Abstract Background: Inflammatory bowel diseases’ (IBD) increasing incidence and prevalence place a heavy health and economic burden on society. Objectives: This study assesses the burden and cost of IBD in Portugal to support the definition of health policies, resource allocation, and patient care. Methods: The burden of disease was expressed using disability-adjusted life years (DALY). Costs were estimated considering the societal perspective, using a prevalence-based model and prices established by law. An expert panel composed of 5 expert Portuguese gastroenterologists and a patient-reported study were conducted to support the cost analysis and fill in information gaps. Results: In Portugal, with a prevalence of 24,069 IBD patients and an incidence of 15/100,000, the burden of disease was estimated at 6,067 DALYs: 507 resulting from premature deaths and 5,560 from disability. Total cost was estimated at EUR 146 million per year, with direct costs representing 59%. Average yearly cost per IBD patient is EUR 6,075, where 60% is related to Crohn’s disease and 40% to ulcerative colitis (UC). Conclusion: This study estimates the annual health burden and cost of IBD in Portugal, thus generating information with the intent to raise awareness of the need to advance health policies as well as better clinical and economic decisions in this pathology.

Resumo Contexto: A crescente incidência e prevalência das Doenças Inflamatórias Intestinais (DII) representam um pesado fardo para a saúde e economia na sociedade. Objetivos: Este estudo avalia o custo e a carga da DII em Portugal, com o objetivo de suportar a definição de políticas de saúde, alocação de recursos e cuidados com o doente. Métodos: A carga da doença foi calculada utilizando anos de vida ajustados à incapacidade (DALY). Os custos foram estimados tendo em conta a perspetiva da sociedade, utilizando um modelo baseado na prevalência e preços estabelecidos por lei. Foi realizado um painel de peritos, composto por 5 gastroenterologistas portugueses, assim como um estudo de mercado a doentes, de forma a suportar a análise de custos e colmatar lacunas de informação. Resultados: Em Portugal, com uma prevalência de 24,069 doentes e uma incidência de 15/100,000, o peso das DII foi estimado em 6.067 DALYs: 507 dos quais resultantes de mortes prematuras e 5.560 de incapacidade. O custo total foi estimado em 146 milhões de euros por ano, com os custos diretos a representarem 59% do total. O custo médio anual por doente de DII é de 6.075 EUR, onde 60% está relacionado com Doença de Crohn (DC) e 40% com Colite Ulcerosa. Conclusão: Este estudo estima os encargos anuais para a saúde e o custo da DII em Portugal, gerando informação relevante, com o intuito de alertar para a necessidade de uma evolução nas políticas de saúde, assim como como suportar melhores decisões clínicas e económicas nesta patologia.

RESUMO: O estudo quantificou os parâmetros cinéticos de captação de K nas gramíneas Paspalum notatum, Paspalum urvillei e Axonopus affinis associados com o crescimento. Dez mililitros (10 ml) de solução nutritiva foram coletados em vasos de dois litros - com cinco repetições em 24 horas - para determinação das concentrações de K nas amostras. A matéria seca da parte aérea e raízes; comprimento, volume, diâmetro e área superficial radicular, bem como parâmetros cinéticos associados à absorção de nutrientes (Vmax, Km, Cmin e I) foram avaliados. A espécie P. notatum apresentou a maior produção de raiz, parte aérea e MS total, bem como o maior volume de raiz. P. urvillei apresentou o maior teor de K, que pode ser associado a raízes mais finas e resultando em maior área superficial. A. affinis registrou o maior valor de Vmax, o que levou a uma maior eficiência de absorção de K.

ABSTRACT: This study quantified K uptake kinetic parameters in grass species Paspalum notatum, Paspalum urvillei and Axonopus affinis to associate them with growth. Ten milliliters (10 ml) of nutrient solution were collected in two-liter pots - with five repetitions in 24 hours - in order to determine K concentrations in the samples. Shoot and root dry matter, root length, volume, diameter and surface area, as well as kinetic parameters associated with nutrient uptake (Vmax, Km, Cmin and I) were determined. Species P. notatum was the one presenting the highest root, shoot and total dry matter production, as well as the highest root volume. P. urvillei recorded the highest K content, which may be associated with thinner roots and greater root surface area. A. affinis recorded the highest Vmax value, which led to greater K uptake efficiency.

