Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study).

OBJECTIVE: Guidelines for the adrenergic support of septic shock are controversial. In patients with community-acquired septic shock, we assessed the impact of the choice of vasopressor support on mortality. DESIGN: Cohort, multiple center, observational study. SETTING: Seventeen Portuguese intensive care units (ICUs). PATIENTS: All adult patients admitted to a participating ICU between December 2004 and November 2005. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were followed up during the first five ICU days, the day of discharge or death, and hospital outcome. Eight hundred ninety-seven consecutive patients with community-acquired sepsis (median age, 63 years; 577 men; and hospital mortality, 38%) were studied. Of the 458 patients with septic shock, 73% received norepinephrine and 50.5% dopamine. The norepinephrine group had a higher hospital mortality (52% vs. 38.5%, p = 0.002). A Kaplan-Meier survival curve showed diminished 28-day survival in the norepinephrine group (log-rank = 22.6, p < 0.001). A Cox proportional hazard analysis revealed that the administration of norepinephrine was associated with an increased risk of death (adjusted hazard ratio, 2.501; 95% confidence interval, 1.413-4.425; p = 0.002). In a multivariate analysis with ICU mortality as the dependent factor, Simplified Acute Physiology Score II and norepinephrine administration were independent risk factors for ICU mortality in patients with septic shock. CONCLUSIONS: In patients with community-acquired septic shock, our data suggest that norepinephrine administration could be associated with worse outcome.

Sun protection behaviour and skin cancer literacy among outdoor runners.

Outdoor runners have an increased risk of melanoma and non-melanoma skin cancer. The purpose of this study was to assess skin cancer literacy and sun exposure and protection behaviour among outdoor runners during training. A cross-sectional survey-based study was conducted. All athletes registered for four consecutive running events in Porto: the Porto Marathon (November 2014), the Fathers' Day 10-km race (March 2015), the Saint John's Day 15-km race (June 2015), and the Porto half-marathon (September 2015). Athletes were invited to answer an online survey with 23 questions on the following items: sociodemographic and constitutional factors, skin cancer literacy, and sun exposure and protection behaviour. A scoring system was devised to analyse behaviour. Multivariate analysis was performed. The survey was completed by 2,445 runners, 2,159 of whom trained outdoors. Only 23.5% had adequate sun exposure and protection behaviour. A higher proportion of women than men had adequate behaviour (33% versus 17%; P < 0.001). Athletes with a university, or higher degree were more knowledgeable about skin cancer than those with a lower level of education, however, their behaviour in relation to sun exposure and protection was the same. Based on multivariate analysis, gender, skin type, marital status, and average number of hours spent training significantly affected attitude score. Investment in more targeted campaigns, aimed particularly at high-risk groups such as outdoor athletes, is essential to modify attitudes and behaviour regarding sun exposure and protection. Outdoor sports event organisers and sport associations also need to engage.