Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry. / Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19.

BACKGROUND: Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. OBJECTIVES: To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. METHODS: This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. RESULTS: Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. CONCLUSION: Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

FUNDAMENTO: As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. OBJETIVOS: Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. MÉTODOS: Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. RESULTADOS: Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. CONCLUSÃO: Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians.

OBJECTIVES: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population. METHODS: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group. RESULTS: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer. CONCLUSION: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease.

Hospital characteristics associated with COVID-19 mortality: data from the multicenter cohort Brazilian Registry.

The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (ß = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (ß = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (ß = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (ß = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.

Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19 / Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

Autonomia reprodutiva entre mulheres: uma revisão integrativa da literatura / Reproductive autonomy among women: an integrative literature review / Autonomía reproductiva entre las mujeres: una revisión integrativa de la literatura

Objetivo: analisar as evidências científicas acercada capacidade da mulher de decidir livremente sobre questões reprodutivas através das subescalas daEscala de Autonomia Reprodutiva e sua associação com as características sociodemográficas. Método:revisão de literatura integrativa em torno da análise daautonomia reprodutiva entre mulheres. Para a seleção dos artigos foi efetuada uma consulta aos Descritores em Ciência da Saúde (DeCS) e Medical Subject Headings (MeSH), sendo identificados e utilizados os descritores: Reproductive Autonomy Scale, Decision-Making, Women, Tomada de decisões, Mulheres, e combinados através do operador booleano AND. Resultados: a busca bibliográfica ocorreu em dezembro/2021nas bases Pubmed, SCOPUS, Scielo, Lilacse portal BVS, inicialmente encontrou 238títuloscom exclusão de 93 duplicatas, e após a triagem, seteartigos foram incluídos.Após realização das análises desses estudos foram apontadas as categorias "Autonomia reprodutiva: gênero e poder" e "Característicassociodemográficasdas mulheres e autonomia reprodutiva".Considerações finais:é importante conhecer o contexto sociodemográfico e a dinâmica de autonomia reprodutiva no qual as mulheres estão inseridas. Assim, diante de um cenário real de fragilidades sociais que a mulher vivencia, inclusive as que estão em condições desfavoráveis, a exemplo das questões raciais, faz-se necessário ações que fortaleçam a promoção dos direitos reprodutivos na atenção primária de saúde.

Objective: to analyze the scientific evidence about the woman's ability to decide freely on reproductive issues through the subscales of the Reproductive Autonomy Scale and their association with sociodemographic characteristics. Method:integrative literature review onthe analysis of reproductive autonomy among women. For the selection of articles, the Health Science Descriptors (DeCS) and Medical Subject Headings (MeSH) were consulted, and the following descriptors were identified and used: Reproductive Autonomy Scale, Decision-Making, Women, Decision-making, Women, and combined using the Boolean AND operator. Results:the bibliographic search took place in December/2021 in Pubmed, SCOPUS, Scielo, Lilacs and BVS portal, initially found 238 titles with the exclusion of 93 duplicates, and after screening, seven articles were included. After performing the analyses of these studies, the categories "Reproductive autonomy: gender and power" and "Sociodemographic characteristics of women and reproductive autonomy" were pointed out. Final considerations:it is important to know the sociodemographic context and the dynamics of reproductive autonomy in which women are inserted. Thus, faced with a real scenario of social weaknesses that women experience, including those in unfavorable conditions, such as racial issues, actions that strengthen the promotion of reproductive rights in primary health care are necessary.

Objetivo: analizar las evidencias científicas sobre la capacidad de las mujeres para decidir libremente sobre cuestiones reproductivas a través de las subescalas de la Escala de Autonomía Reproductiva y su asociación con características sociodemográficas. Método:revisión integrativa de la literatura sobre el análisis de la autonomía reproductiva de las mujeres. Para seleccionar los artículos se realizó una consulta a los Descriptores de Ciencias de la Salud (DeCS) y a los Encabezamientos de Temas Médicos (MeSH), y se identificaron y utilizaron los siguientes descriptores: Escala de Autonomía Reproductiva, Toma de Decisiones, Mujeres, Toma de Decisiones, Mujeres, y combinados usando el operador booleano AND. Resultados:la búsqueda bibliográfica se realizó en diciembre/2021 en Pubmed, SCOPUS, Scielo,Lilacs y el portal de la BVS, encontró inicialmente 238 títulos con la exclusión de 93 duplicados, y después de la selección, se incluyeron siete artículos. Luego de realizar el análisis de estos estudios, se identificaron las categorías "Autonomía reproductiva: género y poder" y "Características sociodemográficas de las mujeres y autonomía reproductiva". Consideraciones finales:es importante conocer el contexto sociodemográfico y la dinámica de autonomía reproductiva en la que se insertan las mujeres. Así, ante un escenario real de fragilidades sociales que viven las mujeres, incluidas aquellas en condiciones desfavorables, como las cuestiones raciales, son necesarias acciones que fortalezcan la promoción de los derechos reproductivos en la atención primaria de salud.

Interfaces entre profissionais de saúde e a humanização da assistência ao parto / Interfaces between healt professionals and humanization of labor assistance

Objetivo: descrever a percepção dos profissionais de saúde acerca dos aspectos relacionados à humanização ao parto e nascimento Metodologia: Estudo descritivo com abordagem qualitativa, realizado com 26 profissionais de saúde especialistas em obstetrícia (10 enfermeiros e 16 médicos) de três maternidades públicas de risco habitual em Recife-PE. Utilizou-se como referencial teórico a Análise crítica do discurso. Resultados: Dificuldades enfrentadas no desenvolvimento da assistência ao parto e nascimento; Discurso divergente em relação à humanização da assistência ao parto e nascimento; Divergência entre modelos assistenciais obstétricos seguidos. Conclusões: percebe-se a necessidade de ampliar a compreensão de humanização do parto e nascimento pelos profissionais, tendo como objetivo prestar uma atenção voltada às necessidades da parturiente e família.

Objective: to describe the perception of health professionals about the aspects related to humanization at birth and birth. Methodology: A descriptive study with a qualitative approach, carried out with 26 health professionals specialized in obstetrics (10 nurses and 16 physicians) from three public maternity hospitals at usual risk In Recife-PE. Critical analysis of discourse was used as theoretical reference. Results: Difficulties faced in the development of delivery and birth care; Divergent discourse regarding the humanization of delivery and birth care; Divergence between assisted obstetric care models. Conclusions: the need to extend the understanding of humanization of birth and birth by professionals is perceived, with the objective of paying attention to the needs of the parturient and the family.

Objetivo: describir la percepción de los profesionales de salud acerca de los aspectos relacionados con la humanización al parto y el nacimiento. Métodos: Estudio descriptivo con abordaje cualitativo, realizado con 26 profesionales de salud especialistas en obstetricia (10 enfermeros y 16 médicos) de tres maternidades públicas de riesgo habitual En Recife-PE. Se utilizó como referencial teórico el análisis crítico del discurso. Resultados: Dificultades enfrentadas en el desarrollo de la asistencia al parto y el nacimiento; Discurso divergente en relación con la humanización de la asistencia al parto y el nacimiento; Divergencia entre modelos asistenciales obstétricos seguidos. Conclusiones: se percibe la necesidad de ampliar la comprensión de humanización del parto y nacimiento por los profesionales, teniendo como objetivo prestar una atención volcada a las necesidades de la parturienta y familia.