Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score.

BACKGROUND: The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died. METHODS: This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score. RESULTS: From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641-0.944) and 0.704 (95% IC: 0.617-0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001). CONCLUSIONS: The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.

Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry.

Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11-2.02); being an ex-smoker (OR 1.44, 95% CI 1.03-2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14-4.23); axillary temperature (OR 1.41, 95% CI 1.22-1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26-3.67), lactate (OR 1.10, 95% CI 1.02-1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01-1.18); and neutrophil count (OR 1.04, 95% CI 1.005-1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.

Diagnostic accuracy of a SARS-CoV-2 rapid test and optimal time for seropositivity according to the onset of symptoms.

Point-of-care serological tests for SARS-CoV-2 have been used for COVID-19 diagnosis. However, their accuracy over time regarding the onset of symptoms is not fully understood. We aimed to assess the accuracy of a point-of-care lateral flow immunoassay (LFI). Subjects, aged over 18 years, presenting clinical symptoms suggestive of acute SARS-CoV-2 infection were tested once by both nasopharyngeal and oropharyngeal RT-PCR and LFI. The accuracy of LFI was assessed in periodic intervals of three days in relation to the onset of symptoms. The optimal cut-off point was defined as the number of days required to achieve the best sensitivity and specificity. This cut-off point was also used to compare LFI accuracy according to participants' status: outpatient or hospitalized. In total, 959 patients were included, 379 (39.52%) tested positive for SARS-CoV-2 with RT-PCR, and 272 (28.36%) tested positive with LFI. LFI best performance was achieved after 10 days of the onset of symptoms, with sensitivity and specificity of 84.9% (95%CI: 79.8-89.1) and 94.4% (95%CI: 91.0-96.8), respectively. Although the specificity was similar (94.6% vs. 88.9%, p = 0.051), the sensitivity was higher in hospitalized patients than in outpatients (91.7% vs. 82.1%, p = 0.032) after 10 days of the onset of symptoms. Best sensitivity of point-of-care LFI was found 10 days after the onset of symptoms which may limit its use in acute care. Specificity remained high regardless of the number of days since the onset of symptoms.

Diagnostic accuracy of a SARS-CoV-2 rapid test and optimal time for seropositivity according to the onset of symptoms / Acurácia diagnóstica de um teste rápido para SARS-CoV-2 e tempo ótimo para a soropositividade a partir do início dos sintomas / Precisión diagnóstica del test rápido SARS-CoV-2 y período óptimo para la seropositividad según la aparición de síntomas

Point-of-care serological tests for SARS-CoV-2 have been used for COVID-19 diagnosis. However, their accuracy over time regarding the onset of symptoms is not fully understood. We aimed to assess the accuracy of a point-of-care lateral flow immunoassay (LFI). Subjects, aged over 18 years, presenting clinical symptoms suggestive of acute SARS-CoV-2 infection were tested once by both nasopharyngeal and oropharyngeal RT-PCR and LFI. The accuracy of LFI was assessed in periodic intervals of three days in relation to the onset of symptoms. The optimal cut-off point was defined as the number of days required to achieve the best sensitivity and specificity. This cut-off point was also used to compare LFI accuracy according to participants' status: outpatient or hospitalized. In total, 959 patients were included, 379 (39.52%) tested positive for SARS-CoV-2 with RT-PCR, and 272 (28.36%) tested positive with LFI. LFI best performance was achieved after 10 days of the onset of symptoms, with sensitivity and specificity of 84.9% (95%CI: 79.8-89.1) and 94.4% (95%CI: 91.0-96.8), respectively. Although the specificity was similar (94.6% vs. 88.9%, p = 0.051), the sensitivity was higher in hospitalized patients than in outpatients (91.7% vs. 82.1%, p = 0.032) after 10 days of the onset of symptoms. Best sensitivity of point-of-care LFI was found 10 days after the onset of symptoms which may limit its use in acute care. Specificity remained high regardless of the number of days since the onset of symptoms.

Os testes sorológicos no local de atendimento (point-of-care) para a infecção pelo SARS-CoV-2 têm sidos utilizados para o diagnóstico da COVID-19. Entretanto, não está plenamente elucidada a acurácia dos testes ao longo do tempo em relação ao início dos sintomas. Nosso objetivo foi de avaliar a acurácia, no local de atendimento, do imunoensaio de fluxo lateral (LFI). Pacientes com ≥ 18 anos de idade que apresentavam sintomas clínicos sugestivos de infecção aguda pelo SARS-CoV-2 foram testados uma vez com RT-PCR da nasofaringe e orofaringe, além do LFI. A acurácia do LFI foi avaliada com intervalos periódicos de 3 dias a partir do início dos sintomas. O ponto de corte ótimo foi definido como o número necessário de dias para atingir a melhor sensibilidade e especificidade. Esse ponto foi utilizado também para comparar a acurácia do LFI de acordo com a situação do paciente (ambulatorial ou hospitalizado). Foram incluídos 959 pacientes, dos quais 379 (39,52%) testaram positivos para SARS-CoV-2 pelo RT-PCR e 272 (28,36%) pelo LFI. Foi atingido o melhor desempenho para o LFI com 10 dias a partir do início dos sintomas, com sensibilidade e especificidade de 84,9% (IC95%: 79,8-89,1) e 94,4% (IC95%: 91,0-96,8), respectivamente. Embora a especificidade não tenha sido diferente entre os grupos de pacientes (94,6% vs. 88,9%, p = 0,051), a sensibilidade foi mais alta nos pacientes hospitalizados que nos ambulatoriais (91,7% vs. 82,1%, p = 0,032) no dia 10 depois do início dos sintomas. A melhor sensibilidade do LFI no local de atendimento ocorre 10 dias depois do início dos sintomas, o que pode limitar seu uso no atendimento agudo. A especificidade permanece alta, independentemente do número de dias desde o início dos sintomas.

