Atrial Fibrillation and Sepsis in Elderly Patients and Their Associaton with In-Hospital Mortality. / Fibrilação Atrial e Sepse em Pacientes Idosos e sua Associação com Mortalidade Intra-hospitalar.

BACKGROUND: Atrial fibrillation (AF) affects about 2% to 4% of the world population, and in patients hospitalized in intensive care units, this incidence can reach up to 23% in those with septic shock. The impact of AF in patients with sepsis is reflected in worse clinical outcomes, and the identification of the triggering factors can be a target for future prevention and treatment strategies. OBJECTIVES: To verify the relationship between the development of AF and mortality in patients over 80 years of age included in the sepsis protocol and to identify the risk factors that contribute to the development of AF in this population. METHODS: Retrospective observational study, with a review of electronic medical records and inclusion of 895 patients aged 80 years or older, included in the sepsis protocol of a high-complexity private hospital in São Paulo, SP, from January 2018 to December 2020. All tests were performed with a significance level of 5%. RESULTS: The incidence of AF in the sample was 13%. After multivariate analysis, using multiple logistic regression, it was possible to demonstrate an association of mortality, in the studied population, with the SOFA score (odds ratio [OR] 1.21 [1.09 - 1.35]), higher values of C-reactive protein (OR 1.04 [1.01 - 1.06]), need for vasoactive drugs (OR 2.4 [1.38 - 4.18]), use of mechanical ventilation (OR 3.49 [1.82 - 6.71]), and mainly AF (OR 3.7 [2.16 - 6.31]). CONCLUSION: In very elderly patients (80 years of age and older) with sepsis, the development of AF was shown to be an independent risk factor for in-hospital mortality.

FUNDAMENTO: A fibrilação atrial (FA) acomete cerca de 2% a 4% da população mundial. Nos pacientes internados em unidades de terapia intensiva, esta incidência pode chegar em até 23% naqueles com choque séptico. O impacto da FA nos pacientes sépticos se reflete em piores desfechos clínicos e o reconhecimento dos fatores desencadeantes pode ser alvo para estratégias de tratamento e prevenção futuras. OBJETIVOS: Verificar a relação entre desenvolvimento de FA e mortalidade nos pacientes acima de 80 anos incluídos no protocolo sepse e identificar fatores de risco que contribuam para o desenvolvimento de FA nesta população. MÉTODOS: Estudo observacional retrospectivo, com revisão de prontuários eletrônicos e inclusão de 895 pacientes com 80 anos ou mais, incluídos no protocolo sepse de um hospital privado de alta complexidade em São Paulo/SP, no período de janeiro de 2018 a dezembro de 2020. Todos os testes foram realizados com nível de significância de 5%. RESULTADOS: A incidência de FA na amostra foi de 13%. Após análise multivariada por regressão logística múltipla, foi possível demonstrar associação de mortalidade na população estudada, com o escore SOFA ( odds ratio [OR] 1,21 [1,09 ­ 1,35]), valores mais altos de proteína C-reativa (OR 1,04 [1,01 ­ 1,06]), necessidade de droga vasoativa (OR 2,4 [1,38 ­ 4,18]), uso de ventilação mecânica (OR 3,49 [1,82 ­ 6,71]) e principalmente FA (OR 3,7 [2,16 ­ 6,31). CONCLUSÕES: No paciente grande idoso (80 anos ou mais) com sepse, o desenvolvimento de FA se mostrou como fator de risco independente para mortalidade intra-hospitalar.

Muscle Echogenicity and Changes Related to Age and Body Mass Index.

INTRODUCTION: Muscle fibers are lost and replaced by fat- and fibrous-tissue infiltration during aging. This process decreases muscle quality and influences tissue appearance on ultrasound images over time. Increased muscle "echogenicity" represents changes caused by fat- and fibrous-tissue infiltration and can be quantified with recently developed software. OBJECTIVE: To investigate skeletal muscle quality through echogenicity, estimates according to participant's body mass index (BMI) and age were taken. METHODS: This was a cross-sectional study performed at the Pennington Biomedical Research Center, Baton Rouge, Louisiana with 117 participants (57 men and 60 women), with mean age (±SD) 38.9 ± 17.0 years and BMI 28.6 ± 6.2 kg/m². All participants were examined by ultrasound (LOGIQ GE Healthcare), using a 5.0-MHz linear transducer. Participants had muscle thickness measured by ultrasound at 4 anatomic locations (biceps and triceps brachial, femoral quadriceps, and calf triceps). Echogenicity was analyzed with specific software (Pixel Health) that evaluated the image in gray scale. RESULTS: According to BMI, 41% of participants were obese. There was a positive correlation between age and thigh-muscle echogenicity (rp = 0.534, P < .0001) and a negative correlation between thigh-muscle echogenicity and thickness (rp = -0.395, P <.0001). There was high muscle echogenicity in participants with overweight and obesity aged 50 years or older (P < .05). CONCLUSION: Older age and higher BMI were associated with stronger echogenicity signals and smaller muscle thickness. People with overweight, obesity, and/or older than 50 years old have reduced muscle quality with smaller muscle thickness, as observed with ultrasound.

Trend in mortality from preventable causes in children: contributions to the evaluation of the performance of public health services in the Southeast Region of Brazil. / Tendência da mortalidade por causas evitáveis na infância: contribuições para a avaliação de desempenho dos serviços públicos de saúde da Região Sudeste do Brasil.