ABSTRACT If scarce resources are not used efficiently, welfare could be increased without any cost. Efficiency metrics have a long tradition in economics. However, measures of spatial efficiency (SE) are far less common in the literature. In health care, SE is crucial to guarantee population’s access to health care providers. We develop a metric of SE of Primary Health Care Centres (PHCCs) location based on the comparison of the minimum distances users must travel to reach a PHCC, considering their current location, against the distances they should travel if all PHCCs were optimally located. We apply this metric to assess the spatial efficiency of the PHCCs of Bahía Blanca City (Argentina). To determine the optimal location of the centres we used a capacitated P-Median model. The annual demand for medical consultations of each demand node was estimated by adjusting the number of inhabitants of that node by a socioeconomic index.

Considering the bicentenary of Brazil’s Independence in 2022 and that this year was proclaimed by UNESCO as the International Year of Basic Sciences for Sustainable Development, in mid-2021 the Brazilian Chemical Society (SBQ) launched the “Post 2022 Chemistry Movement - Sustainability and Sovereignty”, with the main goal of promoting different activities so that chemistry contributes for the sustainable development and sovereignty of Brazil in the coming years. One of these activities is the proposal of an action plan, with goals to be achieved by 2030 and 2050. This article describes in detail how this action plan was formulated by a working group, with the help of an advisory council and interviews of 18 professionals from universities, the government, industries, the third sector and other organizations. Mimicking the Agenda 2030 SDGs, the resulting action plan is based on two broad Chemistry Sustainable Development Goals: promoting sustainability through chemistry in basic education, and promoting sustainability in the industry and university through science, technology, innovation, and education (STI&E) in chemistry. After the definition of three driving technological challenges in STI&E, they shall be successively implemented through different actions starting in 2023 yet.

Resumo O objetivo deste trabalho foi avaliar a resposta das cultivares de feijão (Phaseolus vulgaris) Triunfo, Garapiá e BRS-FC104 ao déficit hídrico representado pela fração de água transpirável no solo (FATS). O delineamento experimental foi inteiramente casualizado, em arranjo bifatorial 3×2 (cultivares × irrigação e sem irrigação). Avaliaram-se a transpiração, o crescimento e a produtividade na safra e na safrinha. Na safra, com baixa demanda atmosférica do ar (inferior a 15 hPa em 55% dos dias), 'Garapiá' apresentou fechamento precoce dos estômatos com FATS crítica (FATSc) de 0,36, mas teve a mesma produtividade que 'Triunfo', cujos estômatos fecharam tardiamente (FATSc = 0,23). Na safrinha, com alta demanda atmosférica do ar (superior a 15 hPa em 83,3% dos dias), 'Garapiá' apresentou fechamento estomático precoce (FATSc = 0,17) e maior produtividade (392,2 kg ha−1 a mais que 'Triunfo'). Na safra e na safrinha, 'Garapiá' apresentou tolerância ao déficit hídrico no período reprodutivo. O déficit hídrico resultou em menores valores de estatura, massa seca da parte aérea, massa seca da raiz e área foliar. Tanto 'Garapiá' como 'Triunfo' apresentaram alta produtividade na safra, mas apenas Garapiá na safrinha. 'Garapiá' apresenta tolerância ao déficit hídrico, com controle estomático eficiente e com altos crescimento e produtividade.

Abstract The objective of this work was to evaluate the response of the Garapiá, Triunfo, and BRS-FC104 bean (Phaseolus vulgaris) cultivars to the water deficit represented by the fraction of transpirable soil water (FTSW). The experimental design was completely randomized in a 3×2 bifactorial arrangement (cultivars × irrigation and no irrigation). Transpiration, growth, and yield were evaluated in the crop season and off-season. In the crop season, with a low atmospheric air demand (below 15 hPa in 55% of the days), 'Garapiá' presented early stomatal closure with the critical FTSW (FTSWc) of 0.36, but had the same yield as 'Triunfo', whose stomata closed late (FTSWc = 0.23). In the off-season, with a high atmospheric air demand (greater than 15 hPa in 83.3% of the days), 'Garapiá' presented an early stomatal closure (FTSWc = 0.17) and a higher yield (392.2 kg ha-1 more than 'Triunfo'). In the crop season and off-season, 'Garapiá' showed tolerance to water deficit in the reproductive period. Water deficit resulted in lower values of height, shoot dry mass, root dry mass, and leaf area. Both 'Garapiá' and 'Triunfo' showed a high yield in the crop season, but only 'Garapiá' in the off-season. 'Garapiá' presents tolerance to water deficit, with efficient stomatal control and high growth and yield.

