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
3 resultados
Resultados de Busca
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- Nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in a Brazilian elderly cohort(2019) ZANELLA, Rosemeire Cobo; BRANDILEONE, Maria Cristina de Cunto; ALMEIDA, Samanta Cristine Grassi; LEMOS, Ana Paula Silva de; SACCHI, Claudio Tavares; GONCALVES, Claudia R.; GONCALVES, Maria Gisele; FUKASAWA, Lucila Okuyama; SARAIVA, Marcos Daniel; RANGEL, Luis Fernando; CUNHA, Julia Lusis Lassance; ROTTA, Thereza Cristina Ariza; DOURADINHO, Christian; JACOB-FILHO, Wilson; MINAMISAVA, Ruth; ANDRADE, Ana LuciaWe aimed to investigate the nasopharyngeal colonization (NPC) by Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in the elderly population and to assess the demographic factors associated with NPC. This was an observational cohort study in which outpatients aged >= 60 years were enrolled from April to August 2017, with a follow-up visit from September through December 2017. Nasopharyngeal (NP) swabs were collected, bacteria were detected and isolated, and isolates were subjected to phenotypic and molecular characterization using standard microbiological techniques. At enrolment, the rates of S. aureus, methicillin-resistant S. aureus (MRSA), H. influenzae, and S. pneumoniae among 776 elderly outpatients were 15.9%, 2.3%, 2.5%, and 2.2%, respectively. Toxin production was detected in 21.1% of methicillin-susceptible S. aureus, and three SCCmec types were identified: II/IIb, IVa, and VI. At the follow-up visit, all carriage rates were similar (p > 0.05) to the rates at enrolment. Most of S. pneumoniae serotypes were not included in pneumococcal conjugate vaccines (PCVs), except for 7F, 3, and 19A. All strains of H. influenzae were non-typeable. Previous use of antibiotics and 23-valent pneumococcal polysaccharide vaccination (p < 0.05) were risk factors for S. aureus and MRSA carriage; S. aureus colonization was also associated with chronic kidney disease (p = 0.021). S. pneumoniae carriage was associated with male gender (p = 0.032) and an absence of diabetes (p = 0.034), while not receiving an influenza vaccine (p = 0.049) and chronic obstructive pulmonary disease (p = 0.031) were risk factors for H. influenzae colonization. The frailty of study participants was not associated with colonization status. We found a higher S. aureus carriage rate compared with the S. pneumoniae- and H. influenzae-carriage rates in a well attended population in a geriatric outpatient clinic. This is one of the few studies conducted in Brazil that can support future colonization studies among elderly individuals.
- 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.