OBJECTIVE: The aim of this study was to analyze the trend in mortality of children under 5 years old living in the Southeast Region of Brazil and states using the "Brazilian List of Causes of Preventable Deaths". METHOD: We conducted an ecological time-series study of mortality from preventable and non-preventable causes, with corrections for ill-defined causes and underreporting of deaths, from 2000 to 2013. RESULTS: There was a decline in the rate of childhood mortality due to preventable (4.4% per year) and non-preventable (1.9% per year) causes in the Southeast Region and its states, except for those reducible by vaccine prevention, which remained stable in the period. The study called attention to the smaller decrease in causes of preventable deaths by providing adequate care to women during pregnancy (1.7%), with an increase in mortality rates due to basic causes of death due to maternal conditions affecting the fetus or newborn and stability in disorders related to short-term pregnancy and low birth weight, a fact that possibly occurred due to inadequate quality of prenatal care. Minas Gerais showed the greatest reduction in annual percentage of deaths from preventable causes (5.5%), compared to other FUs, but it led in mortality rates up to 2010, while Rio de Janeiro led between 2010 and 2013. CONCLUSION: The decline in childhood mortality was expected in the last decade, due to progress in the response of health care systems, and to improvements in health and determinant social conditions as well. However, the rate is still high compared to other countries, showing that there is still much room for improvement.

OBJETIVO: Analisar a tendência da mortalidade de crianças menores de 5 anos, residentes na Região Sudeste e Unidades Federativas (UFs), utilizando-se a "Lista Brasileira de Causas de Mortes Evitáveis". MÉTODO: Estudo ecológico de séries temporais da taxa de mortalidade por causas evitáveis e não evitáveis, com correções para causas mal definidas e sub-registro de óbitos informados, no período de 2000 a 2013. RESULTADOS: Houve declínio da taxa de mortalidade na infância por causas evitáveis (4,4% ao ano) e não evitáveis (1,9% ao ano) na Região Sudeste e nas UFs, exceto para aquelas reduzíveis por imunoprevenção, que se mantiveram estáveis no período. O estudo chama a atenção para a menor redução das causas de óbitos reduzíveis por adequada atenção à mulher na gestação (1,7%), com aumento das taxas de mortalidade por afecções maternas que afetam o feto e o recém-nascido e a estabilidade nos transtornos relacionados com a gestação de curta duração e peso baixo ao nascer. Minas Gerais apresentou o maior percentual de redução anual dos óbitos por causas evitáveis (5,5%), comparado às demais UFs; no entanto, liderou as taxas de mortalidade até o ano de 2010 e o Rio de Janeiro, entre 2010 e 2013. CONCLUSÃO: O declínio da taxa de mortalidade na infância já era esperado nessa última década, levando a acreditar na evolução da resposta dos sistemas de saúde, além das melhorias nas condições de saúde e determinantes sociais.No entanto, o coeficiente se mantém alto quando comparado ao de outros países, mostrando que ainda há muito a se avançar.

Factors associated with family violence against adolescents based on the results of the National School Health Survey (PeNSE). / Fatores associados aos episódios de agressão familiar entre adolescentes, resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE).

The study analyzes factors associated with family aggression against adolescents. Data from the National School Health Survey for 2015 were analyzed, and the prevalence of physical aggression per family was calculated according to four blocks. The bivariate analysis was performed, calculating the unadjusted Odds Ratio (OR) within each block and the multivariate regression. Familial aggression was reported by 14.5%. The variables associated with the model were: female, black, yellow, brown, mothers with no higher educational level, adolescent workers (OR 2.10 CI 95% 1.78-2.47). In the family context, they remained associated with aggression, lack of parents "understanding" (OR 1.71 CI95% 1.63 -1.80) and their intrusion into adolescent's privacy (OR 1.80 CI95% 1.70 -1, 91). Report of missing school (OR1.43 CI95% 1.36-1.50). Among the behaviors: smoking (OR 1.23 CI95% 1.12-1.34), alcohol (OR 1.49 CI95% 1.41-1.57), drug experience (OR 1.24 CI95% 1, 15-1,33), early sexual intercourse (OR 1.40 CI95% 1.33 -1.48), reports of loneliness, insomnia and bullying (ORa 2.14 CI95% 2.00-2.30). It is concluded by the association between violence and gender, greater victimization of girls, living in unfavorable social and family contexts.

O estudo analisa fatores associados à agressão familiar contra adolescentes. Foram utilizados dados da Pesquisa Nacional de Saúde dos Escolares 2015 e calculada a prevalência de sofrer agressão física por familiar, segundo quatro blocos de investigação. Procedeu-se a análise bivariada, calculando-se os Odds Ratios (ORs) não ajustados e, por fim, foi realizada a regressão multivariada. A agressão familiar foi referida por 14,5%. Variáveis associadas no modelo mutivariado no bloco sociodemográfico foram: sexo feminino, raça cor preta, amarela, parda, mães sem nível superior de escolaridade, adolescente que trabalham (OR 2,10 IC95% 1,78-2,47). No contexto familiar: a falta de compreensão dos pais (OR 1,71 IC95% 1,63 -1,80) e a intromissão na privacidade dos adolescentes (OR 1,80 IC95% 1,70 -1,91). Relato de faltar às aulas (OR 1,43 IC95% 1,36-1,50). Dentre os comportamentos: tabagismo (OR 1,23 IC95% 1,12-1,34), álcool (OR 1,49 IC95% 1,41-1,57), experiência com drogas (OR 1,24 IC95% 1,15-1,33), relação sexual precoce (OR 1,40 IC95% 1,33 -1,48), relato de solidão, insônia e bullying (ORa 2,14 IC95% 2,00-2,30). Conclui-se pela associação entre violência e gênero, maior vitimização das meninas e adolescentes mais jovens, que vivem em contextos sociais e familiares desfavoráveis.

Deaths preventable by actions of the Unified Health System in the population of the Brazilian Southeast Region. / Mortes evitáveis por ações do Sistema Único de Saúde na população da Região Sudeste do Brasil.

This paper aims to analyze the mortality trend in the population aged 5-69 years residing in the Southeast and Federal Units (UF), using the "Brazilian List of Preventable Deaths Causes". An ecological study on time series of the standardized mortality rate from preventable and non-preventable causes, with adjustments for ill-defined causes and underreporting of notified deaths, from 2000 to 2013. A declining mortality rate from preventable (2.4% per year) and non-preventable causes (1.5% per year) was found in the population aged 5-69 years living in the Southeast in the period 2000-2013. A drop in all groups of preventable deaths causes and stability in the maternal death causes was observed. Deaths from noncommunicable diseases fell 2.7% annually and were higher in the age group of 60-69 years in 2013 (211.8/100,000 inhabitants for deaths from ischemic heart disease, 146.3/100,000 inhabitants for cerebrovascular diseases and 96.5/100,000 inhabitants for diabetes). The highest preventable death rates are from chronic noncommunicable diseases and external causes, both of which are sensitive to health promotion and intersectoral interventions, which reinforces the need for integrated health policies.

