Senior Professor and Researcher at the Department of Social Medicine, in the Federal University of Pelotas, Brazil.
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Multimorbidity and population at risk for severe COVID-19 in the Brazilian Longitudinal Study of Aging/ Multimorbidade e população em risco para COVID-19 grave no Estudo Longitudinal da Saúde dos Idosos Brasileiros/ Multimorbilidad y población en riesgo para la COVID-19 grave en el Estudio Brasil...
Objectives This study aimed to evaluate the existence of socioeconomic inequalities related to th... more Objectives This study aimed to evaluate the existence of socioeconomic inequalities related to the prevalence of multimorbidity in the Brazilian population aged 60 and older. Methods This was a cross-sectional study with data from the last Brazilian National Health Survey (PNS) collected in 2019. Multimorbidity was the dependent variable and was defined as the presence of two or more chronic diseases. All the diseases were assessed based on a self-reported previous medical diagnosis. Education and per capita family income were the measures of socioeconomic position. Socioeconomic inequalities related to multimorbidity were assessed using two complex measures of inequality; the Slope Index of Inequality (SII) and the Concentration Index (CI). Results The prevalence of multimorbidity in Brazil was 56.5% 95% CI (55.4; 57.6) and varied from 46.9% (44.3; 49.6) in the North region to 59.3% (57.0; 61.5) in the South region. In general, individuals with higher socioeconomic positions had a ...
Comportamentos de proteção para COVID-19 entre adultos e idosos brasileiros que vivem com multimorbidade (Iniciativa ELSI-COVID-19)
Objetivou-se medir a ocorrência de comportamentos de proteção para a COVID-19 e fatores sociodemo... more Objetivou-se medir a ocorrência de comportamentos de proteção para a COVID-19 e fatores sociodemográficos segundo a ocorrência de multimorbidade (MM) na população brasileira com 50 anos ou mais de idade. Foram utilizados dados de inquérito telefônico entre participantes do ELSI (Estudo Longitudinal da Saúde dos Idosos Brasileiros), conduzidas entre maio e junho de 2020. Avaliou-se o uso de medidas de prevenção não farmacológica para COVID-19, motivos para sair de casa segundo a presença de multimorbidade e variáveis sociodemográficas. Participaram do estudo 6.149 pessoas. Multimorbidade foi mais frequente no sexo feminino, em casados, na faixa etária 50-59 anos de idade e em moradores da zona urbana. A maior parte da população saiu de casa entre uma e duas vezes na última semana, aumentando segundo o número de morbidades (22,3% sem morbidades e 38% com MM). Sair de casa todos os dias teve menor ocorrência entre indivíduos com MM (10,3%) e 9,3% saíram de casa na última semana para ob...
Condiciones Estructurales Para La Atención Materno-Infantil en La Atención Primaria a La Salud en Brasil
Introduccion. El objetivo del estudio fue evaluar la oferta de servicios de salud para el cuidado... more Introduccion. El objetivo del estudio fue evaluar la oferta de servicios de salud para el cuidado prenatal y de los ninos en cuanto a su estructura. Metodos. Estudio descriptivo en una muestra de 244 servicios de dos regiones de Brasil: Sur y Noreste. El jefe de cada servicio respondio a un cuestionario sobre la existencia de recursos minimos para la realizacion de actividades de promocion de salud y prevencion de enfermedades durante el periodo prenatal y la infancia. Resultados. Fueron estudiados 220 servicios de salud (90%). El 40% de los servicios tenia todas las dependencias basicas. La suficiencia de materiales permanentes fue de 37% (atencion prenatal) y de 58% (cuidado de los ninos). La suficiencia de medicamentos y vacunas fue de 80% (atencion prenatal) y 86% (cuidado de los ninos). El acceso satisfactorio a los examenes de laboratorio fue bajo: cuidado prenatal (50%) y cuidado de los ninos (60%). Ya el acceso satisfactorio a la atencion especializada fue de 64% para el pre...
Prevalencia De Caídas Entre Los Adultos Mayores en Brasil: Un Análisis Nacional
Introduccion . Las caidas son un acontecimiento importante en los ancianos. El objetivo del estud... more Introduccion . Las caidas son un acontecimiento importante en los ancianos. El objetivo del estudio fue evaluar las caidas en ancianos en Brasil. Metodo. Se realizo un estudio transversal de una muestra de 6.616 adultos mayores que viven en las zonas urbanas de 100 municipios en 23 estados brasilenos, que respondieron a las preguntas sobre la aparicion de caidas en los 12 meses anteriores a la entrevista, y la aparicion de fracturas a causa de las caidas. Resultados. La prevalencia de caidas entre los adultos mayores fue de 27,6% (IC 95%: 26,5-28,7). Entre los que reportaron caida 11% habian sufrido fracturas como resultado. De los adultos mayores, 36% habian recibido orientacion sobre las precauciones necesarias para prevenir las caidas, y 1% habia requerido cirugia. Las caidas fueron asociados con el sexo femenino, edad avanzada, bajo nivel socioeconomico, la obesidad y el sedentarismo. La prevalencia de caidas difirio significativamente entre las regiones del Norte y otros de Br...
