Mestrado em Enfermagem e Saúde (FEN)
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Item Estudo de coorte sobre o uso de medicamentos potencialmente inapropriados em idosos(Universidade Federal de Goiás, 2020-02-21) Araújo, Natacha Christina de; Pagotto, Valéria; http://lattes.cnpq.br/9865313041988933; Pagotto, Valéria; Silva, Ana Elisa Bauer de Camargo; Modesto, Ana Carolina FigueiredoINTRODUCTION: Population ageing is accompanied by an increase in chronic diseases and use of medicines. Although pharmacological therapy plays an important role in disease control, some drugs are classified as Potentially Inappropriate Medicines (PIM), creating new challenges for the elderly, their families andhealth services.OBJECTIVE: To analyze the evolution, incidence and mortality of elderly people using Potentially Inappropriate Medicines (PIM) in a decade-long cohort study. METHOD: Prospective cohort epidemiological study, with a ten-year follow-up period, carried out in Goiânia, with an initial sample (baseline) of 418 elderly people in 2008. A home interview was conducted, using a standardized questionnaire including socioeconomic, demographic, living conditions and healthvariables. Information was collected on the active ingredient, dosage, route and schedule of the drugs. PIM were classified according to theAmerican Geriatrics Society Beers Criteria. The analyses were performed withSTATA 15.0. To analyze the factors associated with the incidence of PIM usage, a generalized linear model was constructed, and presented as Adjusted Relative Risk (aRR). In order to analyze the evolution of PIM usage, a longitudinal analysis was performed using Generalized Estimating Equations models. Finally, the mortality rate was calculated, as well as the effect of refusals and 6%loss from follow-up, totaling 221 included in the year 2018. The mean age was 79.1 years (± 5.8); 67.4% were women; 21.2% rated their health as poor or very poor, 24.4% were hospitalized in the last year and 69.2% presented more than three diseases. In 2008, the mean number of drugs used was 3.3 (± 2.6); while in 2018 the mean was 8.0 (± 5.1). In 2008, the PIM most frequently consumed were in this order: nifedipine, glibenclamide and sodium diclofenac. In 2018, the mostfrequently consumed were: sodium diclofenac, amiodarone and scopolamine. The incidence of PIM use in the sample of the elderly cohort was 44.1 cases (95% CI: 35.2-54.7) per 1,000 person-years (56 incident cases/1,270 person-years). Multiple regression revealed that the incidence of PIM use was statistically associated with polypharmacy (aRR: 3.00; 95% CI: 1.31-6.88) and diabetes mellitus (aRR: 1.57; 95% CI: 1.03-2.39). In the longitudinal analysis, elderly people with a history of hospitalization (RTaj: 1.20; 95% CI: 1.01-1.40), with three or more morbidities (RTaj: 1.41; 95% CI: 1.14- 1.74), using polypharmacy aRR(RTaj: 1.81; 95% CI: 1.47-2.24) and diagnosed with diabetes mellitus (PIM on the survival of the elderly, using Cox proportional regression analysis, presented as Adjusted Hazard Ratio (aHR). The study was approved by HC/UFG ethics committee.RESULTS: From a total of 418 elderly followed up, 34.9% died, there were¨6% RTaj: 1.24; 95% CI: 1.05-1, 47) had a higher rate of PIM usage over the ten years. The overall mortality rate in the group that used PIM at the baseline was 46.3 deaths (70/1,513 person-years) and in the unexposed group it was 37.7 deaths (75/1,992 person-years). In the Cox regression analysis adjusted according to age, sex, economic class, polypharmacy and use of PIM, no statistical association was observed between survival of the elderly in the cohort and use of PIM in the adjusted analysis (aHR: 1.02; 95% CI: 0.69-1.51). CONCLUSION: This research indicated that the incidence of PIM usage in the elderly is high, and polypharmacy and Diabetes Mellitus are factors that increase both the incidence and the rate of use. Although PIM usage has not decreased, the survival of the elderly and the association of polypharmacy with mortality show that the use of medications in the elderly should be continuously monitored. The results are a warning to prescribers and health professionals regarding the rational use of medicines in the elderly population, in order to prevent adverse reactions and other health problems. Furthermore, they signal the need to review the type of drugs used and to monitor their use at all levels of health care and especially primary care.Item Letramento em saúde de cuidadores vinculados ao Serviço de Atenção Domiciliar de Goiânia/GO(Universidade Federal de Goiás, 2020-05-29) Soares, Thales Antônio Martins; Brasil, Virginia Visconde; http://lattes.cnpq.br/1940761888797180; Brasil, Virginia Visconde; Vila, Vanessa da Silva Carvalho; Borges Júnior, Laerte HonoratoINTRODUCTION: Health literacy (LS) refers to the skills and capacity of individuals and populations to access, understand and use health information to promote, maintain and make health decisions. Home caregivers with HL limitations are prone to fail in home care due to problems related to poor communication, incomplete health information, inadequate education, limited access to health services and lack of continuity of care. It is believed that the caregiver's HL can influence the way he cares for the person under his responsibility. There are no studies that investigate the LS of home caregivers linked to home care programs, using a multidimensional instrument. OBJECTIVE: to determine the HL conditions of caregivers of people linked to the Home Care Service of Goiânia / Goiás, Brazil. METHODOLOGY: cross-sectional study carried out between March and June 2019 in Goiânia / Goiás, with 90 caregivers linked to the municipality's Home Care Service, interviewed with a sociodemographic questionnaire and the Brazilian version of the Health Literacy Questionnaire (HLQ-Br). Measures of central tendency and dispersion, HLQ reliability and the Mann Whitney, Kruskal-Wallis tests were used to compare the variables. RESULTS: most caregivers were female (90.0%), had a steady partner (58.89%), lived in the home of those they cared for (75.6%), had a reading habit (57.8% ), was an informal caregiver (91.1%), had parents without schooling (44.2%), studied nine years or more (53.3%) in a public school (84.4%) and had a personal income of up to one minimum wage (72.2%). The type of caregiver, reading habit, living with the patient, having a family income greater than a minimum wage and education of the caregiver and their parents, influenced the HLQ-Br scores. The lowest score in part 1 of the HLQ-Br was found on the “Active health caregiver” scale and the highest on the “Social support for health” scale. In part 2, the lowest score is found on the “Navigating the health system” scale and the highest on the “Understanding health information and knowing what to do” scale. CONCLUSIONS: Income, education and reading habits influenced most HLQ scales. The results can guide the actions of health professionals, who must use the HL construct in their practice. This health indicator helps to improve guidelines for home caregivers, and consequently improve the quality of care. New studies should be carried out to broaden the understanding of HL in this context, to identify how to reduce situational demands, including how services can contribute. LS is broader than the ability to read and understand. It implies the ability to act.