O objetivo deste artigo é analisar a tendência da mortalidade na população de 5 a 69 anos, residente na região Sudeste e Unidades Federadas (UF), utilizando-se a "Lista Brasileira de Causas de Mortes Evitáveis". Estudo ecológico de séries temporais da taxa de mortalidade padronizada por causas evitáveis e não evitáveis, com correções para as causas mal definidas e o sub-registro de óbitos informados, no período de 2000 a 2013. Evidenciou-se o declínio da taxa de mortalidade na população de 5 a 69 anos residente na região Sudeste por causas evitáveis (2,4% ao ano) e não evitáveis (1,5% ao ano) no período 2000-2013. Houve queda em todos os grupos de causas de mortes evitáveis e estabilidade nas causas de morte materna. As mortes por doenças não transmissíveis reduziram 2,7% ao ano e foram mais elevadas na faixa etária de 60 a 69 anos em 2013 (211,8/100.000 hab. para as mortes por doenças isquêmicas do coração; 146,3/100.000 hab. para as doenças cerebrovasculares; e 96,5/100.000 hab. para diabetes). As taxas de mortes evitáveis mais elevadas são por doenças crônicas não transmissíveis e causas externas, ambas sensíveis às intervenções de promoção da saúde e intersetoriais, o que reforça a necessidade de políticas de saúde integradas.

Preventable deaths in childhood, according to actions of the Unified Health System, Brazil. / Mortes evitáveis na infância, segundo ações do Sistema Único de Saúde, Brasil.

OBJECTIVE: To analyze the mortality trend of children under five years of age living in Brazil and regions, using the "Brazilian List of Preventable Causes of Death." METHOD: Ecological time-series study of mortality rate due to preventable and non-preventable causes, with corrections for ill-defined causes and underreporting of deaths from 2000 to 2013. RESULTS: In Brazil, preventable death rates (5.1% per year) had a higher decrease compared with non-preventable ones (2.5% per year). Preventable causes associated with proper care during pregnancy had the highest concentration of deaths in 2013 (12,267) and the second lowest average percentage reduction in the year (2.1%) and for the period (24.4%). The South and Southeast regions had the lowest mortality rates in childhood. However, the Northeast region had the highest decrease in reducible child mortality (6.1% per year) and the Midwest, the lowest (3.5% per year). CONCLUSION: The decrease in childhood mortality rates was expected in the last decade, suggesting the progress in the response of health systems, in addition to improvements in health conditions and social determinants. Special attention should be given to pregnancy-related causes, i.e., expand the quality of prenatal care, in particular, due to fetal and newborn deaths resulted from maternal conditions, which increased significantly in the period (8,3% per year).

OBJETIVO: Analisar a tendência da mortalidade de crianças menores de cinco anos, residentes no Brasil e regiões, utilizando a "Lista Brasileira de Causas de Mortes Evitáveis". MÉTODO: Estudo ecológico de séries temporais da taxa de mortalidade por causas evitáveis e não evitáveis, com correções para as causas mal definidas e para o sub-registro de óbitos informados, no período de 2000 a 2013. RESULTADOS: No Brasil, houve maior declínio da taxa de mortalidade por causas evitáveis (5,1% ao ano), comparadas com as causas não evitáveis (2,5% ao ano). As causas evitáveis por adequada atenção à gestação constituíram a maior concentração de óbitos em 2013 (12.267) e tiveram a segunda menor redução percentual média anual (2,1%) e do período (24,4%). As menores taxas de mortalidade na infância foram evidenciadas nas regiões Sul e Sudeste. Observa-se, no entanto, que a Região Nordeste apresentou o maior declínio da mortalidade infantil reduzível (6,1% ao ano) e o Centro-Oeste, o menor (3,5% ao ano). CONCLUSÃO: O declínio da taxa de mortalidade na infância já era esperado nessa última década, levando a acreditar na evolução da resposta dos sistemas de saúde, além de nas melhorias nas condições de saúde e determinantes sociais. Atenção especial deve ser oferecida às causas relacionadas à gestação, ou seja, avançar na qualidade do pré-natal, em particular, em razão da ocorrência de mortes no feto e no recém-nascido oriundas de afecções maternas que apresentaram importante acréscimo no período (8,3% ao ano).

Probability of premature death for chronic non-communicable diseases, Brazil and Regions, projections to 2025. / Probabilidade de morte prematura por doenças crônicas não transmissíveis, Brasil e regiões, projeções para 2025.

OBJECTIVE: Objective: To analyze the mortality trends for Chronic Noncommunicable Diseases (NCDs) in the period 2000-2013 and its probability of death until 2025. METHOD: time series analysis of mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory disease, with correction for ill-defined causes and underreporting of deaths and calculation of probability of death. RESULTS: There was an average decline of 2.5% per year in all four major NCDs in Brazil. There was a decline in all regions and federal units. The reduced likelihood of death by 30% in 2000 to 26.1% in 2013 and expected decline to 20.5% in 2025. CONCLUSION: From the trend of reduction is expected to reach Brazil reducing overall goal 25% by 2025.

OBJETIVO: Analisar as tendências de mortalidade por doenças crônicas não transmissíveis (DCNT) no período de 2000 a 2013 e a probabilidade de morte até 2025. MÉTODO: Análise de série temporal de mortalidade das DCNT (doenças cardiovasculares, câncer, diabetes e doenças respiratórias crônicas), com correções para causas mal definidas e sub-registro de óbitos, e a probabilidade de morte por essas doenças. RESULTADOS: Houve declínio médio de 2,5% ao ano no conjunto das quatro principais DCNT no Brasil entre 2000 e 2013, em todas as regiões e unidades federativas. A probabilidade de morte foi reduzida de 30% em 2000 para 26,1% em 2013, e estima-se que caia para 20,5% em 2025. CONCLUSÕES: Dada a tendência de queda, prevê-se que o Brasil atinja a meta global de redução de 25% até 2025.