Los puestos de atención para pruebas serológicas del SARS-CoV-2 han sido usado para la diagnosis de la COVID-19. No obstante, su precisión a lo largo del tiempo, en lo que respecta a la aparición de los síntomas, no se ha comprendido completamente. Nuestro objetivo fue evaluar la precisión de un puesto de atención de inmunoanálisis de flujo lateral (LFI). Se hizo pruebas a individuos ≥ 18 años, presentando síntomas clínicos compatibles con una infección aguda de SARS-CoV-2, tanto vía nasofaríngea y orofaríngea RT-PCR, como LFI. La precisión de LFI fue evaluada en intervalos periódicos de 3 días con respecto a la aparición de los síntomas. El punto óptimo de corte se definió como el número de días requerido para alcanzar la mejor sensibilidad y especificidad. Este punto también se usó para comparar la precisión del LFI, según el estatus de los participantes: ambulatorios u hospitalizados. Se incluyeron a 959 pacientes, 379 (39,52%) dieron positivo en las pruebas de SARS-CoV-2 RT-PCR, y 272 (28,36%) fueron positivos en los LFI. Se alcanzó el mejor rendimiento de los LFI tras 10 días de la aparición de los síntomas, con una sensibilidad y especificidad de un 84,9% (IC95%: 79,8-89,1) y 94,4% (IC95%: 91,0-96,8), respectivamente. A pesar de que la especificidad no fue diferente (94,6% vs. 88,9%, p = 0,051), la sensibilidad fue mayor en pacientes hospitalizados que en los ambulatorios (91,7% vs. 82,1%, p = 0,032) tras 10 días desde la aparición de los síntomas. La mejor sensibilidad LFI del puesto de cuidado se produce tras 10 días de la aparición de los síntomas, lo que quizás limite su uso en el cuidado de urgencias. La especificidad permanece alta independientemente del número de días desde la aparición de los síntomas.

Clinical characteristics and predictors of mechanical ventilation in patients with COVID-19 hospitalized in Southern Brazil. / Características clínicas e preditores de ventilação mecânica em pacientes com COVID-19 hospitalizados no sul do país.

OBJECTIVE: This study aims to describe the clinical characteristics and predictors of mechanical ventilation of adult inpatients with COVID-19 in a single center. METHODS: A retrospective cohort study was performed and included adult inpatients hospitalized from March 17th to May 3rd, 2020, who were diagnosed with SARS-CoV-2 infection. Clinical and demographic characteristics were extracted from electronic medical records. RESULTS: Overall, 88 consecutive patients were included in this study. The median age of the patients was 63 years (IQR 49 - 71); 59 (67%) were male, 65 (86%) had a college degree and 67 (76%) had at least one comorbidity. Twenty-nine (33%) patients were admitted to the intensive care unit, 18 (20%) patients needed mechanical ventilation, and 9 (10.2%) died during hospitalization. The median length of stay in the intensive care unit and the median duration of mechanical ventilation was 23 and 29.5 days, respectively. An age ≥ 65 years was an independent risk factor for mechanical ventilation (OR 8.4 95%CI 1.3 - 55.6 p = 0.02). CONCLUSION: Our findings describe the first wave of Brazilian patients hospitalized for COVID-19. Age was the strongest predictor of respiratory insufficiency and the need for mechanical ventilation in our population.

OBJETIVO: Descrever as características clínicas e os preditores de ventilação mecânica em pacientes adultos internados com COVID-19. MÉTODOS: Conduziu-se um estudo de coorte retrospectiva com inclusão de pacientes hospitalizados entre 17 de março e 3 de maio de 2020, que tiveram o diagnóstico de infecção pelo SARS-CoV-2. As características clínicas e demográficas foram extraídas de registros em prontuário eletrônico. RESULTADOS: Incluíram-se no estudo 88 pacientes consecutivos. A mediana da idade dos pacientes foi de 63 anos (IQR: 49 - 71); 59 (67%) pacientes eram do sexo masculino, 65 (86%) tinham educação universitária e 67 (76%) tinham, no mínimo, uma comorbidade. Dentre eles, 29 (33%) pacientes foram admitidos à unidade de terapia intensiva, 18 (20%) necessitaram de ventilação mecânica e nove (10,2%) morreram durante a hospitalização. O tempo mediano de permanência na unidade de terapia intensiva e o tempo mediano de ventilação mecânica foram, respectivamente, de 23 e 29,5 dias. Idade acima ou igual a 65 anos foi fator de risco independente para ventilação mecânica (RC: 8,4; IC95% de 1,3 - 55,6; valor de p = 0,02). CONCLUSÃO: Nossos achados descrevem a primeira onda de pacientes brasileiros hospitalizados por COVID-19. Em nossa população, idade foi o maior preditor de insuficiência respiratória e necessidade de ventilação mecânica.

