MARCOS DANIEL CABRAL SARAIVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
4 resultados
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- Persistent pain and cognitive decline in older adults: a systematic review and meta-analysis from longitudinal studies(2020) AGUIAR, Gabriella Pequeno Costa Gomes de; SARAIVA, Marcos Daniel; KHAZAAL, Eugenia Jatene Bou; ANDRADE, Daniel Ciampi de; JACOB-FILHO, Wilson; SUEMOTO, Claudia KimieBoth persistent pain and cognitive decline prevalence increase with advancing age and are associated with functional decline. However, the association of pain and cognitive decline has not been evaluated yet by a systematic assessment of longitudinal studies. We aimed to assess the association of persistent pain as a risk factor for cognitive decline in community older adults, using data from longitudinal studies in a systematic review and meta-analysis. Publications were identified using a systematic search on PubMed, EMBASE, and Cochrane Library databases from inception to June 2019. Because heterogeneity across studies was high, we used random-effects meta-analysis to calculate the pooled relative risk (RR) for the association between persistent pain and cognitive decline incidence. We investigated sources of heterogeneity among studies using meta-regression and stratified analyses. We included 10 prospective longitudinal studies with 57,495 participants with a mean age at the baseline ranging from 61.8 to 88.4 years and mean follow-up times ranging from 2.75 to 11.8 years. Persistent pain at baseline was not associated with the development of cognitive decline during the follow-up (pooled RR = 1.05, 95% confidence interval = 0.92-1.21). In sensitivity analyses, only length of follow-up time <= 4.5 years was associated with a higher risk of cognitive impairment (pooled RR = 1.19, 95% confidence interval = 1.10-1.28). Persistent pain was not associated with the incidence of cognitive decline.
bookPart Manejo da dor aguda e crônica(2020) KHAZAAL, Eugênia Jatene Bou; AGUIAR, Gabriella Pequeno Costa Gomes de; SARAIVA, Marcos Daniel- AMPI-AB validity and reliability: a multidimensional tool in resource-limited primary care settings(2020) SARAIVA, Marcos Daniel; VENYS, Amanda Lagreca; ABDALLA, Fabio Luiz Pantaleao; FERNANDES, Mariana Seabra; PISOLI, Priscila Henriques; SOUSA, Danilsa Margareth da Rocha Vilhena; BIANCONI, Barbara Lobo; HENRIQUE, Expedita Angela; GARCIA, Vanessa Silva Suller; MAIA, Lucas Henrique de Mendonca; SUZUKI, Gisele Sayuri; SERRANO, Priscila Goncalves; HIRATSUKA, Marcel; SZLEJF, Claudia; JACOB-FILHO, Wilson; PASCHOAL, Sergio Marcio PachecoBackgroundThe early identification of individuals at high risk for adverse outcomes by a Comprehensive Geriatric Assessment (CGA) in resource-limited primary care settings enables tailored treatments, however, the evidence concerning its benefits are still controversial. The main objective of this study was to examine the validity and reliability of the ""Multidimensional Assessment of Older People in Primary Care (AMPI-AB)"", a CGA for primary care in resource-limited settings.MethodsLongitudinal study, with median follow-up time of 16months. Older adults from a public primary care unit in SAo Paulo, Brazil, were consecutively admitted. Reliability was tested in a sample from a public geriatric outpatient clinic. Participants were classified by the AMPI-AB score as requiring a low, intermediate or high complexity of care. The Physical Frailty Phenotype was used to explore the AMPI-AB's concurrent validity. Predictive validity was assessed with mortality, worsening of the functional status, hospitalizations, emergency room (ER) visits and falls. The area under the ROC curve and logistic regression were calculated for binary outcomes, and a Cox proportional hazards model was used for survival analysis.ResultsOlder adults (n=317) with a median age of 80 (74-86) years, 67% female, were consecutively admitted. At the follow-up, 7.1% of participants had died, and increased dependency on basic and instrumental activities of daily living was detected in 8.9 and 41.1% of the participants, respectively. The AMPI-AB score was accurate in detecting frailty (area under the ROC curve=0.851), predicted mortality (HR=1.25, 95%CI=1.13-1.39) and increased dependency on basic (OR=1.26, 95%CI=1.10-1.46) and instrumental (OR=1.22, 95%CI=1.12-1.34) activities of daily living, hospitalizations (OR=2.05, 95%CI=1.04-1.26), ER visits (OR=1.20, 95%CI=1.10-1.31) and falls (OR=1.10, 95%CI=1.01-1.20), all models adjusted for sex and years of schooling. Reliability was tested in a sample of 52 older adults with a median age of 72 (85-64) years, 63.5% female. The AMPI-AB also had good interrater (ICC=0.87, 95%CI=0.78-0.92), test-retest (ICC=0.86, 95%CI=0.76-0.93) and proxy reliability (ICC=0.84, 95%CI=0.67-0.93). The Cronbach's alpha was 0.69, and the mean AMPI-AB administration time was 05:4402:42min.ConclusionThe AMPI-AB is a valid and reliable tool for managing older adults in resource-limited primary care settings.
- Prospective GERiatric Observational (ProGERO) study: cohort design and preliminary results(2020) SARAIVA, Marcos Daniel; RANGEL, Luis Fernando; CUNHA, Julia Lusis Lassance; ROTTA, Thereza Cristina Ariza; DOURADINHO, Christian; KHAZAAL, Eugenia Jatene Bou; ALIBERTI, Marlon Juliano Romero; AVELINO-SILVA, Thiago Junqueira; APOLINARIO, Daniel; SUEMOTO, Claudia Kimie; JACOB-FILHO, WilsonBackgroundThe demographic changes in Brazil as a result of population aging is one of the fastest in the world. The far-reaching new challenges that come with a large older population are particularly disquieting in low- and middle-income countries (LMICs). Longitudinal studies must be completed in LMICs to investigate the social and biological determinants of aging and the consequences of such demographic changes in their context. Therefore, we designed the Prospective GERiatric Observational (ProGERO) study, a longitudinal study of outpatient older adults in SAo Paulo, Brazil, to collect data both on aging and chronic diseases, and investigate characteristics associated with adverse outcomes in this population.MethodsThe ProGERO study takes place in a geriatric outpatient clinic in the largest academic medical center in Latin America. We performed baseline health examinations in 2017 and will complete subsequent in-person visits every 3 years when new participants will also be recruited. We will use periodic telephone interviews to collect information on the outcomes of interest between in-person visits. The baseline evaluation included data on demographics, medical history, physical examination, and comprehensive geriatric assessment (CGA; including multimorbidity, medications, social support, functional status, cognition, depressive symptoms, nutritional status, pain assessment, frailty, gait speed, handgrip strength, and chair-stands test). We used a previously validated CGA-based model to rank participants according to mortality risk (low, medium, high). Our selected outcomes were falls, disability, health services utilization (emergency room visits and hospital admissions), institutionalization, and death. We will follow participants for at least 10 years.ResultsWe included 1336 participants with a mean age of 828years old. Overall, 70% were women, 31% were frail, and 43% had a Charlson comorbidity index score >= 3. According to our CGA-based model, the incidence of death in 1 year varied significantly across categories (low-risk=0.6%; medium-risk=7.4%; high-risk=17.5%; P<0.001).Conclusion The ProGERO study will provide detailed clinical data and explore the late-life trajectories of outpatient older patients during a follow-up period of at least 10years. Moreover, the study will substantially contribute to new information on the predictors of aging, senescence, and senility, particularly in frail and pre-frail outpatients from an LMIC city.