Prevalence of practice of bullying reported by Brazilian students: data from the National School Health Survey, 2015. / Prevalência da prática de bullying referida por estudantes brasileiros: dados da Pesquisa Nacional de Saúde do Escolar, 2015.

OBJECTIVE: to identify the practice of bullying reported by Brazilian students, according to sex, age and geographical location. METHODS: this was a cross-sectional study based on two national samples from the National School Health Survey (PeNSE), 2015; a total of 102,301 students participated in the study forming a nationally representative sample; data were collected through a self-administered questionnaire. RESULTS: bullying prevalence was 19.8% (95%CI - 19.2;20.3), with higher prevalence in the Southeast region of the country (22.2% - 95%CI 21.1;23.4), and in the State of São Paulo (24.2% - 95%CI 22.3;26.2), however the city with the highest prevalence was Boa Vista (25.5% - 95%CI 22.9;28.1), capital of the State of Roraima; boys (24.2% - 95%CI 23.4;25.0) practiced more bullying than girls (15.6% - 95%CI 14.9;16.2), as did younger students aged 13 to 15 years (22.0% - 95%CI 20.4;23.6). CONCLUSION: higher rates of reported bullying practices were found among adolescents from the Southeast region, among male and younger students.

Prevalence of bullying and associated factors among Brazilian schoolchildren in 2015. / Prevalência de bullying e fatores associados em escolares brasileiros, 2015.

This study analyzed the prevalence of bullying and associated factors among Brazilian schoolchildren using data produced by the 2015 National School Health Survey (PeNSE, acronym in Portuguese) consisting of a national sample of 102,301 eighth grade students. The prevalence of bullying was calculated and bivariate analysis was performed using a 95% confidence level to determine the association between victimization and socio-demographic variables and other variables relating to family background, mental health, and risk behaviors. Multivariate analysis was then conducted using the biologically plausible variables of interest. For the final model, variables that obtained p-values of < 0.05 were maintained. The prevalence of bullying was found to be 7.4%. The results of the multivariate analysis showed that boys aged 13 years studying in public schools who worked and whose mother did not have any schooling were more likely to be bullied, as were schoolchildren who felt lonely, had no friends, suffered from insomnia, skipped lessons without parental permission, and who smoked. Victims of bullying were predominantly 13-year-olds from an unfavorable social and family background, painting a picture of vulnerability that calls for support from social protection networks, schools and families alike .

O estudo analisou a prevalência de sofrer bullying e fatores associados em escolares brasileiros. Trata-se de análise da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015 em amostra nacional com 102.301 alunos do 9º ano. Foi calculada a prevalência de sofrer bullying e foi feita inicialmente análise bivariada com estimativas de razões de chance (OR) e IC95% para estimar as associações entre vitimização e variáveis sociodemográficas, contexto familiar, violência familiar, saúde mental e comportamentos de risco. Posteriormente, procedeu-se ao modelo de regressão logística múltipla, inserindo as variáveis de interesse com (p < 0,20). No modelo final ajustado (ORa) permaneceram variáveis com p < 0,05. A prevalência de bullying foi de 7,4%. A análise multivariada mostrou que quem tem maior chance de sofrer bullying são os escolares do sexo masculino, com 13 anos, da escola pública, filhos de mães sem escolaridade, que trabalham, com relato de solidão, sem amigos, com insônia; que sofreram agressão física dos familiares, faltaram as aulas sem avisar aos pais, usaram tabaco. Predominaram vítimas de 13 anos, com contexto social e familiar desfavorável, mostrando cenário de vulnerabilidades, demandando apoio de redes de proteção social, escolar e famíliar.

Preventable deaths within Brazil's Public Health System in a population from 5 to 69 years old, 2000 - 2013. / Mortes evitáveis no Sistema Único de Saúde na população brasileira, entre 5 e 69 anos, 2000 - 2013.

OBJECTIVES: To analyze the mortality trend in the Brazilian population aged between 5 and 69 years old, using the "Brazilian List of Causes of Preventable Deaths". METHODS: This is an ecological study that uses a time-series analysis of the standardized mortality rate for preventable and unpreventable causes in the period from 2000 to 2013, with corrections for ill-defined causes and the under-reporting of informed deaths. RESULTS: There was a decline in the mortality rate in the Brazilian population aged 5 to 69 due to preventable causes (1.6% per year) and unpreventable causes (1.4% per year), in addition to a decrease among all of the groups of causes of preventable deaths in the period from 2000 - 2013. The study draws attention to the increase in deaths from specific causes such as pneumonia (1.9% per year) and transportation accidents (0.6% per year), as well the stability in the number of deaths from aggression and intentional self-harm. Deaths from noncommunicable diseases fell by 2.2% per year and were highest in the age group of 60 - 69 years old in 2013 (209.9/100,000 inhabitants for ischemic heart disease deaths, 157.2/100,000 inhabitants for cerebrovascular diseases and 116.8/100,000 inhabitants for diabetes). CONCLUSION: The rates of preventable deaths are still high, especially for noncommunicable diseases and external causes. These causes of death are sensitive to health promotion interventions and, therefore, this study reinforces the need to remain focused on these causes of illness and death, as well as their risk factors.

Use of psychoactive substances among Brazilian adolescents and associated factors: National School-based Health Survey, 2015. / Uso de substâncias psicoativas em adolescentes brasileiros e fatores associados: Pesquisa Nacional de Saúde dos Escolares, 2015.