Características clínicas e preditores de ventilação mecânica em pacientes com COVID-19 hospitalizados no sul do país / Clinical characteristics and predictors of mechanical ventilation in patients with COVID-19 hospitalized in Southern Brazil

RESUMO Objetivo: Descrever as características clínicas e os preditores de ventilação mecânica em pacientes adultos internados com COVID-19. Métodos: Conduziu-se um estudo de coorte retrospectiva com inclusão de pacientes hospitalizados entre 17 de março e 3 de maio de 2020, que tiveram o diagnóstico de infecção pelo SARS-CoV-2. As características clínicas e demográficas foram extraídas de registros em prontuário eletrônico. Resultados: Incluíram-se no estudo 88 pacientes consecutivos. A mediana da idade dos pacientes foi de 63 anos (IQR: 49 - 71); 59 (67%) pacientes eram do sexo masculino, 65 (86%) tinham educação universitária e 67 (76%) tinham, no mínimo, uma comorbidade. Dentre eles, 29 (33%) pacientes foram admitidos à unidade de terapia intensiva, 18 (20%) necessitaram de ventilação mecânica e nove (10,2%) morreram durante a hospitalização. O tempo mediano de permanência na unidade de terapia intensiva e o tempo mediano de ventilação mecânica foram, respectivamente, de 23 e 29,5 dias. Idade acima ou igual a 65 anos foi fator de risco independente para ventilação mecânica (RC: 8,4; IC95% de 1,3 - 55,6; valor de p = 0,02). Conclusão: Nossos achados descrevem a primeira onda de pacientes brasileiros hospitalizados por COVID-19. Em nossa população, idade foi o maior preditor de insuficiência respiratória e necessidade de ventilação mecânica.

Abstract Objective: This study aims to describe the clinical characteristics and predictors of mechanical ventilation of adult inpatients with COVID-19 in a single center. Methods: A retrospective cohort study was performed and included adult inpatients hospitalized from March 17th to May 3rd, 2020, who were diagnosed with SARS-CoV-2 infection. Clinical and demographic characteristics were extracted from electronic medical records. Results: Overall, 88 consecutive patients were included in this study. The median age of the patients was 63 years (IQR 49 - 71); 59 (67%) were male, 65 (86%) had a college degree and 67 (76%) had at least one comorbidity. Twenty-nine (33%) patients were admitted to the intensive care unit, 18 (20%) patients needed mechanical ventilation, and 9 (10.2%) died during hospitalization. The median length of stay in the intensive care unit and the median duration of mechanical ventilation was 23 and 29.5 days, respectively. An age ≥ 65 years was an independent risk factor for mechanical ventilation (OR 8.4 95%CI 1.3 - 55.6 p = 0.02). Conclusion: Our findings describe the first wave of Brazilian patients hospitalized for COVID-19. Age was the strongest predictor of respiratory insufficiency and the need for mechanical ventilation in our population.

Effectiveness of multidisciplinary intervention on blood pressure control in primary health care: a randomized clinical trial.

BACKGROUND: Hypertension is a public health problem and a major risk factor for cardiovascular disease. The purpose of this study is to compare the effectiveness of a multidisciplinary program based on group and individual care versus group-only care, to promote blood pressure control in hypertensive patients in primary health care. METHODS: Randomized controlled clinical trial. The study was conducted within the primary health care, in two units of the Family Health Strategy, covering 11,000 individuals, in Porto Alegre, Brazil. Two hundred and 56 patients, older than 40 years old and with uncontrolled hypertension, systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg or ≥130 mmHg and/or diastolic BP ≥80 mmHg for individuals with diabetes. Eligible patients were randomly assigned to a health care program aiming for blood pressure control, with the multidisciplinary program group or with the multidisciplinary program plus personalized care group. Primary outcome measures were reduction in systolic BP from baseline to 6 months. Secondary measures included proportion of patients with systolic or diastolic BP controlled. Student t test, Pearson's chi-squared test, Fisher's exact test, Mann-Whitney U test, Wilcoxon signed-ranks test and generalized estimating equation (GEE) model were used in the analysis. RESULTS: The baseline characteristics of participants were similar between groups. After 6 months of follow-up, systolic BP decreased markedly in both groups (Δ - 11.8 mmHg [SD, 20.2] in the multidisciplinary program group and Δ - 12.9 mmHg [SD, 19.2] in the personalized care group; p < 0.001). Similarly, we noted a significant change in diastolic BP over time in both groups (Δ - 8.1 mmHg [SD, 10.8] in the multidisciplinary program group and Δ - 7.0 mmHg [SD, 11.5] in the personalized care group; p < 0.001). CONCLUSIONS: The study demonstrates similar effectiveness of a group intervention in comparison to a personalized education program in hypertension patients to achieve BP control. These findings indicate that the intervention can be for all hypertensive patients assisted in primary health care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01696318 (May 2013).