Resumo Apesar do quantitativo de moradias produzidas por inúmeros programas estatais, a prática da construção popular sem formalização ou participação de técnicos da área continua prevalecendo em todo o país como alternativa habitacional dos despossuídos. Resultado de pesquisa sobre moradia popular no Maranhão, este texto parte dos modos de vida das camadas populares rurais e urbanas do estado para demonstrar que, além de fornecerem abrigo e qualificarem espaços de vida, tais construções representam exercícios de autonomia e resistência social que enfrentam pressões sistêmicas variadas. Diferentemente dos procedimentos impositivos da política habitacional estatal, as decisões familiares para autoprodução da moradia estão intrinsecamente relacionadas com especificidades socioespaciais que caracterizam a arquitetura vernacular e, ao levarem em conta regime de posse da terra, estrutura familiar, práticas produtivas e acesso à renda, os construtores demonstram capacidade de concepção e gerenciamento na produção de seus espaços, aspectos a considerar nas análises acadêmicas e em parcerias profissionais, evitando criminalização e subordinação das práticas populares.

Abstract Despite the number of housing units built by government programs in recent years, informal construction of public housing—which lacks formal technical aid—still prevails throughout the country as an affordable alternative for the poor. Based on field research of popular housing in rural and urban Maranhão, this text demonstrates that the living arrangements, in addition to providing shelter and quality living spaces, demonstrate autonomy and social resistance in the face of multiple systemic pressures. Unlike the imposed state housing policy procedures, family decisions for the self-production of housing are intrinsically related to socio-spatial particularities that characterize vernacular architecture. By taking into account the land tenure regime, family structure, productive practices, and access to income, builders demonstrate the capacity to design and manage the production of their spaces. These are important features to consider in academic analyses and professional partnerships to avoid devaluation and even criminalization of popular practices.

Currently, approximately 1.4 billion tons per year of iron ore tailing wastes (IOT) are generated, mainly in Australia, Brazil, and China. This work describes the characterization and application of two typical IOT, i.e., fine and coarse wastes. The physicochemical characterization of these IOT by different techniques such as XRF (X-ray fluorescence), XRD (X-ray diffraction), Mössbauer spectroscopy, and granulometry, indicates for the fine tailing a composition of Fe2O3/FeOOH (10-55%), SiO2 (18-65%) and Al2O3 (up to 15%) with particles of 6-40 µm, whereas the coarse tailing presents 40-150 µm particles with the composition of 8-48% Fe2O3/FeOOH, 30-90% SiO2 and Al2O3 (up to 20%). The main IOT applications discussed in this review are related to civil construction (aggregates for concrete, mortar, Portland cement additives), ceramic industry, geopolymer, synthesis of new materials such as zeolites, mesoporous silica, carbon nanotubes, adsorbents, catalysts for different reactions, in batteries and in fuel cells. It was also carried out an analysis of patents related to IOT applications and the main technological and market barriers that hinder the industrial and commercial uses of these wastes.

