TEDE Coleção: Programa Pós Graduação em Ciências da Saúde

Prevalência do uso e prescrição de analgésicos opioides para idosos com dor crônica não oncológica: uma revisão sistemática com meta-análise

Wed, 26 Mar 2025 00:00:00 GMT

Título: Prevalência do uso e prescrição de analgésicos opioides para idosos com dor crônica não oncológica: uma revisão sistemática com meta-análise Autor: SALINI, Maria Carolina Rodrigues Primeiro orientador: Oliveira, Crystian Bitencourt Soares de Abstract: Background: Chronic non-cancer pain is a common problem among older people. Opioids are among the treatment options for chronic non-cancer pain, this medication only provides limited benefits. This medication is also associated with a high risk of serious harms (e.g., overdoses) specially in older people. This review estimated the proportion of opioid use and prescription among older adults with chronic non-cancer pain. Methods: Searches were performed by identifying eligible studies included in two published systematic reviews, performing backward citations and updating the searches from October 2018 until June 2024. Observational studies investigating the proportion of opioid use and prescriptions in a representative sample of older adults (60 years or older) with chronic non-cancer pain were included. Risk of bias was assessed using a tool developed for epidemiological studies. Meta-analysis was performed using random effect models to obtain the pooled prevalence and their 95% confidence intervals. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Nine studies (476,140 older people) were included in this review. Six (66.6%) were classified as having a low risk of bias. The rate of opioid prescription among older people with chronic non-cancer pain was 35.6% (95% CI: 27.8% to 44.2%), while the proportion of opioid use was 26.4% (95% CI: 16.6% to 39.3%). The overall quality of evidence was moderate according to GRADE (downgraded for inconsistency). Conclusion: Approximately one-third of older people with chronic non-cancer pain are prescribed opioids and one-quarter reported their use. Given the limited benefits and increased risk of harm associated with opioid use, strategies to reduce the overuse of opioids among older people with chronic noncancer pain are needed. Instituição: Universidade do Oeste Paulista Tipo do documento: Dissertação

Efeitos da poluição no sistema respiratório e na qualidade de vida de idosos moradores de uma área portuária no município de Guarujá/SP

Tue, 11 Mar 2025 00:00:00 GMT

Título: Efeitos da poluição no sistema respiratório e na qualidade de vida de idosos moradores de uma área portuária no município de Guarujá/SP Autor: FORTE, Giulianna Primeiro orientador: Rossi, Renata Calciolari Abstract: Air pollution is a threat to public health, the second leading cause of chronic non-communicable diseases and responsible for high mortality rates. This study aims to evaluate the effects of air pollution on the respiratory system and quality of life of elderly residents of a port area in the city of Guarujá/SP. This is a cross-sectional study that evaluated elderly individuals aged 60 years or older, of both genres, living in a port area (exposed group) and a neighborhood far from the port (control group), both in the city of Guarujá/SP. Data from 87 individuals were analyzed from December 2023 to August 2024 through socioeconomic assessment, respiratory symptoms and quality of life questionnaires - Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Vital signs, exhaled carbon monoxide (COex), lung function (spirometry) and blood pressure were measured. Data analysis found significantly lower spirometric values (p<0.05) in Forced Vital Capacity (FVC) both in absolute values (mean of 3.02 in controls and 2.56 in exposed subjects) and in percentage of predicted (mean of 102.19 in controls and 95.36 in exposed subjects) and in absolute values of Forced Expiratory Volume in one second (FEV1) (mean of 2.30 in controls and 1.96 in exposed subjects) and greater limitation due to emotional aspects (mean of 80.3 in controls and 60.5 in exposed subjects) through responses to Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). We conclude that air pollution appears to be associated with impaired lung function in the elderly, determined by spirometric criteria, and with implications for quality of life through limitations due to emotional aspects. Instituição: Universidade do Oeste Paulista Tipo do documento: Dissertação

Confiabilidade entre avaliadores na estratificação de risco cardíaco com um protocolo baseado em parâmetros clínicos e físicos.