Effectiveness of pharmaceutical care at discharge in the emergency department: study protocol of a randomized controlled trial.

BACKGROUND: Patient education on pharmacological therapy may increase medication adherence and decrease hospitalizations. Our aim is to evaluate the effectiveness of pharmaceutical care at emergency department discharge in patients with hypertension and/or diabetes. METHODS/DESIGN: This is a randomized controlled trial. Participants will be recruited from a public emergency department at Restinga district in Porto Alegre, southern Brazil. A total of 380 patients will be randomly assigned into 2 groups at the moment of emergency department discharge after receiving medical orientations: an intervention group, consisting of a structured individual counseling session by a pharmacist in addition to written orientations, or a control group, consisting only of written information about the disease. Outcomes will be assessed in an ambulatory visit 2 months after the randomization. The primary outcome is the proportion of patients with high medication adherence assessed using the Morisky-Green Test and the Brief Medication Questionnaire. The secondary outcomes are reduction of blood pressure, glycated hemoglobin, fasting plasma glucose, quality of life and number of visits to the emergency department. DISCUSSION: Pharmaceutical care interventions have shown to be feasible and effective in increasing medication adherence in both hospital outpatient and community pharmacy settings. However, there have been no previous assessments of the effectiveness of pharmacy care interventions initiated in patients discharged from emergency departments. Our hypothesis is that pharmaceutical counseling is also effective in this population. TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT01978925 (11 November 2013) and Brazilian Registry of Clinical Trials U1111-1149-8922 (5 November 2013).

Prevalência e fatores associados à consulta médica entre adultos de uma comunidade de baixa renda do Sul do Brasil / Prevalence of medical appointments and associated factors among adults in a low-income community in southern Brazil

Objetivo: estimar a prevalência de consultas médicas, nos três meses que antecederam à entrevista, em adultos de 20 anos ou mais, de uma comunidade de baixa renda, do Sul do Brasil, em 2O09. Métodos: foi realizado estudo transversal, com análise ajustada por meio de Regressão de Poisson. Resultados: a prevalência de consulta médica nos 3.391 entrevistados foi 76,2 por cento (Intervalo de Confiança de 95 por cento (IC95 por cento) 74,8; 77,6 por cento) no último ano e 64,8 por cento (IC95 por cento 63,0; 66,7 por cento) nos últimos três meses, maior entre as mulheres (67,8 por cento) do que entre os homens (60,2 por cento) (p<0,001). Na análise ajustada, para homens, o desfecho associou-se mais fortemente: ao aumento de idade (p=0,001) e autopercepção de saúde ruim/ muito ruim (p<0,001). Entre mulheres, ao aumento da idade (p=0,001), possuir médico de referência (p=0,001), local usual de atendimento (p<0,001) e morbidades (p= 0,001). Conclusões: a diferença na utilização de consultas deve ser considerada no planejamento e organização do acesso

Objective: to estimate medical appointment prevalence during the three months prior to interview, in adults aged ≥20 from a low-income community in Southern Brazil in 2009. Methods: cross-sectional study with analysis adjusted using Poisson regression. Results: 3391 people were interviewed. Medical appointment prevalence was 76.2 percent (95 percent CI 74.8, 77.6) in the last year and 64.8 percent (95 percent CI 63.0, 66.7) in the last three months: 67.8 percent in females (95 percent CI 65.5, 70.1) (p<0.001); 60.2 percent in males (95 percent CI57.1, 63.2). Adjusted analysis outcome in males was more strongly associated with increasing age (p 0.001) and poor/very poor self-rated health (p<0.001). In females association was with increasing age (p 0.001), seeing the same physician (p 0.001), usual place of care (p<0.001) and morbidities (p 0.001). Conclusions: differences in appointment use should be considered when planning and organizing access

Objetivo: estimar la prevalencia de consultas médicas, en los tres meses que antecedieron a la entrevista, en adultos de 20 años o más, de una comunidad de renta baja, del Sur de Brasil, en 2009.Método: se realizó un estudio transversal, con análisis ajustado por la Regresión de Poisson.Resultados: la prevalencia de consulta médica en los 3.391 entrevistados fue de 76,2% (Intervalo de Confianza de 95% (IC95%) 74,8; 77,6%) el último año y de 64,8% (IC95% 63,0; 66,7%) los últimos tres meses, mayor entre las mujeres (67,8%) que entre los hombres (60,2%) (p<0,001). En el análisis ajustado, para hombres, el desenlace está asociado más intensamente: al aumento de edad (p=0,001) y a la auto percepción de salud mala/muy mala (p<0,001). Entre las mujeres al aumento de la edad (p=0,001), tener un médico de referencia (p=0,001), local usual de atención (p<0,001) y a morbilidades (p= 0,001). Conclusiones: la diferencia en la utilización de consultas debe ser llevada en cuenta en la planificación y la organización del acceso.