ABSTRACT Objective We aimed to compare the diagnostic utility of the STOP-Bang questionnaire for moderate apnoea against the gold standard (type I polysomnography) in a primary care setting. Method Study of diagnostic utility in primary care. Estimated sample: 85 cases and 85 healthy controls. In convenience sampling, 203 patients were recruited by their physicians at six health centres. Twenty-five were excluded, and 57 women and 121 men, of whom 74 had apnoea-hypopnoea index (AHI) ≥15, were analyzed. STOP-Bang was validated by comparing scores in the same patient with the apnoea-hypopnoea index observed in polysomnography, as a gold standard. Sample size, ROC curve analysis and optimal cut-off points were identified with the easyROC, pROC, and OptimalCutpoints packages. Results The area under the curve in moderate apnoea (AHI ≥15) of the STOP-Bang was 0.777 (0.667-0.808), with optimal cut-off points different by sex (4 in women and 6 in men). In the cross-validation with k=10, the area under the curve for the STOP-Bang was 0.678. Conclusions The STOP-Bang presents a diagnostic moderate utility for AHI≥15, but superior to other scales, in a community population. Its performance is more appropriate in women.

RESUMEN Objetivo Validar el cuestionario STOP-Bang para la apnea moderada frente al método de referencia (polisomnografía de tipo I) en atención primaria. Método Estudio de utilidad diagnóstica en atención primaria con una muestra estimada de 85 casos y 85 controles sanos. Con muestreo por conveniencia, 203 pacientes fueron reclutados por sus médicos en seis centros de salud. Se excluyeron 25 y se analizaron 57 mujeres y 121 hombres, de los cuales 74 tenían un índice de hipopnea-apnea (IHA) ≥15. Se evaluaron el STOP-Bang y el IHA observado en la polisomnografía en cada paciente. El tamaño de la muestra, el análisis de la curva ROC y los puntos de corte óptimos se identificaron con los paquetes easyROC, pROC y OptimalCutpoints delsoftwarelibre R. Resultados El área bajo la curva en la apnea moderada (IHA ≥15) del STOP-Bang fue 0,737 (0,667-0,808), con puntos de corte óptimos diferentes por sexo (4 en mujeres y 6 en hombres). En la validación cruzada con k=10, el área bajo la curva para el STOP-Bang fue 0,678. Conclusiones El STOP-Bang tiene una utilidad diagnóstica moderada para un IHA ≥15, pero superior a la de otras escalas, en una población comunitaria. Su desempeño es más adecuado en las mujeres.

ABSTRACT Objective We aimed to compare the diagnostic utility of the STOP-Bang questionnaire for moderate apnoea against the gold standard (type I polysomnography) in a primary care setting. Method Study of diagnostic utility in primary care. Estimated sample: 85 cases and 85 healthy controls. In convenience sampling, 203 patients were recruited by their physicians at six health centres. Twenty-five were excluded, and 57 women and 121 men, of whom 74 had apnoea-hypopnoea index (AHI) ≥15, were analyzed. STOP-Bang was validated by comparing scores in the same patient with the apnoea-hypopnoea index observed in polysomnography, as a gold standard. Sample size, ROC curve analysis and optimal cut-off points were identified with the easyROC, pROC, and OptimalCutpoints packages. Results The area under the curve in moderate apnoea (AHI ≥15) of the STOP-Bang was 0.777 (0.667-0.808), with optimal cut-off points different by sex (4 in women and 6 in men). In the cross-validation with k=10, the area under the curve for the STOP-Bang was 0.678. Conclusions The STOP-Bang presents a diagnostic moderate utility for AHI≥15, but superior to other scales, in a community population. Its performance is more appropriate in women.

RESUMEN Objetivo Validar el cuestionario STOP-Bang para la apnea moderada frente al método de referencia (polisomnografía de tipo I) en atención primaria. Método Estudio de utilidad diagnóstica en atención primaria con una muestra estimada de 85 casos y 85 controles sanos. Con muestreo por conveniencia, 203 pacientes fueron reclutados por sus médicos en seis centros de salud. Se excluyeron 25 y se analizaron 57 mujeres y 121 hombres, de los cuales 74 tenían un índice de hipopnea-apnea (IHA) ≥15. Se evaluaron el STOP-Bang y el IHA observado en la polisomnografía en cada paciente. El tamaño de la muestra, el análisis de la curva ROC y los puntos de corte óptimos se identificaron con los paquetes easyROC, pROC y OptimalCutpoints delsoftwarelibre R. Resultados El área bajo la curva en la apnea moderada (IHA ≥15) del STOP-Bang fue 0,737 (0,667-0,808), con puntos de corte óptimos diferentes por sexo (4 en mujeres y 6 en hombres). En la validación cruzada con k=10, el área bajo la curva para el STOP-Bang fue 0,678. Conclusiones El STOP-Bang tiene una utilidad diagnóstica moderada para un IHA ≥15, pero superior a la de otras escalas, en una población comunitaria. Su desempeño es más adecuado en las mujeres.

