjer för att förebygga kardiovaskulär sjukdom, och dessa har vidare kvantifierats av Livsmedelsverket. Trots de stora hälsofördelar som en sådan kosthållning medför når få svenskar de uppsatta målen och kunskapen om hur kostvanorna ser ut hos gruppen av personer som genomgått akut koronar händelse är begränsad. Syftet var att undersöka hur kosthållningen hos patienter som vårdades för akut koronart syndrom stämmer överens med de nordiska näringsrekommendationerna. För att svara på syftet användes en kvantitativ metod i form av en enkätstudie. Fyrtiotvå personer som genomgått akut koronart syndrom rekryterades genom konsekutivt urval på tre hjärtmottagningar i södra Sverige. Svarsfrekvensen var 76 procent, vilket antyder att studien har god generaliserbarhet. Samband undersöktes genom Students t-test test och Fishers exakta test. Resultatet visade att enbart två procent av patienterna nådde kostrekommendationerna gällande frukt och grönsaker, och lika stor andel nådde det rekommenderade intaget av fullkornsprodukter. För konsumtion av rött kött och charkuteriprodukter åt 88 procent i enlighet med näringsrekommendationerna. Tjugosex procent åt den rekommenderade mängden nötter och frön medan 64 procent av studiedeltagarna nådde det uppsatta målet för intag av fisk. Enbart en liten andel av studiedeltagarna hade helt uteslutit feta mejeriprodukter och smörbaserade matfetter från sin kost i enlighet med rekommendationerna. Slutsatsen kunde dras att patienter som genomgått akut koronar händelse har en kosthållning som i liten grad överensstämmer med de Nordiska Näringsrekommendationerna. Med ökad kunskap om kostintagets betydelse finns det förbättringspotential för denna grupp patienters kostförändringar och hur personcentrerade kostinterventioner kan bidra till ökad kardiovaskulär hälsa. / Adhering to a healthy diet reduces the risk of cardiovascular disease and contributes to a lower risk of acute coronary syndrome. The Nordic Nutrition Recommendations includes a set of nutritional guidelines aimed at preventing cardiovascular disease and these have been further quantified by the Swedish National Food Agency. Despite the big health improvements that such a diet entails, few Swedes meet the recommended daily intakes. Little is known about how the dietary patterns of the specific subgroup of people who have experienced an acute coronary event compares to the Nordic Nutrition Recommendations. The aim was to investigate to what extent patients whom have been treated for acute coronary syndrome adhere to the latest nutritional guidelines given by the Nordic Nutrition Recommendations 2012. To answer the aim of the study a quantitative method was used through a survey study. Forty-two people were enrolled by consecutive sampling from three different heart polyclinics in southern Sweden. The study had a response rate of 76 percent, which suggests that the study had a high generalisability. Correlations between independent variables were controlled with Student’s t-test and Fisher’s exact test. The results showed that only two percent of the patients reached the guidelines dietary reference level when it comes to fruits and vegetables. The same result was shown when it comes to wholegrain dietary intake among this population, only two percent reached the recommended level. Looking at the dietary intake of red meat the result showed that 88 percent eat according to The Nordic Nutrition Recommendations. Looking at the intake of nuts and seeds, 26 percent of the patients ate as suggested in the guidelines. Sixty-four percent of this studies participants reached the recommended intake of fish per week. Only a low rate of the patients had completely excluded fat dairy products and butter-based products. The conclusion was made that patients who went through an acute coronary event have a dietary consumption that to a low extent correspond to The Nordic Nutrition Recommendations. There are room for improvement in this area. With the help of further studies in this subject would illuminate greater understanding about the dietary patterns among this patient group and how patient participatory dietary interventions could contribute to cardiovascular health.

PURPOSE: This study examined medication use by individuals with tinnitus who were seeking help for their tinnitus by means of a psychological intervention. METHOD: This study used a cross-sectional survey design and included individuals with tinnitus enrolled in an Internet-based cognitive behavioral therapy trial ( = 439). Study participants provided demographic details, completed various structured questionnaires and provided details about the medications used. The self-reported medications were classified using the United States Pharmacopeial Medicare Model Guidelines v7.0. RESULTS: Current medication use was reported by 67% ( = 293) of the study participants. Those currently using medication were older; had consulted their primary care physician, had greater tinnitus severity, depression, anxiety, and insomnia when compared with those not reporting any current medication use. The top 10 medication used included cardiovascular agents ( = 162; 55.3%), antidepressants ( = 80; 27.3%), electrolytes/minerals/metals/vitamins ( = 70; 23.9%), respiratory tract/pulmonary agents ( = 62; 21.2%), anxiolytics ( = 59; 20.1%), hormonal agents/stimulant/replacement/modifying (thyroid; = 45; 15.4%), gastrointestinal agents ( = 43; 14.7%), analgesics ( = 33; 11.3%), blood glucose regulators ( = 32; 10.9%), and anticonvulsants ( = 26; 8.87%). Some associations between type of medication used and demographic or tinnitus-related variables were noted especially for the cardiovascular agents, electrolytes/minerals/metals/vitamins, and anxiolytics. CONCLUSIONS: This exploratory study indicated a large percentage of patients using medication and a range of medications. Further studies are required to assess the effects of such medications on the tinnitus percept and concurrent medication moderate treatment effects.

Diabetes is a critical public health concern with considerable financial and personal costs in the United States. Research has identified several interventions available to primary care providers to prevent diabetes. These interventions may prevent diabetes by influencing personal, community, and public health policy factors. These factors are key components of the social ecological model, which examines the influence of diverse social influences on health. Therefore, the purpose of this study was to determine the univariate relationship between PCP density and diabetes prevalence, as well as the multivariate relationship between PCP density and diabetes prevalence with physical inactivity prevalence, obesity prevalence, and social vulnerability scores held constant. This study also accounted for state-level differences in diabetes prevalence through fixed-level state effects. The initial univariate analysis yielded no significant relationship. The final multivariate regression yielded a statistically significant relationship in a model that better fit the data—as seen by p values <0.001 and information criteria decreases from 12,538.67 to 11,099.72 (AIC) and 12,538.67 to 11,099.72 (BIC). In this final multivariate regression, a 1% increase in primary care provider density was associated with a 0.0019% decrease in diabetes prevalence. Meanwhile, a 1%- or 1-point increase in physical inactivity prevalence, obesity prevalence, and social vulnerability scores led to 0.20%, 0.06%, and 0.14% increases in diabetes prevalence respectively. These findings highlight the value of social ecological factors in diabetes research, as well as the increased need for evidence-based diabetes prevention in primary care, including strategies that target personal, community, and public health policy factors related to diabetes.