Blood pressure control in hypertensive patients in the "Hiperdia Program": a territory-based study.

BACKGROUND: Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level. OBJECTIVE: To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil). METHODS: Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤ 140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR) with 95% confidence interval, Wald's χ(2) test, and simple and multiple Poisson regression were used in the statistical analysis. RESULTS: The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM) was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled. CONCLUSION: Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control.

Blood Pressure Control in Hypertensive Patients in the "Hiperdia Program": A Territory-Based Study / Controle da Pressão Arterial em Hipertensos do Programa Hiperdia: Estudo de Base Territorial

Background: Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level. Objective: To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil). Methods: Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR) with 95% confidence interval, Wald's χ2 test, and simple and multiple Poisson regression were used in the statistical analysis. Results: The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM) was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled. Conclusion: Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control. .

Fundamento: A hipertensão arterial sistêmica apresenta alta prevalência e é um importante fator de risco para eventos cardiovasculares. O controle da pressão arterial em pacientes hipertensos cadastrados no Programa Hiperdia, um programa do Sistema Único de Saúde para acompanhamento e monitoramento dos hipertensos, permanece muito abaixo do desejável. Objetivo: Descrever o perfil epidemiológico e avaliar o controle da pressão arterial em pacientes cadastrados no Hiperdia, em Novo Hamburgo (RS). Metodologia: Estudo transversal, com amostra probabilística estratificada por conglomerados, incluindo 383 adultos cadastrados no Programa Hiperdia das 15 Unidades Básicas de Saúde do município, realizado entre 2010 e 2011. A pressão arterial controlada foi definida como ≤140 mmHg × 90 mmHg. Os hipertensos foram entrevistados e a pressão arterial foi mensurada com aparelho aneroide calibrado. Na análise estatística foram utilizados razões de prevalência (RP) com intervalo de confiança de 95%, teste χ2 de Wald e regressão de Poisson simples e múltipla. Resultados: A média de idade foi de 63 ± 10 anos, sendo a maioria mulheres, pertencentes à classe C, com baixa escolaridade, sedentários e com histórico familiar para HAS. O diabetes melito (DM) estava presente em 31%, a adesão ao tratamento anti-hipertensivo era de 54,3%, e 33,7% estavam com pressão arterial controlada. O DM mostrou-se fortemente associado com o controle inadequado da PA, com 15,7% dos diabéticos com PA considerada controlada. Conclusão: Mesmo com o cadastro no Programa Hiperdia, o controle da PA nos hipertensos não é satisfatoriamente alcançado e mantido, sendo os hipertensos diabéticos os que apresentam o controle mais inadequado. .

Prevalence of risk factors for hepatitis C and associated factors: a population-based study in southern Brazil.

CONTEXT: The hepatitis C is a severe public health problem worldwide because its consequences. Studies which aim at determining the prevalence of risk factors are really important to understand the problem. OBJECTIVE: To estimate the prevalence and factors associated with some risk factors for the disease in a community, called Restinga, located in the city of Porto Alegre, RS, Brazil. METHOD: This paper is based on a population-based cross-sectional study, with systematic sampling and proportional to the size of census tracts in which 3,391 adults answered a standardized questionnaire. RESULTS: The prevalence of blood transfusion among the people who were interviewed was 14.98%, 60.83% of those had it before 1993. A total of 16.16% of the people had a tattoo, 7.23% wore a piercing, 1.09% said they had already injected illicit drugs and 12.39% reported previous hospitalization. Prevalence ratios showed that tattoos were more common among young people, piercings among women and illicit drugs among men. CONCLUSIONS: To summarize, the recognition of risk factors for hepatitis C enables proper screening of possible carriers of the hepatitis C virus, thus enabling a reduction in virus shedding. However, being only possible if health services are prepared to deal with hepatitis C virus, through education and public awareness.

Prevalence of insufficient physical activity in adolescents in South Brazil / Prevalência de atividade física insuficiente em adolescentes do Sul do Brasil

The purpose of the study was to estimate the prevalence of insufficient physical activity and associated factors in adolescents 10 to 19 years old living in the Health Districts of Restinga and Extremo Sul of Porto Alegre, RS. A population-based, cross-sectional study was conducted by a systematic sampling with 967 adolescents randomly selected. Data was collected by using a questionnaire with the following variables: gender, age, skin color, if currently studying, occupation, socioeconomic status, weight and height, as well as insufficient physical activity, which was defined as less than 300 minutes per week of physical activity, not counting physical education classes. The prevalence of insufficient physical activity found was 70.5%: 58.9% in boys and 81.9% in girls. The higher prevalence of insufficient levels of PA was found among adolescents who are not studying (p=0.01) and next by those who are between 16 and 19 years old (p=0.05). In boys it was observed that as they got older, physical activity decreased (p=0.05). The most types of activities found were field soccer and riding bikes for boys, and walking and field soccer for girls. In conclusion, the prevalence of insufficient physical activity found in the adolescents evaluated was high. Being a girl, not studying, and between the ages of 16 and 19, were factors that increased the levels of insufficient physical activity. This reveals, therefore, the importance to developed interventions to promote the practice of physical activity in this population.