Introdução e objetivo: No adulto com doença de Crohn (DC) a nutrição entérica (NE) é aplicável como terapêutica da desnutrição ou como alternativa, menos eficaz, aos corticoides, para indução de remissão. O objetivo desta revisão é determinar se a NE pré-operatória tem impacto nas complicações pós-operatórias, seja pelo efeito nutricional seja pelo terapêutico. Sumário: Foi realizada uma revisão sistemática dos artigos de investigação que incluíssem doentes adultos submetidos a cirurgia abdominal por DC complicada, após NE, redigidos em inglês e publicados entre janeiro de 1990 e novembro de 2017. De 22 estudos foram selecionados quatro institucionais e retrospetivos de coorte, um de “fraca qualidade” e três de “pobre qualidade” pela “Newcastle-Ottawa Scale”. Nos estudos revistos foi utilizada NE exclusiva (NEE) já que, não intencionalmente, os estudos com NE suplementar reuniram critérios de exclusão. O pequeno número e a heterogeneidade dos estudos elegíveis impossibilitaram uma meta-análise. A NEE foi utilizada e bem tolerada em todos os estudos, e permitiu melhorar o estado global dos doentes e protelar ou mesmo evitar a cirurgia. Nos dois estudos com maior número de doentes, a NEE pré-operatória foi um fator independente contra deiscências de sutura e abcessos em 219 doentes, e contra complicações infeciosas intra-abdominais em 38. Em análise univariada também se verificou que, no maior estudo, a NEE aumentou o intervalo pré-operatório livre de imunossupressores e foi protetora contra deiscências anastomóticas, abscessos intra-abdominais, infeções da ferida operatória, ileus, estomas e reoperações; noutro estudo menores correlacionou-se com menos complicações infeciosas intra-abdominais. Mensagens-chave: Todos os estudos revistos são retrospetivos e, consequentemente, de relevância limitada. No entanto, todos chamam a atenção da comunidade científica para os potenciais benefícios da NEE pré-operatória nos resultados pós-operatórios dos adultos com DC e para a necessidade de estudos prospetivos multi-institucionais e de ensaios clínicos randomizados.

Background and Aim: Enteral nutrition (EN) is applicable to adult Crohn’s disease (CD) in treating malnutrition and in inducing remission - here as a less effective alternative than corticosteroids. The purpose of this review is to determine whether preoperative EN impacts postoperative complications of adult CD, either by means of nutritional or therapeutic effects. Summary: A systematic review of English written full-text research articles published between January 1990 and November 2017, including adult patients undergoing abdominal surgery for complicated CD after EN, was performed. Four studies out of 22 were selected, all of which institutional, retrospective, case-control cohorts, one classified as “good quality” and three as “poor quality,” as rated by the Newcastle-Ottawa Scale. The application of inclusion and exclusion criteria resulted in a non-intentional absence of studies referring to supplemental EN among those reviewed. The reduced number of heterogeneous eligible studies impeded meta-analysis. In all studies, exclusive EN (EEN) was used and well tolerated, allowing to defer or even avoid surgery altogether, improving patients’ global state. The two studies with the greatest number of patients found preoperative EEN to be an independent factor against infectious and non-infectious complications in 219 patients and against anastomotic leaks or abscesses in 38 patients. Also, in univariate analysis, EEN was found to increase preoperative immunosuppressant-free intervals and to protect against anastomotic dehiscences, intra-abdominal abscesses, surgical wound infections, ileus, stomas, and reoperations in the largest study; in another study it was related to fewer intra-abdominal septic complications. Key Messages: All reviewed studies are retrospective and, consequently, of limited relevance. Nonetheless, all of them call the attention of the scientific community to the potential benefits of preoperative EEN on postoperative outcomes in adult CD, calling for prospective multi-institutional studies and randomized controlled trials.

