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      Determinantes socioeconômicos e demográficos na assistência à fratura de fêmur em idosos Translated title: Socioeconomic and demographic determinants in the provision of assistance to elderly people with a fractured femur

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          Abstract

          Resumo A fratura de fêmur afeta os idosos apresentando alta morbimortalidade. O objetivo do estudo foi analisar o perfil da assistência à fratura de fêmur em idosos, relacionando às condições socioeconômicas e demográficas, no Paraná entre os anos 2008 a 2013. As relações foram obtidas por meio de análise fatorial e construção dos índices: PAI - potencial de atenção ao idoso, cuja variável foi representada pelo PIB municipal idoso; PAP - potencial de atenção à população, representado pelo PIB per capta; e ET - eficiência do tratamento representado pela taxa anual de fraturas e taxa anual de óbitos por residência. Os municípios foram classificados de acordo com a faixa de variação por índice. Em relação ao PAI, 10 municípios foram classificados com baixo potencial de atenção ao idoso; 357 com moderado potencial; e 32 com baixo potencial. Em relação ao PAP, 12 municípios foram classificados com alto potencial de atenção à população; 303 com moderado potencial; e 84 com baixo potencial. Em relação ao ET, 109 municípios apresentaram alta eficiência do tratamento; 110 com moderada eficiência; e 180 com baixa eficiência. Conclui-se que o desempenho da economia exerce significativa influência na assistência à fratura de fêmur em idosos.

          Translated abstract

          Abstract Femur fracture affects the elderly with high morbidity and mortality. The purpose of the present study was to analyze the profile of the assistance given to the elderly who have femoral fractures, relating to their socioeconomic and demographic conditions, in the state of Paraná between the years 2008 to 2013. These relationships were obtained through factor analysis and the development and analysis of the following rates: PAE - the potential of primary health care to the elderly, whose variable was represented by the contribution of the elderly to the municipal GDP, PAP - the potential of the primary health care to the population, represented by GDP per capita and TE - treatment efficiency represented by the annual rate of fractures and annual rate of death per residence. The municipalities were classified according to the rate variation range. In relation to PAE, 10 municipalities were classified with low potential of care for the elderly, 357 with moderate potential and 32 had low potential. In relation to PAE, 12 municipalities were classified with low potential of primary care for the elderly, 303 with moderate potential and 84 had low potential. In relation to TE, 109 municipalities showed high treatment efficiency, 110 with moderate efficiency and 180 had low efficiency. Our conclusion was that the performance of the economy exerts significant influence on femoral fracture morbidity in the elderly.

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          Changes in health care inequity in Brazil between 2008 and 2013

          Background Brazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis. This study measured predictors of health care utilization and changes in horizontal inequity between 2008 and 2013. Method Data were from two nationally representative surveys that measured a variety of sociodemographic, health behaviors and health care indicators. We used Poisson regression models to estimate adjusted prevalence ratios and the Horizontal Equity Index (HEI) standardized by health needs to measure inequity in the utilization of doctor and dentist visits, hospitalizations and reporting of a usual source of care (USC) for those 18 and older. To estimate the HEI, we ranked the population from the poorest to the richest using a wealth index. We also decomposed the HEI into its different components and assessed changes from 2008 to 2013. Results The population proportion with doctor and dentist visits in the past year and a USC increased between 2008 and 2013, while hospitalizations declined. In 2013, pro-rich inequity in doctor visits increased significantly while the distribution of hospitalizations shifted from pro-rich in 2008 to neutral in 2013. Dentist visits were highly pro-rich and USC was slightly pro-rich; the distribution of dentist visits and USC did not change over time. Health need was a strong predictor of health care utilization regardless of the type of coverage (public or private). Education, wealth, and private health plans were associated with the pro-rich orientation of doctor and dentist visits. Private health plans contributed to the pro-rich orientation of all outcomes, while the Family Health Strategy contributed to the pro-poor orientation of all outcomes. Conclusion The results of this study support the claim that Brazil’s population continued to see absolute gains in access to care despite recent economic crises. However, gains in equity have slowed and may even decline if investments are not maintained as the country enters deeper financial and political crises. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0431-8) contains supplementary material, which is available to authorized users.
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            Prognostic factors for mortality after hip fracture: Operation within 48 hours is mandatory

            The aim of this study was to assess whether surgery delay and other variables are associated with an increased mortality rate after surgical treatment of hip fractures in the elderly. Patients treated for a proximal femoral fracture at our Orthopaedic Department between 2005 and 2012 were included in this study. A logistic regression was performed to evaluate the relationship between mortality rate at different follow-up times (30 days, six months and one year) and different patient or treatment variables. A total of 1448 consecutive patients with 1558 proximal femoral fractures (55 bilateral) were enrolled in this study (mean age 80.3 years, 75.8% female). The postoperative mortality rate was 4% at 30 days, 14.1% at six months, and 18.8% at one year after surgery. Logistic regression revealed an increased mortality at all the endpoints in patients affected by more than two co-morbidities (respectively OR30-day=2.003, OR6-month=1.8654 and OR1-year=1.5965). Male sex was associated with an increased six-month (OR=1.7158) and one-year (OR=1.9362) mortality. Patients aged under 74 years had a decreased mortality at all endpoints (OR30-day=0.0703, OR6-month=0.2191 and OR1-year=0.2486). In this study, the surgery delay influenced mortality at one-year follow-up: operating within 48hours was associated with a decreased mortality rate (OR=0.7341; p=0.0392). Additionally, the patients who were operated on within 72hours were specifically analysed to understand if the option of 'operating within day 3' was acceptable. In the logistic regression, operating between 48 and 72hours was not reported as a risk factor for mortality, both compared to early surgery (within 48 hours) and to late surgery (after 72hours). This study showed that age, sex and number of co-morbidities influenced both early and late mortality in patients affected by proximal hip fractures. Early surgery influenced late mortality, with a decreased risk in patients operated on within 48hours. The option of operating within day 3 is not a valid alternative.
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              Geriatric distal femur fracture: Are we underestimating the rate of local and systemic complications?

              Low energy distal femur fractures often occur in a fragile elderly population that is prone to local and systemic complications following operative treatment of extremity fractures. The nonunion rate and early complication rate following laterally based locked plating in this specific fracture are not well described.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                2019
                : 24
                : 1
                : 97-104
                Affiliations
                [1] Maringá Paraná orgnameCentro Universitário de Maringá orgdiv1Programa de Pós-Graduação em Promoção da Saúde Brazil fisioterapia.joselene@ 123456santacasamaringa.com.br
                [3] Maringá Paraná orgnameUniversidade Estadual de Maringá orgdiv1Programa de Pós-Graduação em Ciências Econômicas Brazil
                [4] Maringá Paraná orgnameUniversidade do Norte do Paraná Brazil
                [2] Maringá Paraná orgnameUniversidade Estadual de Maringá orgdiv1Programa de Pós-Gradução em Bioestatística Brazil
                Article
                S1413-81232019000100097
                10.1590/1413-81232018241.03862017
                b48f878d-94bd-4a3b-abb5-0d7f2658724f

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 10 November 2016
                : 29 March 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 8
                Product

                SciELO Public Health

                Categories
                Artigo

                Envelhecimento,Condições socioeconômicas,Fraturas femorais,Socioeconomic conditions,Aging,Femoral fractures

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