O objetivo do estudo foi estimar a prevalência de atividade física insuficiente e fatores associados em adolescentes de 10 a 19 anos, residentes nos Distritos Sanitários da Restinga e Extremo Sul, Porto Alegre, RS. Este é um estudo transversal de base populacional por amostragem sistemática, com 967 adolescentes selecionados de forma randomizada, os quais responderam um questionário composto pelas seguintes variáveis: sexo, idade, cor da pele, estar estudando, ocupação, nível socioeconômico, massa corporal e estatura, e atividade física insuficiente; definida como prática menor que 300 minutos semanais de atividade física, sem contar as aulas de educação física. A prevalência de atividade física insuficiente encontrada foi de 70,5%, sendo 58,9% nos meninos e 81,9% nas meninas. As prevalências mais altas de níveis insuficientes de AF foram observadas nos adolescentes que não se encontram estudando (p=0,01), sucedidos pelos da faixa etária entre 16 e 19 anos (p=0,05). Nos meninos, observou-se que, com o aumento da idade, ocorreu diminuição na prática de atividade física (p=0,05). Dentre os tipos de atividade, o futebol de campo e o andar de bicicleta mostraram-se os mais frequentes para os meninos, e a caminhada e o futebol de campo para as meninas. Conclui-se que foi elevada a prevalência de atividade física insuficiente nos adolescentes avaliados. Sexo feminino, não estar estudando e estar na faixa etária entre 16 e 19 anos, foram fatores que aumentaram os níveis de atividade física insuficiente. Assim, revela-se a importância de que sejam desenvolvidas intervenções para promoção da prática de atividade física nessa população.

Prevalence and risk factors for stroke in a population of Southern Brazil.

UNLABELLED: Stroke is the leading cause of death in many countries of Latin America. Population studies are necessary in this region. OBJECTIVES: To evaluate the prevalence of stroke and its risk factors in a population of vulnerable communities of southern Brazil. METHODS: Population-based crosssectional study with systematic sampling. Individuals aged 20 and over were included (n=3,391). Individuals with previous diagnosis of stroke or identified by a validate stroke questionnaire were compared with those without stroke in many variables. RESULTS: 285 individuals (8.4%) had previous stroke. The group without stroke showed greater average of years of study than the group with stroke (p<0.001). Multivariable analysis identified as risk factors for stroke (p<0.05): age from 40 to 59, age from 60 to 79, widowhood, present smoking, previous smoking, hypertension and ischemic heart disease. CONCLUSION: The findings in this population indicate the need of preventive cost-effective public health policies in Brazil.

[Factors that influence outpatient service user satisfaction in a low-income population: a population-based study]. / Fatores que influenciam a satisfação do paciente ambulatorial em uma população de baixa renda: um estudo de base populacional.

AIM: To measure the prevalence of overall satisfaction with the previous medical consultation and their associated factors, among adults aged 20 years or more, in a city located in southern Brazil. METHODS: A cross-sectional population-based study was performed in Porto Alegre, RS, Brazil, from July to December 2009. Systematic sampling was used with a probability proportional to the size of each of the 121 census tracts in the area studied. Overall satisfaction with the previous consultation was evaluated with a standardized questionnaire. Crude analysis was performed using the chi-square test, while the adjusted analysis used Poisson regression with robust variance. Results were expressed as prevalence ratios. RESULTS: Among the 3,700 eligible individuals, 3,391 answered the survey. Of those, 64.8% (1677) reported having had their previous medical consultation in the three months prior to the interview. Regarding the overall satisfaction with the previous consultation, 63.7% reported being satisfied and 23.2% were very satisfied. Adjusted analysis showed that those who went to private/health plan-affiliated services were 1.15 times more likely to be satisfied than those going to public services. Easy consultation booking and being well treated by receptionist and physician were directly related with a higher level of satisfaction. The length of time waiting was inversely associated with satisfaction both in the crude and adjusted analyses. CONCLUSION: The present study revealed a high prevalence of satisfaction with medical consultations and a significant positive association between satisfaction and the location of consultation (health plan-affiliated or private services).