AIM: To analyze the consumption of tobacco, alcohol and illicit drugs among schoolchildren according to demographic factors, family context and mental health. METHODS: We used data from the National School-based Health Survey 2015 and included in the sample 102,301 schoolchildren in the 9th grade. We estimated the prevalence of tobacco and alcohol use in the last 30 days and drug experimentation according to demographic, mental health and family context variables. Then, a bivariate analysis was performed using Pearson's χ2 test and the unadjusted odds ratio (OR) was calculated. Finally, we conducted a multivariate analysis including independent variables with an unadjusted association (p < 0.20), for each outcome, estimating the adjusted OR with a 95% confidence interval. RESULTS: The prevalence of tobacco consumption was 5.6%; alcohol consumption, 23.8%; and drug experimentation, 9.0%. Multivariate analysis has indicated that living with parents, having meals with parents or guardian, and family supervision were associated with lower substance consumption; whereas missing classes without parental consent has increased the chances of substance use. Increased chance of substance use was also associated with white skin color, increasing age, to work, feeling lonely and having insomnia. Not having friends was associated with drug and tobacco use, but this was protective for alcohol consumption. CONCLUSIONS: Family supervision was protective for psychoactive substance use among Brazilian schoolchildren, whereas work, loneliness and insomnia have increased their chances of use.

OBJETIVO: Analisar o uso de substâncias psicoativas (tabaco, álcool e drogas ilícitas) em escolares em relação a fatores sociodemográficos, contexto familiar e saúde mental. MÉTODOS: Foram utilizados dados da amostra de 102.301 escolares do nono ano da Pesquisa Nacional de Saúde do Escolar de 2015. Realizou-se o cálculo da prevalência de uso de tabaco e de álcool nos últimos 30 dias e experimentação de drogas, segundo variáveis sociodemográficas, contexto familiar e saúde mental. Procedeu-se a análise univariada, por teste do χ2 de Pearson e cálculo das odds ratios (OR) não ajustadas. Por fim, realizou-se análise multivariada para cada desfecho com as variáveis que apresentaram associação com os desfechos (p < 0,20), calculando-se as OR ajustadas com intervalo de confiança de 95%. RESULTADOS: A prevalência de uso de tabaco foi de 5,6%; do uso de álcool, 23,8%; e da experimentação de drogas, 9,0%. A análise multivariada apontou que, no contexto familiar, morar com os pais, fazer refeição com pais ou responsável e a supervisão familiar foram associados a menor uso de substâncias; enquanto faltar às aulas sem consentimento dos pais aumentou a chance de uso. Maior chance do uso de substâncias esteve ainda associada a cor branca, aumento da idade, trabalhar, sentir-se solitário e ter insônia. Não ter amigos foi associado com uso de drogas e tabaco, porém foi protetor para o uso de álcool. CONCLUSÕES: A supervisão familiar foi protetora do uso de substâncias psicoativas em escolares brasileiros, enquanto trabalhar, sentir-se solitário e ter insônia aumentaram suas chances de uso.

Factors associated with the use of waterpipe and other tobacco products among students, Brazil, 2015. / Fatores associados ao uso de narguilé e outros produtos do tabaco entre escolares, Brasil, 2015.

OBJECTIVE: To identify the frequency and factors associated with the use of waterpipe and other tobacco products among Brazilian students. METHODS: This is a cross-sectional study based on data from the National Adolescent Student Health Survey. The sample consisted of 9th-grade students from elementary school. We conducted a descriptive analysis of the use of tobacco products in 2012 and 2015. To explore the relationship between the use of other tobacco products and factors such as sociodemographic characteristics, family, mental health, and life habits, we calculated the adjusted odds ratio. RESULTS: The use of other tobacco products increased from 4.8% (95%CI 4.6 - 5.0) in 2012 to 6.1% (95%CI 5.7 - 6.4) in 2015, with a higher proportion among boys. Waterpipe was the most commonly used product in 2015 (71.6%; 95%CI 68.8 - 74.2), especially among girls. Factors positively associated with the use of other tobacco products were: attending private school, living with father/mother, working, not having friends, suffering domestic violence, skipping classes, consuming cigarettes and alcohol, experimenting drug, having had sex, having smoker parents or guardians, and seeing people smoking. The protective factors were: female gender, increasing age, multiracial or indigenous people, having meals with a guardian, family supervision, and practicing physical activity. CONCLUSION: The use of other tobacco products was high and has been increasing in recent years, particularly waterpipe. It is important to raise awareness of the risks and monitor the use of these products, as well as improve public policies of tobacco control in the country.

OBJETIVO: Identificar a frequência e os fatores associados ao uso de narguilé e outros produtos do tabaco entre os escolares brasileiros. MÉTODOS: Estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar. A amostra foi composta por alunos do 9º ano do Ensino Fundamental. Foi realizada análise descritiva do uso de produtos do tabaco em 2012 e 2015. Para explorar a relação de fatores como características sociodemográficas, familiares, saúde mental e hábitos de vida com o uso de outros produtos do tabaco, foram calculados odds ratio ajustados. RESULTADOS: O uso de outros produtos do tabaco aumentou de 4,8% (IC95% 4,6 - 5,0), em 2012, para 6,1% (IC95% 5,7 - 6,4), em 2015, com maior proporção em meninos. O narguilé foi o produto mais usado em 2015 (71,6%; IC95% 68,8 - 74,2), sendo mais frequente em meninas. Foram positivamente associados ao uso de outros produtos do tabaco: escola privada, morar com pai/mãe, trabalhar, não ter amigos, sofrer violência familiar, faltar às aulas, fazer uso de cigarros e álcool, ter experimentado drogas, já ter tido relação sexual, ter pais ou responsáveis fumantes e presenciar pessoas fumando. Os fatores de proteção foram: sexo feminino, incremento da idade, cor da pele parda ou indígena, fazer refeições com responsável, ter supervisão familiar e praticar atividade física. CONCLUSÃO: Conclui-se que o uso de outros produtos do tabaco foi elevado, com aumento nos últimos anos, destacando-se o narguilé. Torna-se importante a conscientização dos riscos e a vigilância do uso desses produtos, bem como o avanço das políticas públicas de controle do tabagismo no país.