Thu, 13 Mar 2025 00:00:00 GMT

Título: Confiabilidade entre avaliadores na estratificação de risco cardíaco com um protocolo baseado em parâmetros clínicos e físicos. Autor: PINHEIRO, Dyovana Gomes Primeiro orientador: Pacagnelli, Francis Lopes Abstract: Introduction: Existing cardiac risk stratification (CRS) protocols are not effective in predicting the occurrence of minor and more complex adverse events (AEs) in cardiac rehabilitation (CRP) programs. A new protocol based on clinical/physical variables was developed to predict the occurrence of lower AEs in these programs, and an important step to verify the existence of errors inherent to the tool and the reliability of the classification obtained by the instrument is the evaluation of the agreement between evaluators. Objective: To evaluate the inter-rater agreement of a CRT protocol based on clinical/physical variables. Methods: 62 participants who attended PRC were evaluated by two physiotherapists randomly and individually. A third physiotherapist selected the evaluation with the best result for each participant, generating a spreadsheet with unique data. Subsequently, the two physiotherapists performed the ERC twice, using the Exercise-induced sings and symtons (Exiss Score) protocol: Using the single selected data and the data from their own evaluation. The inter-rater agreement for the ERC classification with percentage of agreement and Kappa index was analyzed. For reproducibility of the Exiss Score, the intraclass correlation coefficient (ICC) was used. Results: Inter-rater agreement was 100% (single data selected) with perfect Kappa index (K: 1.00; p<0.001). However, when each evaluator used their own evaluation, the agreement was 82.3%, with Kappa of 0.37 (p=0.004). The Exiss score showed moderate reliability (ICC: 0.688 [95%CI 0.523 – 0.801] – P<0.001*) and no significant differences between the raters (41.63 ± 25.32 vs 35.57 ± 26.40; p = 0.09). Conclusion: There is 100% agreement in the ERC with the Exiss Score using the same evaluations, classified as perfect agreement in the Kappa index. In the ERC carried out through different evaluations, the agreement was 82.3%, with the Kappa index suggesting minimal agreement. There was no significant difference in the Exiss score between evaluators. Instituição: Universidade do Oeste Paulista Tipo do documento: Dissertação

Intervenções locais no câncer de mama oligometastático: revisão sistemática e metanálise

Tue, 10 Dec 2024 00:00:00 GMT

Título: Intervenções locais no câncer de mama oligometastático: revisão sistemática e metanálise Autor: MOLINA, Camila Bettoni Primeiro orientador: Toledo, Ana Clara Campagnolo Gonçalves Abstract: Introduction: Breast cancer is the most common neoplasm among women worldwide. It is estimated that, in the 2023-2025 period, around 22,000 women will develop metastases, of which approximately 20% will have oligometastases. Some evidence suggests that local treatment with radiotherapy or surgery may prolong survival. However, the benefits of this approach are still not fully clear. Objective: To evaluate the effectiveness of local therapies, such as radiotherapy and surgery in combination with systemic therapy in the treatment of patients with oligometastatic breast cancer. Method: A systematic review was carried out with registration in the PROSPERO database (CRD42024525782), Medline via Ovid, EMBASE, Web of Science, Cochrane Library Databases, Scopus and Clinical Trials, until November 2024. RCTs were selected, involving women with oligometastatic breast cancer in systemic treatment associated with intervention, radiotherapy or surgery, compared to standard systemic treatment. The processes of study selection, data extraction, risk of bias analysis and level of evidence were carried out by independent and blind authors. For this, platforms such as Rayyan and a standardized Excel form were used. The methodological quality was analyzed by ROB-2 and the evidence was assessed with GRADE. For quantitative data analysis, the Review Manager – RevMan program (version 5.3) was used. Results: Among 717 studies, 2 randomized controlled trials were included in this review. When comparing the association of radiotherapy or surgery with systemic therapy, overall survival presents RR: 1.78 (CI: 0.26 - 12.17), 162 participants, high risk of bias, very low quality of evidence. For progression-free survival in this same comparison RR: 1.05 (CI: 0.76 – 1.46) 162 participants, high risk of bias, very low quality of evidence. Finally, in this same comparison for the secondary outcome, adverse effects, it was analyzed by subgroups, Grade 3 RR: 1.06 (CI: 0.52 – 2.13) 162 participants, high risk of bias, very low quality of evidence and the subgroup Grade 4 RR:0.42 (CI: 0.10 – 1.80) 162 participants, high risk of bias, very low quality of evidence. Conclusion: There are no benefits from the association of systemic therapy with radiotherapy or surgery in oligomestases compared to systemic therapy for the outcomes of overall survival, disease progression-free survival and adverse events. Instituição: Universidade do Oeste Paulista Tipo do documento: Dissertação