Prevalence and risk factors for stroke in a population of Southern Brazil / Prevalência e fatores de risco para AVC numa população do sul do Brasil

Stroke is the leading cause of death in many countries of Latin America. Population studies are necessary in this region. Objectives: To evaluate the prevalence of stroke and its risk factors in a population of vulnerable communities of southern Brazil. Methods: Population-based crosssectional study with systematic sampling. Individuals aged 20 and over were included (n=3,391). Individuals with previous diagnosis of stroke or identified by a validate stroke questionnaire were compared with those without stroke in many variables. Results: 285 individuals (8.4%) had previous stroke. The group without stroke showed greater average of years of study than the group with stroke (p≪0.001). Multivariable analysis identified as risk factors for stroke (p≪0.05): age from 40 to 59, age from 60 to 79, widowhood, present smoking, previous smoking, hypertension and ischemic heart disease. Conclusion: The findings in this population indicate the need of preventive cost-effective public health policies in Brazil. .

O acidente vascular cerebral (AVC) é a principal causa de morte em muitos países da América Latina. Objetivos: Avaliar prevalência e fatores de risco para AVC em população de comunidades vulneráveis no sul do Brasil. Métodos: Estudo transversal de base populacional com amostragem sistemática. Foram incluídos os indivíduos a partir de 20 anos de idade (n=3.391). Indivíduos com prévio diagnóstico de AVC ou identificados por questionário validado para AVC foram comparados àqueles sem AVC em diversas variáveis. Resultados: 285 indivíduos (8,4%) referiram AVC prévio. O grupo sem AVC teve maior média de anos de estudo que o grupo com AVC (p≪0,001). Foram identificados como fatores de risco para AVC (p≪0,05): idade de 40 a 59 anos, idade de 60 a 79 anos, viuvez, tabagismo no presente, tabagismo no passado, hipertensão arterial sistêmica e doença isquêmica do coração. Conclusão: São necessárias no Brasil políticas de saúde pública preventivas e custo-efetivas. .

PREVALENCE OF RISK FACTORS FOR HEPATITIS C AND ASSOCIATED FACTORS: a population-based study in southern Brazil

Context The hepatitis C is a severe public health problem worldwide because its consequences. Studies which aim at determining the prevalence of risk factors are really important to understand the problem. Objective To estimate the prevalence and factors associated with some risk factors for the disease in a community, called Restinga, located in the city of Porto Alegre, RS, Brazil. Method This paper is based on a population-based cross-sectional study, with systematic sampling and proportional to the size of census tracts in which 3,391 adults answered a standardized questionnaire. Results The prevalence of blood transfusion among the people who were interviewed was 14.98%, 60.83% of those had it before 1993. A total of 16.16% of the people had a tattoo, 7.23% wore a piercing, 1.09% said they had already injected illicit drugs and 12.39% reported previous hospitalization. Prevalence ratios showed that tattoos were more common among young people, piercings among women and illicit drugs among men. Conclusions To summarize, the recognition of risk factors for hepatitis C enables proper screening of possible carriers of the hepatitis C virus, thus enabling a reduction in virus shedding. However, being only possible if health services are prepared to deal with hepatitis C virus, through education and public awareness. .

Contexto A hepatite C é um grave problema de saúde pública mundial, devido as suas consequências. Trabalhos voltados à determinação da prevalência dos fatores de risco são essenciais para a compreensão do problema. Objetivo Estimar a prevalência e os fatores associados a alguns fatores de risco da enfermidade na comunidade da Restinga, localizada na cidade de Porto Alegre, Rio Grande do Sul, Brasil. Método Realizou-se estudo transversal de base populacional, com amostragem sistemática e proporcional ao tamanho dos setores censitários, no qual 3391 adultos responderam a um questionário padronizado. Resultados A prevalência de transfusão de sangue foi 14,98% sendo que desses, 60,83% realizaram antes de 1993, 16,16% possuíam tatuagem, 7,23% usavam piercing. 1,09% afirmou já ter usado drogas injetáveis e 12,39% relatou internação hospitalar. As razões de prevalência demonstraram que a utilização da tatuagem era mais comum entre os jovens, o uso de piercing mais comum entre as mulheres e o consumo de drogas maior entre o sexo masculino. Conclusões Em suma, o reconhecimento dos fatores de risco para hepatite C permitem a correta triagem dos possíveis portadores do vírus da hepatite C, possibilitando assim, diminuição na disseminação do vírus. Porém, só sendo possível se os serviços de saúde estejam preparados para lidar com o vírus da hepatite C, através da educação e conscientização da população. .

Fatores que influenciam a satisfação do paciente ambulatorial em uma população de baixa renda: um estudo de base populacional / Factors that influence outpatient service user satisfaction in a low-income population: a population-based study