Fibrilação Atrial e Sepse em Pacientes Idosos e sua Associação com Mortalidade Intra-hospitalar / Atrial Fibrillation and Sepsis in Elderly Patients and Their Associaton with In-Hospital Mortality

Resumo Fundamento A fibrilação atrial (FA) acomete cerca de 2% a 4% da população mundial. Nos pacientes internados em unidades de terapia intensiva, esta incidência pode chegar em até 23% naqueles com choque séptico. O impacto da FA nos pacientes sépticos se reflete em piores desfechos clínicos e o reconhecimento dos fatores desencadeantes pode ser alvo para estratégias de tratamento e prevenção futuras. Objetivos Verificar a relação entre desenvolvimento de FA e mortalidade nos pacientes acima de 80 anos incluídos no protocolo sepse e identificar fatores de risco que contribuam para o desenvolvimento de FA nesta população. Métodos Estudo observacional retrospectivo, com revisão de prontuários eletrônicos e inclusão de 895 pacientes com 80 anos ou mais, incluídos no protocolo sepse de um hospital privado de alta complexidade em São Paulo/SP, no período de janeiro de 2018 a dezembro de 2020. Todos os testes foram realizados com nível de significância de 5%. Resultados A incidência de FA na amostra foi de 13%. Após análise multivariada por regressão logística múltipla, foi possível demonstrar associação de mortalidade na população estudada, com o escore SOFA ( odds ratio [OR] 1,21 [1,09 - 1,35]), valores mais altos de proteína C-reativa (OR 1,04 [1,01 - 1,06]), necessidade de droga vasoativa (OR 2,4 [1,38 - 4,18]), uso de ventilação mecânica (OR 3,49 [1,82 - 6,71]) e principalmente FA (OR 3,7 [2,16 - 6,31). Conclusões No paciente grande idoso (80 anos ou mais) com sepse, o desenvolvimento de FA se mostrou como fator de risco independente para mortalidade intra-hospitalar.

Abstract Background Atrial fibrillation (AF) affects about 2% to 4% of the world population, and in patients hospitalized in intensive care units, this incidence can reach up to 23% in those with septic shock. The impact of AF in patients with sepsis is reflected in worse clinical outcomes, and the identification of the triggering factors can be a target for future prevention and treatment strategies. Objectives To verify the relationship between the development of AF and mortality in patients over 80 years of age included in the sepsis protocol and to identify the risk factors that contribute to the development of AF in this population. Methods Retrospective observational study, with a review of electronic medical records and inclusion of 895 patients aged 80 years or older, included in the sepsis protocol of a high-complexity private hospital in São Paulo, SP, from January 2018 to December 2020. All tests were performed with a significance level of 5%. Results The incidence of AF in the sample was 13%. After multivariate analysis, using multiple logistic regression, it was possible to demonstrate an association of mortality, in the studied population, with the SOFA score (odds ratio [OR] 1.21 [1.09 - 1.35]), higher values of C-reactive protein (OR 1.04 [1.01 - 1.06]), need for vasoactive drugs (OR 2.4 [1.38 - 4.18]), use of mechanical ventilation (OR 3.49 [1.82 - 6.71]), and mainly AF (OR 3.7 [2.16 - 6.31]) Conclusion In very elderly patients (80 years of age and older) with sepsis, the development of AF was shown to be an independent risk factor for in-hospital mortality.

Family influence on the consumption of sugary drinks by children under two years old.

OBJECTIVE: To evaluate the influence of family habits and household characteristics on the consumption of sugary drinks by Brazilian children under two years old. METHODS: This was a cross-sectional study that used secondary data generated by the National Health Survey (PNS) in 2013. We studied 4,839 pairs of children under two years old and adults living in the same house. We estimated the prevalence of the indicator of sugary drinks consumption for the total sample of children and according to family and household variables. We applied multiple logistic regression analysis to evaluate the influence of family habits and household characteristics on the consumption of sugary drinks by the children. RESULTS: The consumption of sugary drinks was identified in 32% of the studied children (95%CI 30.6-33.3) and was independently associated with the following family and household characteristics: regular consumption of sugary drinks by the adult living in the house (OR = 1.78; 95%CI 1.51-2.10), watching TV for more than three hours per day (OR = 1.22; 95%CI 1.03-1.45), older age (OR = 3.10; 95%CI 1.54-6.26), greater education level (OR = 0.70; 95%CI 0.53-0.91), house located in the Northeast region (OR = 0.65; 95%CI 1.54-6.26), and number of family members (OR = 1.05; 95%CI 1.00-1.09). CONCLUSIONS: Our findings indicate the high prevalence of sugary drinks consumption by Brazilian children under two years old and show that sociodemographic characteristics and family habits affect this feeding practice not recommended in childhood.

OBJETIVO: Avaliar a influência de hábitos familiares e características do domicílio sobre o consumo de bebidas açucaradas em crianças brasileiras menores de dois anos. MÉTODOS: Estudo transversal que utilizou dados secundários gerados pela Pesquisa Nacional de Saúde (PNS), em 2013. Foram estudados 4.839 pares de crianças menores de dois anos e adultos residentes no mesmo domicílio. Foram estimadas as prevalências do indicador consumo de bebidas açucaradas para a amostra total de crianças e segundo categorias de variáveis familiares e do domicílio. Aplicou-se análise de regressão logística múltipla para avaliar a influência de hábitos familiares e características do domicílio sobre o consumo de bebidas açucaradas pelas crianças. RESULTADOS: O consumo de bebidas açucaradas foi identificado em 32% das crianças estudadas (IC95% 30,6-33,3) e esteve independentemente associado com as seguintes caraterísticas familiares e domiciliares: consumo regular de bebidas açucaradas pelo adulto residente no domicílio (OR = 1,78; IC95% 1,51-2,10), hábito de assistir TV por mais de 3 horas diárias (OR = 1,22; IC95% 1,03-1,45), maior idade (OR = 3,10; IC95% 1,54-6,26), maior escolaridade (OR = 0,70; IC95% 0,53-0,91), domicílio localizado na região Nordeste (OR = 0,65; IC95% 1,54-6,26) e número de componentes da família (OR = 1,05; IC95% 1,00-1,09). CONCLUSÕES: Os achados apontam a alta prevalência de consumo de bebidas açucaradas em crianças brasileiras menores de dois anos e que características sociodemográficas e hábitos familiares influenciam essa prática alimentar não recomendada na infância.