Envelhecimento, multimorbidade e risco para COVID-19 grave: ELSI-Brasil
O objetivo deste estudo foi medir a ocorrência de multimorbidade e estimar o número de indivíduos... more O objetivo deste estudo foi medir a ocorrência de multimorbidade e estimar o número de indivíduos na população brasileira com 50 anos ou mais em risco para COVID-19 grave. Estudo transversal utilizando dados da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI), conduzido em 2015–2016, com 9.412 indivíduos com 50 anos ou mais. O desfecho do estudo foi a ocorrência de multimorbidade baseando-se em uma lista de 17 morbidades consideradas de risco para COVID-19 grave e operacionalizado de duas formas: ≥1 e ≥2 condições. Avaliou-se a gravidade da situação de saúde por meio da autoavaliação do estado de saúde, fragilidade e Atividades Básicas da Vida Diária. As análises incluíram cálculo de prevalência e número absoluto estimado de pessoas na população. Sexo, idade, região geopolítica e escolaridade foram utilizadas como covariáveis. Cerca de 80% (≈34 milhões) dos indivíduos apresentaram pelo menos alguma das morbidades avaliadas; multimorbidade esteve presente e...
To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors a... more To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity and physical inactivity. Deaths were identified through linkage to mortality registers. For each risk factor, estimated all-cause mortality hazard ratios (HR) and population attributable fractions (PAF) were adjusted by age, sex, all other risk factors and socioeconomic position (wealth) using Cox proportional hazards modelling. We also quantified the risk factor adjusted wealth gradients in mortality, by age and sex. Among the participants, 659 (ELSA) and 638 (SIGa-Bagé) died during the 9-year follow-up. Mortality rates were higher in SIGa-Bagé. HRs and PAFs showed more similarities than differe...
Objective: to describe the structure of Family Health Support Unit (FHSU) teams with regard to ph... more Objective: to describe the structure of Family Health Support Unit (FHSU) teams with regard to physical space, training received, continuing education and professionals that support Primary Health Care (PHC) teams in Brazil, in 2013. Methods: this is a descriptive study using data from the external evaluation stage of the Program for Improving Primary Health Care Access and Quality (PMAQ). Results: the 1,773 FHSU teams mainly used shared clinics at primary health care centers (85.7%); 63.4% of professionals were offered specific training when they started work at their FHSU, while 67.4% were offered continuing education; the teams received support mainly from physiotherapists (87.4%) and Physical Education professionals (87,0%). Conclusion: the structure available for FHSU teams is in accordance with the guidelines; some FHSU professionals have not received any specific training for the job.
Objective: to describe reported health promotion actions directed towards chronic non-communicabl... more Objective: to describe reported health promotion actions directed towards chronic non-communicable disease (CNCD) patients, the support of physical education professionals (PEP) and the implementation of actions to promote body practices and physical activity (BPPA) by the Family Health Support Center (FHSC) teams, according to Brazilian municipality context variables. Methods: this was a cross-sectional study, forming part of the 2013/2014 National Primary Health Care Access and Quality Improvement Program (PMAQ), by means of interviews with FHSC professionals. Results: the action most reported by the teams was evaluation and rehabilitation of psychosocial conditions (90.8%); promotion of BPPA was the sixth most performed action, and was more prevalent in the Brazilian Southeast region (89.6%), in medium-sized municipalities (88.7%), with medium human development index (HDI) (86.7%); PEP provided support to 87% of the teams. Conclusion: FHSC were found to make an important contribution to BPPA.
publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a chec... more publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form () and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below.
Objective: to review literature and provide a pooled effect for the association between multimorb... more Objective: to review literature and provide a pooled effect for the association between multimorbidity and mortality in older adults. Methods: a systematic review was performed of articles held on the PUBMED database published up until January 2015. Studies which used different diseases and other conditions to define frailty, evaluated multimorbidity related only to mental health or which presented disease homogeneity were not included. A meta-analysis using random effect to obtain a pooled effect of multimorbidity on mortality in older adults was conducted only with studies which reported hazard ratio (HR). Stratified analysis and univariate meta-regression was performed to evaluate sources of heterogeneity. Results: Out of 5806 identified articles, 26 were included in meta-analysis. Overall, positive association between multimorbidity and mortality [HR: 1.44 (95%CI: 1.34; 1.55] was detected. The number of morbidities was positively related to risk of death [HR: 1.20 (95%CI: 1.10; 1.30)]. Compared to individuals without multimorbidity, the risk of death was 1.73 (95%CI: 1.41; 2.13) and 2.72 (95%CI: 1.81; 4.08) for people with 2 or more and 3 or more morbidities, respectively. Heterogeneity between studies was high (96.5%). The sample, adjustment and follow-up modified the associations. Only nine estimates performed adjustment which included demographic, socioeconomic and behavior variables. Disabilities appear to mediate the effect of multimorbidity on mortality. Conclusions: Multimorbidity was associated with an increase in risk of death. Multimorbidity measurement standardization is needed to produce more comparable estimates. Adjusted analysis which includes potential confounders might contribute to better understanding of causal relationships between multimorbidity and mortality.
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