OBJETIVO: Medir a prevalência de satisfação geral com a última consulta médica e seus fatores associados entre adultos com 20 anos ou mais, em uma cidade do Sul do país. MÉTODOS: Estudo transversal de base populacional realizado em Porto Alegre-RS, de julho a dezembro de 2009. Foi utilizada amostragem sistemática com probabilidade proporcional ao tamanho de cada um dos 121 setores censitários da região em estudo. A satisfação geral da última consulta foi avaliada por questionário padronizado. As variáveis independentes foram: sexo, idade, cor da pele, classe social, escolaridade, motivo e local da consulta. Na análise bruta empregou-se o teste qui-quadrado e na ajustada regressão de Poisson com variância robusta, com os resultados expressos em razões de prevalências. RESULTADOS: Dos 3.700 indivíduos elegíveis, 3.391 responderam a pesquisa. Desses, 64,8% consultaram nos três meses antecedentes a entrevista. Em relação à satisfação geral da última consulta, 63,7% referiram estar satisfeitos e 23,2% estar muito satisfeitos. Na análise ajustada, indivíduos que consultaram em locais conveniados/privados apresentaram uma probabilidade 1,15 vezes maior de estar satisfeitos comparados a locais públicos. A facilidade para conseguir a consulta, o fato de ter sido bem tratado pela recepcionista e pelo médico esteve diretamente relacionado com uma maior satisfação. O tempo de espera para ser atendido esteve inversamente associado à satisfação tanto na análise bruta quanto na ajustada. CONCLUSÃO: O presente estudo revelou elevada prevalência de satisfação com a consulta médica e uma associação significativamente positiva entre satisfação ...

AIM: To measure the prevalence of overall satisfaction with the previous medical consultation and their associated factors, among adults aged 20 years or more, in a city located in southern Brazil. METHODS: A cross-sectional population-based study was performed in Porto Alegre, RS, Brazil, from July to December 2009. Systematic sampling was used with a probability proportional to the size of each of the 121 census tracts in the area studied. Overall satisfaction with the previous consultation was evaluated with a standardized questionnaire. Crude analysis was performed using the chi-square test, while the adjusted analysis used Poisson regression with robust variance. Results were expressed as prevalence ratios. RESULTS: Among the 3,700 eligible individuals, 3,391 answered the survey. Of those, 64.8% (1677) reported having had their previous medical consultation in the three months prior to the interview. Regarding the overall satisfaction with the previous consultation, 63.7% reported being satisfied and 23.2% were very satisfied. Adjusted analysis showed that those who went to private/health plan-affiliated services were 1.15 times more likely to be satisfied than those going to public services. Easy consultation booking and being well treated by receptionist and physician were directly related with a higher level of satisfaction. The length of time waiting was inversely associated with satisfaction both in the crude and adjusted analyses. CONCLUSION: The present study revealed a high prevalence of satisfaction with medical consultations and a significant positive association between satisfaction and the location of consultation (health plan-affiliated or private services). .

[Socioeconomic and demographic indicators associated with functional disability in the elderly]. / Indicadores demográficos e socioeconômicos associados à incapacidade funcional em idosos.

This study analyzed the prevalence of functional disability in the elderly and its association with socioeconomic and demographic factors. This was a population-based cross-sectional study with a sample of 631 elders (≥ 60 years). The Katz index and Lawton scale, respectively, were used to evaluate basic and instrumental activities of daily living. Demographic and socioeconomic variables were analyzed. Numerical variables were tested with the Student t test and non-numerical ones with the chi-square test. The odds of functional disability were measured by logistic regression. Prevalence rates of functional disability for basic and instrumental activities of daily living were 15.5% and 26.1%, respectively. Instrumental activities presented more variables significantly associated with the outcome in the final logistic regression model. Prevalence of functional disability was not higher than described in the Brazilian literature. An important association was found between the outcome and independent variables.

Indicadores demográficos e socioeconômicos associados à incapacidade funcional em idosos / Socioeconomic and demographic indicators associated with functional disability in the elderly

O objetivo do estudo foi observar a frequência de incapacidade funcional de idosos e sua associação com fatores socioeconômicos e demográficos. Foi realizado um estudo transversal de base populacional, incluindo 631 idosos (60 anos ou mais). Para a avaliação das atividades básicas e instrumentais da vida diária foram empregados o índice de Katz e a escala de Lawton, respectivamente. Foram analisadas as variáveis demográficas e socioeconômicas. As variáveis numéricas foram testadas pelo t de Student e as não numéricas pelo qui-quadrado. A chance de apresentar incapacidade funcional foi medida pela regressão logística. As prevalências de incapacidade funcional para as atividades básicas e instrumentais da vida diária foram de 15,5% e 26,1%, respectivamente. As atividades instrumentais apresentaram maior número de variáveis significativamente associadas ao desfecho no modelo final de regressão logística. A prevalência de incapacidade funcional não foi maior do que a descrita na literatura brasileira. Encontrou-se uma importante associação do desfecho com as variáveis analisadas.

This study analyzed the prevalence of functional disability in the elderly and its association with socioeconomic and demographic factors. This was a population-based cross-sectional study with a sample of 631 elders (≥ 60 years). The Katz index and Lawton scale, respectively, were used to evaluate basic and instrumental activities of daily living. Demographic and socioeconomic variables were analyzed. Numerical variables were tested with the Student t test and non-numerical ones with the chi-square test. The odds of functional disability were measured by logistic regression. Prevalence rates of functional disability for basic and instrumental activities of daily living were 15.5% and 26.1%, respectively. Instrumental activities presented more variables significantly associated with the outcome in the final logistic regression model. Prevalence of functional disability was not higher than described in the Brazilian literature. An important association was found between the outcome and independent variables.