ABSTRACT Background: Patients do not always follow medical indications. This is a public health problem, with implications in health care and costs. The objective of this study was to calculate the percentage of non-adherence of adults to the treatment prescribed in a Hospital Emergency Service (“HES”) and understanding wich factors led to poor adherence so improvements can be established. Methods: Prospective observational study. Cohort of adults who attended the HES. We collected sociodemographic data, medical history, chronic treatments, diagnosis and treatment at discharge from each individual. We applied Morisky-Green test (tailor made to the HES) to asses secondary non-adherence and multivariate analysis to find a correlation with the factors studied. Results: We established a non-adherence of 36.6% (IC95%=30.0-43.8). Patients with chronic endocrine pathology (RR=11.2; IC95%=2.1-60.8), diagnosed with ophthalmological problems (RR=9.8; IC95%=1.1-89.6) or contusions, sprains or fractures (RR=2.9; IC95%=1.1-7.8), those who were prescribed antibiotics (RR=5.4; IC95%=2.4-11.9), or those who considered that they had received sufficient explanations (RR=3.5; IC95%=1.0-13.2) were more adherent. Those who received analgesics or anti-inflammatories were less adherent (RR=0.4; IC95%=0.2-0.9). Conclusions: Our results provide information on adherence in acute pathologies in the emergency department. Diabetes and ophthalmological problems or trauma are predictors of increased adherence. We observe more adherence in people with antibiotic treatments, although 20% did not complete treatment. There is a lack of adherence to analgesic/anti-inflammatory treatments. We consider it is important for professionals to take into account patient´s concerns about the medication. Patients who considered they had received enough explanations on their treatment were more adherent tan others. We believe it would be useful to provide further information about the outcomes of the medication we prescribe using new technologies such as mobile applications so we could increase adherence. Further studies would be needed to asses the benefit of the changes recently introduced (electronic hisory and prescription).

RESUMEN Fundamentos: Que los pacientes no siempre sigan las indicaciones médicas es un problema de salud pública, que tiene implicaciones sobre los cuidados de salud y el coste de los servicios sanitarios. El objetivo del estudio fue determinar el porcentaje de no adhesión al tratamiento pautado en adultos en un Servicio de Urgencias Hospitalarias (SUH), así como identificar los factores que influyen en ello para instaurar así medidas de mejora. Sujetos y métodos: Se realizó un estudio observacional prospectivo, mediante una cohorte de personas adultas que acudieron al SUH. De cada persona se recogieron datos sociodemográficos, antecedentes, tratamientos crónicos y diagnóstico y tratamiento al alta. Se evaluaron, por medio de encuesta, la no adhesión primaria y secundaria (test de Morisky-Green adaptado a Urgencias), y se relacionó con los factores recogidos empleando análisis multivariable. Resultados: Se detectó una no adhesión del 36,6% (IC95%=30,0-43,8). Fueron más adherentes las personas con antecedente de enfermedad endocrina (RR=11,2; IC95%=2,1-60,8) y las que al alta fueron diagnosticadas de contusiones, esguinces o fracturas (RR=2,9; IC95%=1,1-7,8), o de algún problema oftalmológico (RR=9,8; IC95%=1,1-89,6). También fueron más adherentes los que al alta recibieron tratamiento antibiótico (RR=5,4; IC95%=2,4-11,9) o recibieron suficientes explicaciones (RR=3,5; IC95%=1,0-13,2). Fueron menos adherentes los pacientes con tratamiento analgésico o antinflamatorio (RR=0,4; IC95%=0,2-0,9). Conclusiones: Los resultados aportan información sobre la adhesión en patologías agudas en Urgencias. El ser diabético y el acudir debido a un problema oftalmológico o traumatológico son predictores de una mayor adhesión. En las personas con tratamiento antibiótico se observa una mayor adhesión, aunque todavía son necesarios esfuerzos para mejorar la situación, ya que un 20% no realizó adecuadamente el tratamiento. Se observa una importante falta de adhesión a los tratamientos con analgésicos o antiinflamatorios. A la vista de nuestros resultados, parece fundamental una buena comunicación. Es necesario sensibilizar a los profesionales para que tengan en cuenta las inquietudes y deseos del paciente acerca de la medicación, así como realizar esfuerzos dirigidos a mejorar la legibilidad del informe de alta y de las prescripciones.