Assessment in the primary care of the State of São Paulo, Brazil: incipient actions in sexual and reproductive health.

OBJECTIVE: The objective of this study is to assess performance in sexual and reproductive health of primary health care services of the Brazilian Unified Health System, in the State of São Paulo, Brazil. METHODS: An evaluative framework was built for sexual and reproductive health with the categorization of 99 indicators in three domains: sexual and reproductive health promotion (25), sexually transmitted infections/AIDS prevention and care (43), and reproductive health care (31). This framework was applied to assess the services responses to the questionnaire of Quality Evaluation of Primary Health Care in the Municipalities of São Paulo State (QualiAB), in 2010. Percentages were calculated for positive responses to indicators and performance in the sexual and reproductive health dimension, according to domains, and their contribution to the overall score in sexual and reproductive health (Friedman), relative participation (Dunn), and correlation (Spearman) was verified. RESULTS: Overall, 2,735 services participated in the study. They were located in 586 municipalities (distributed throughout the 17 regional health departments of São Paulo), of which 70.6% had fewer than 100,000 inhabitants. The overall average performance of these services for sexual and reproductive health is 56.8%. The actions are characterized by: prenatal with adequate beginning and exams, better organization for immediate rather than for late postnatal care, and selective reproductive planning for some contraceptives; prevention based on specific protection, limitations in the prevention of congenital syphilis, in the treatment of sexually transmitted infections, and in the screening of cervical and breast cancer; specific educational activities, with a restricted vulnerability approach, focus on sexuality over reproduction. The domain of reproductive health has greater participation in the overall score, followed by prevention/care and promotion. The three domains are correlated; the domain of prevention/care has the highest correlation with the other ones. CONCLUSIONS: The implementation of sexual and reproductive health in primary health care in the services studied is incipient. The revision of the purpose of the work, the dissemination of technologies, and the investing in permanent education are needed. The evaluative framework built can be used by the sexual and reproductive health program services and management in primary health care, thereby contributing to their actions. OBJETIVO: Avaliar o desempenho em saúde sexual e reprodutiva de serviços de atenção primária à saúde do Sistema Único de Saúde, no estado de São Paulo. MÉTODOS: Construiu-se quadro avaliativo para a saúde sexual e reprodutiva com a categorização de 99 indicadores em três domínios: promoção à saúde sexual e reprodutiva (25), prevenção e assistência às doenças sexualmente transmissíveis/aids (43), e atenção à saúde reprodutiva (31). Esse quadro foi aplicado para avaliar as respostas dos serviços ao questionário Avaliação da Qualidade da Atenção Básica em Municípios de São Paulo (QualiAB), em 2010. Calcularam-se as porcentagens de respostas positivas aos indicadores e o desempenho na dimensão saúde sexual e reprodutiva, segundo os domínios; e verificou-se sua contribuição para o escore geral em saúde sexual e reprodutiva (Friedman), participação relativa (Dunn) e correlação (Spearman). RESULTADOS: Participaram 2.735 serviços, localizados em 586 municípios (distribuídos nos 17 departamentos regionais de saúde paulistas), dos quais 70,6% municípios com menos de 100.000 habitantes. A média geral do desempenho desses serviços para saúde sexual e reprodutiva é 56,8%. As ações são caracterizadas por: pré-natal com início e exames adequados, melhor organização para puerpério imediato do que tardio, e planejamento reprodutivo seletivo para alguns contraceptivos; prevenção baseada em proteção específica, limites na prevenção da sífilis congênita, no tratamento de doenças sexualmente transmissíveis, no rastreamento do câncer cervical e mamário; atividades educativas pontuais, com restrita abordagem das vulnerabilidades, predomínio do enfoque da sexualidade centrado na reprodução. O domínio saúde reprodutiva tem maior participação no escore geral, seguido de prevenção/assistência e promoção. Os três domínios estão correlacionados; o domínio prevenção/assistência apresenta as maiores correlações com os demais. CONCLUSÕES: A implementação da saúde sexual e reprodutiva na atenção primária à saúde nos serviços estudados é incipiente. É necessário rever finalidades do trabalho, disseminar tecnologias e investir em educação permanente. O quadro avaliativo construído pode ser utilizado pelos serviços e pela gestão do programa de saúde sexual e reprodutiva na atenção primária à saúde e contribuir para suas ações.

The practice of bullying among Brazilian schoolchildren and associated factors, National School Health Survey 2015. / A prática de bullying entre escolares brasileiros e fatores associados, Pesquisa Nacional de Saúde do Escolar 2015.

This study explored associations between bullying and sociodemographic, mental health and risk behavior variables in school age children. This cross-sectional survey analyzed data from the National School Health Survey (PeNSE 2015). A multiple logistic regression analysis checked for factors associated with bullying. Nineteen point eight percent (95%CI 10.5 - 20.0) of the students claimed they practiced bullying. The practice of bullying was more common among students enrolled in private schools, those living with their parents, and those whose mothers have more years of schooling and are gainfully employed (28.1% CI 27.3-28.8). In terms of mental health characteristics, bullying was more common among those feeling alone, suffering from insomnia and with no friends. Looking at family characteristics, those reporting they are physically punished by family members (33.09% CI 33.1-34.6) and miss school without telling their family (28.4% 95% CI 27.9-29.0) are more likely to practice bullying. Bullying was more frequent among those reporting tobacco, alcohol and drug use, and among students claiming to have had sexual relations. The data shows that bullying is significant and interferes in school children's health and the teaching-learning process. This must be addressed looking at youth as protagonists and in an inter-sectoral context.