RESUMEN Hasta hace poco los fármacos hipolipemiantes que habían demostrado, de manera consistente y reproducible, capacidad para prevenir la aparición de las enfermedades cardiovasculares, sobre todo de la cardiopatía isquémica, tanto en prevención primaria como secundaria, eran las estatinas1. En España, hay comercializadas siete y todas tienen estudios de reducción de eventos clínicos frente a placebo y, en algunos casos de prevención secundaria, de tratamiento intensivo frente al convencional2, menos la pitavastatina que solo cuenta con un estudio que compara dosis altas con dosis bajas de la misma estatina3,4. Tras los fracasos en la prevención cardiovascular del ácido nicotínico5,6, actualmente no comercializado en España, la limitada utilidad de los fibratos7,8 y de los ácidos grasos omega 39, solo nos quedan como tratamiento para asociar a las estatinas las resinas de intercambio iónico, habitualmente mal toleradas10, y ezetimiba, fármaco que solo tiene estudios de reducción de eventos en asociación con estatinas en pacientes con insuficiencia renal11 y con síndrome coronario agudo12.

ABSTRACT Background: Patients do not always follow medical indications. This is a public health problem, with implications in health care and costs. The objective of this study was to calculate the percentage of non-adherence of adults to the treatment prescribed in a Hospital Emergency Service (“HES”) and understanding wich factors led to poor adherence so improvements can be established. Methods: Prospective observational study. Cohort of adults who attended the HES. We collected sociodemographic data, medical history, chronic treatments, diagnosis and treatment at discharge from each individual. We applied Morisky-Green test (tailor made to the HES) to asses secondary non-adherence and multivariate analysis to find a correlation with the factors studied. Results: We established a non-adherence of 36.6% (IC95%=30.0-43.8). Patients with chronic endocrine pathology (RR=11.2; IC95%=2.1-60.8), diagnosed with ophthalmological problems (RR=9.8; IC95%=1.1-89.6) or contusions, sprains or fractures (RR=2.9; IC95%=1.1-7.8), those who were prescribed antibiotics (RR=5.4; IC95%=2.4-11.9), or those who considered that they had received sufficient explanations (RR=3.5; IC95%=1.0-13.2) were more adherent. Those who received analgesics or anti-inflammatories were less adherent (RR=0.4; IC95%=0.2-0.9). Conclusions: Our results provide information on adherence in acute pathologies in the emergency department. Diabetes and ophthalmological problems or trauma are predictors of increased adherence. We observe more adherence in people with antibiotic treatments, although 20% did not complete treatment. There is a lack of adherence to analgesic/anti-inflammatory treatments. We consider it is important for professionals to take into account patient´s concerns about the medication. Patients who considered they had received enough explanations on their treatment were more adherent tan others. We believe it would be useful to provide further information about the outcomes of the medication we prescribe using new technologies such as mobile applications so we could increase adherence. Further studies would be needed to asses the benefit of the changes recently introduced (electronic hisory and prescription).

RESUMEN Fundamentos: Que los pacientes no siempre sigan las indicaciones médicas es un problema de salud pública, que tiene implicaciones sobre los cuidados de salud y el coste de los servicios sanitarios. El objetivo del estudio fue determinar el porcentaje de no adhesión al tratamiento pautado en adultos en un Servicio de Urgencias Hospitalarias (SUH), así como identificar los factores que influyen en ello para instaurar así medidas de mejora. Sujetos y métodos: Se realizó un estudio observacional prospectivo, mediante una cohorte de personas adultas que acudieron al SUH. De cada persona se recogieron datos sociodemográficos, antecedentes, tratamientos crónicos y diagnóstico y tratamiento al alta. Se evaluaron, por medio de encuesta, la no adhesión primaria y secundaria (test de Morisky-Green adaptado a Urgencias), y se relacionó con los factores recogidos empleando análisis multivariable. Resultados: Se detectó una no adhesión del 36,6% (IC95%=30,0-43,8). Fueron más adherentes las personas con antecedente de enfermedad endocrina (RR=11,2; IC95%=2,1-60,8) y las que al alta fueron diagnosticadas de contusiones, esguinces o fracturas (RR=2,9; IC95%=1,1-7,8), o de algún problema oftalmológico (RR=9,8; IC95%=1,1-89,6). También fueron más adherentes los que al alta recibieron tratamiento antibiótico (RR=5,4; IC95%=2,4-11,9) o recibieron suficientes explicaciones (RR=3,5; IC95%=1,0-13,2). Fueron menos adherentes los pacientes con tratamiento analgésico o antinflamatorio (RR=0,4; IC95%=0,2-0,9). Conclusiones: Los resultados aportan información sobre la adhesión en patologías agudas en Urgencias. El ser diabético y el acudir debido a un problema oftalmológico o traumatológico son predictores de una mayor adhesión. En las personas con tratamiento antibiótico se observa una mayor adhesión, aunque todavía son necesarios esfuerzos para mejorar la situación, ya que un 20% no realizó adecuadamente el tratamiento. Se observa una importante falta de adhesión a los tratamientos con analgésicos o antiinflamatorios. A la vista de nuestros resultados, parece fundamental una buena comunicación. Es necesario sensibilizar a los profesionales para que tengan en cuenta las inquietudes y deseos del paciente acerca de la medicación, así como realizar esfuerzos dirigidos a mejorar la legibilidad del informe de alta y de las prescripciones.

Resumo O presente estudo analisou o consumo alimentar e a presença de fatores de risco cardiovasculares em pessoas vivendo com HIV/AIDS (PVHA) em uso regular de antirretrovirais. O consumo alimentar foi avaliado por meio de questionário de frequência alimentar anual, dividido em alimentos protetores e não protetores para doença cardiovascular (DCV). Os dados foram calculados pelo Teste t de Student para amostras independentes, pelo Teste U de Mann-Whitney e pelo teste exato de Fischer, considerando significativo p < 0,05. A amostra consistiu de 45 PVHA (60% do sexo feminino). O consumo de alimentos não protetores para o risco cardiovascular foi maior do que o de alimentos protetores nos homens (3,91 ± 0,26 vs. 2,79 ± 0,32 p = 0,01) e nas mulheres (3,40 ± 0,23 vs. 2,60 ± 0,29 p = 0,04). A prevalência de síndrome metabólica foi 33,3% nos homens e 37% nas mulheres. Os homens apresentaram hipertrigliceridemia (50%) e baixas concentrações de HDL-c (44%), enquanto que as mulheres apresentaram hipertrigliceridemia (46%), hipercolesterolemia (66,7%, p < 0,02 vs. homens) e obesidade central (54%, p < 0,05 vs. homens). Os resultados deste estudo indicam a presença de padrão de consumo alimentar inadequado e elevada prevalência de fatores de risco relacionados às DCV nos indivíduos avaliados.

Abstract This cross-sectional study evaluated the food intake patterns related to cardiovascular risk disease among people living with HIV/AIDS (PLWHA) with viral suppression and receiving highly active antiretroviral therapy (HAART). Food intake was obtained by the annual food frequency questionnaire, separated into two groups, healthy and unhealthy food related intake and cardiovascular disease. Data were analyzed using Student’s t Test for independent samples or the Mann-Whitney U Test and Fisher’s exact test, with a significance level of p < 0.05. The sample consisted of 45 individuals with HIV/AIDS (60% female). The intake of unhealthy foods for cardiovascular risk was greater compared to the intake of healthy foods, both in men (3.91 ± 0.26 vs. 2.79 ± 0.32 p = 0.01) and women (3.40 ± 0.23 vs. 2.60 ± 0.29 p = 0.04). Metabolic syndrome prevalence was 33.3% in men and 37% in women. Men presented hypertriglyceridemia (50%) and low HDL (44%) and women presented central obesity (54%, p = 0.05 vs. men) hypercholesterolemia (66.7% p = 0.02 vs. men) and hypertriglyceridemia (46%). Study results indicate the presence of unhealthy food intake patterns and a high prevalence of cardiovascular risk factors in the evaluated subjects.