The use of other tobacco products among Brazilian school children (PeNSE 2012). / Uso de outros produtos do tabaco entre escolares brasileiros (PeNSE 2012).

The goal of this paper is to estimate the prevalence and to identify factors related to the use of other tobacco products among schoolchildren. A cross-sectional study was conducted with a representative sample of high school students enrolled in the 9th grade. A total of 109,104 students were interviewed, and 4.8% of them had used other tobacco products in the previous 30 days. The factors that increased the likelihood of using other tobacco products were: male gender, being administratively dependent on the school, having a job, living with mother and/or father, perception that the parents or guardians would not care if they smoked, having difficulties sleeping, not having close friends, having experienced domestic violence, skipping classes, having used tobacco and alcohol within the past 30 days, having experimented drugs, having smoking parents or guardians, having seen people smoking. The prevalence of using other tobacco products is high among Brazilian students, and is associated with higher socioeconomic conditions, presence of risk behavior, and living in an environment permissible to tobacco use.

Risk and protective factors for noncommunicable chronic diseases in adolescents by race/skin color: National Adolescent School-Based Health Survey. / Fatores de risco e proteção de doenças e agravos não transmissíveis em adolescentes segundo raça/cor: Pesquisa Nacional de Saúde do Escolar.

INTRODUCTION:: The race/skin color is an important predictor of health status of the population, as well as a marker of social inequalities. OBJECTIVE:: The aim of this paper was to describe the prevalence of the main risks and the protective factors for chronic diseases in schoolchildren, according to race/skin color differences. METHODS:: Data from the National Adolescent School-Based Health Survey (2012) were used. This is a cross-sectional study carried out in public and private schools. Prevalences were calculated according to the distribution by race/skin color. Prevalence ratios adjusted for age and maternal schooling were analyzed. RESULTS:: White adolescents were younger, studied more frequently in private schools and had mothers with higher levels of education in comparison to the other students. Consumption of beans and fruits was higher among black, brown, and indigenous participants. Physical activity was more frequent among indigenous people. Experimentation with alcohol was higher among white adolescents. Indigenous students reported greater physical violence. Asian and black adolescents reported experiencing greater bullying. CONCLUSION:: Minimizing racial and ethnic disparities in health is necessary to disease prevention and health promotion among adolescents.

Bullying and associated factors in adolescents in the Southeast region according to the National School-based Health Survey. / Bullying e fatores associados em adolescentes da Região Sudeste segundo a Pesquisa Nacional de Saúde do Escolar.

OBJECTIVE:: To estimate the prevalence of bullying from the perspective of victims in students from the Southeast region of Brazil and analyze its association with individual variables and family context. METHODS:: Information on 19,660 adolescents from the National School-based Health Survey was analyzed, calculating the association between bullying and sociodemographic variables, risk behaviors, mental health, and family background. Multivariate analysis and the calculation of odds ratio and confidence intervals were performed. RESULTS:: The prevalence of bullying was 7.8% (95%CI 6.5 - 9.2). After adjustment, the following associations were observed: students with less than 13 years of age (OR = 2.40; 1.4 - 3.93); protection for those aged 14, 15, and 16 years; male gender (OR = 1.47; 95%CI 1.35 - 1.59); black color (OR = 1.24; 95%CI 1.11 - 1.40); yellow color (OR = 1.38 95%CI 1.14 - 1.6); private school students (OR = 1.11; 95%CI 1.01 - 1.23); and students who work (OR = 1.30; 95%CI 1.16 - 1.45). Higher education of the mothers was a protective factor in all groups. Risk factors considered were feeling lonely (OR = 2.68; 95%CI 2.45 - 2.94), having insomnia (OR = 1.95; 95%CI 1.76 - 2.17), having no friends (OR = 1.47; 95%CI 1.24 - 1.75), suffering physical abuse from family members (OR = 1.83; 95%CI 1.66 - 2.03), missing classes without their parents' knowledge (OR = 1.23; 95%CI 1.12 - 1.34), as well as family supervision (OR = 1.14; 95%CI 1.05 - 1.23). To have drunk in the last 30 days (OR = 0.88 95%CI 0.8 - 0.97) was a protective factor. CONCLUSION:: Bullying increases vulnerabilities among students, which suggests the need for an intersectoral approach in order to find measures to prevent them.

Associations between the practice of bullying and individual and contextual variables from the aggressors' perspective.

OBJECTIVES: To estimate the prevalence of bullying among Brazilian students from the aggressor's perspective and to analyze its association with individual and contextual variables. METHODS: This was a cross-sectional population-based study carried out with data from the National Survey on Student Health. A total of 109,104 students attending eight grade in public and private schools were included. Data were collected through a self-applied questionnaire. A model of association between bullying and variables in the following domains was tested: sociodemographics, risk behaviors, mental health, and family context. Univariate and multivariate analyses were also performed. RESULTS: The prevalence of aggressors in bullying situations was 20.8%. The following variables remained associated in the final multivariate model: male gender (OR: 1.87; 95% CI: 1.79-1.94), lower participation of 16-year-old students (OR: 0.66; 95% CI: 0.53-0.82), and students from private schools (OR: 1.33; 95% CI: 1.27-1.39). Most aggressors reported feeling lonely (OR: 1.22; 95% CI: 1.16-1.28), insomnia episodes (OR: 1.21; 95% CI: 1.14-1.29), and a high prevalence of physical violence in the family (OR: 1.97 95% CI: 1.87-2.08). Aggressors missed classes more frequently (OR: 1.45; 95% CI: 1.40-1.51), and they regularly consumed more tobacco (OR: 1.21; 95% CI: 1.12-1.31), alcohol (OR: 1.85; 95% CI: 1.77-1.92), and illegal drugs (OR: 1.91; 95% CI: 1.79-2.04); they also demonstrated increased sexual intercourse (OR: 1.49 95% CI: 1.43-1.55) and regular exercise (OR: 1.20; 95% CI: 1.16-1.25). CONCLUSIONS: The data indicate that bullying is an important aspect that affects the learning-teaching process and the students' health.