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

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

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.

A Retrospective Observational Cohort Study of Periprosthetic Hip Infection Treated by one-stage Method Including Cases With Bone Graft Reconstruction.

Purpose: Prosthetic joint infection (PJI) is a devastating complication that can affect hip arthroplasty. Its treatment is extremely difficult, and issues regarding the optimal treatment remain unanswered. This study intended to show the effectiveness of the one-stage treatment of PJI. Materials and Methods: A retrospective observational cohort study performed from July 2014- August 2018. All patients with suspected PJI were included. Major and minor criteria developed by the International Consensus on Periprosthetic Joint Infection (ICPJI) was used to define infection. Laboratory tests and image exams were performed, and all patients were followed for at least 2 years. Outcomes: Success rate (2018 ICPJI definition to success) in treatment of PJI using one-stage revision method. Clinical and functional outcomes defined by Harris Hip Score (HHS). Results: Thirty-one patients were screened and 18 analyzed. 69.85 ± 9.76 years was the mean age. Mean follow-up time was 63.84 ± 18.55 months. Ten patients had acetabular defects and required bone graft reconstruction. Sixteen patients were classified as Tier 1, 1 as Tier 3D, and as 1 Tier 3E. Almost 90% of patients submitted to one-stage revision with acetabulum graft reconstruction were free of infection. The overall infection survival rate was 78.31±6.34 months. Candida albicans and sinus tract were statistically significant in univariate Cox's analysis. The predictor of one-stage revision surgery failure that remained final Cox's regression model was C. albicans (hazard ratio [HR]: 4.47). Conclusion: Treatment through one-stage revision surgery associated with 6 months of antimicrobial is a viable option with acceptable results even when bone graft reconstruction is necessary. C. albicans was a strong predictor of failure in this cohort.

Molecular detection of Toxoplasma gondii in placentas of women who received therapy during gestation in a toxoplasmosis outbreak.

Toxoplasmosis is a disease caused by T. gondii, a protozoa which affects humans and animals and is widely distributed worldwide. In humans, there is great concern due to the serious consequences that can occur in the infection of pregnant women and the newborn. The early diagnosis of gestational toxoplasmosis is important for treatment to be carried out in order to prevent vertical transmission or reduce damage. The diagnosis can be made through the detection of antibodies in pregnant women or neonates and PCR of amniotic fluid. Previous studies have also reported PCR of the placenta as a good diagnostic test. Our study evaluated the detection of T. gondii DNA in placenta samples from parturients seen at the University Hospital of Santa Maria, Southern Brazil and treated during the pregnancy. We performed PCR in forty samples and five were positive, representing 12.5%. When correlating the treatment time and the detection of DNA in the placentas, no significant result was found. The prevalence of positive samples was lower than in other studies in the literature. The data reaffirm the importance of carrying out the analysis of the placenta.

Isolation, genetic and immunohistochemical identification of Toxoplasma gondii from human placenta in a large toxoplasmosis outbreak in southern Brazil, 2018.

The present study aimed to describe a molecular analysis of environmental and pork samples, the isolation, genetic identification and immunohistochemistry (IHC) of Toxoplama gondii from placenta and amniotic fluid from five pregnant women that miscarried during a toxoplasmosis outbreak in 2018, Santa Maria, Rio Grande do Sul. Environmental and pork samples were submitted to polymerase chain reaction (PCR); placenta and amniotic fluid samples to histopathology, IHC, mouse bioassay and PCR. All samples were genotyped by PCR-RFLP with 11 loci. Histopathologic and IHC were compatibles with toxoplasmosis. All pregnants were positive in PCR and bioassay, the genotypes were compared, and all were equal suggesting a same source of infection. Among the environmental and food samples, a sludge sample from a water tank and two porks samples were positive in PCR, and the genotypes were different from the pregnant women isolates. It is concluded that obtain and compare isolates is essential to elucidate outbreak source.

Isolation and molecular characterization of Toxoplasma gondii from placental tissues of pregnant women who received toxoplasmosis treatment during an outbreak in southern Brazil.

Toxoplasma gondii is a protozoan that has great genetic diversity and is prevalent worldwide. In 2018, an outbreak of toxoplasmosis occurred in Santa Maria, Brazil, which was considered the largest outbreak ever described in the world. This paper describes the isolation and molecular characterization of Toxoplasma gondii from the placenta of two pregnant women with acute toxoplasmosis who had live births and were receiving treatment for toxoplasmosis during the outbreak. For this, placental tissue samples from two patients underwent isolation by mice bioassay, conventional PCR and genotyping using PCR-RFLP with twelve markers. Both samples were positive in isolation in mice. The isolate was lethal to mice, suggesting high virulence. In addition, the samples were positive in conventional PCR and isolates submitted to PCR-RFLP genotyping presented an atypical genotype, which had never been described before. This research contributes to the elucidation of this great outbreak in Brazil.

Antiretroviral therapy does not affect response to chronic hepatitis C therapy in HIV-coinfected patients.

INTRODUCTION: Many patients coinfected with the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are using highly active antiretroviral therapy (HAART) and HCV therapy with peginterferon (PEG-IFN) and ribavirina (RBV) because the use of direct-acting antivirals is not a reality in some countries. To know the impact of such medications in the sustained virological response (SVR) during HCV treatment is of great importance. METHODOLOGY: This was a retrospective cohort study of 215 coinfected HIV/HCV patients. The patients were treated with PEG-IFN and RBV between 2007 and 2013 and analyzed by intention to treat. Treatment-experienced patients to HCV and carriers of hepatitis B were excluded. Demographic data (gender, age), mode of infection, HCV genotype, HCV viral load, hepatic fibrosis, HIV status, and type of PEG were evaluated. One hundred eighty-eight (87.4%) patients were using HAART. RESULTS: SVR was achieved in 55 (29.3%) patients using HAART and in 9 (33.3%) patients not using HAART (p = 0.86). There was no difference in SVR between different HAART medications and regimens using two reverse transcriptase inhibitor nucleosides (NRTIs) or the use of protease inhibitors and non-NRTIs (27.1% versus 31.5%; p = 0.61). The predictive factors for obtaining SVR were low HCV viral load, non-1 genotype, and the use of peginterferon-α2a. CONCLUSIONS: The use of HAART does not influence the SVR of HCV under PEG-IFN and RBV therapy in HIV/HCV coinfected patients.

Introdução à alimentação e nutrição

'Introdução à alimentação e nutrição' é a primeira unidade do Módulo Eletivo 01 do Curso de Especialização em Saúde da Pessoa Idosa da UNA-SUS/UERJ "Nutriçao da pessoa idosa". Nesta unidade abordaremos os hábitos alimentares, destacando sua importância em estabelecer relações entre os alimentos e a saúde do indivíduo.

Avaliação e recomendação nutricional do idoso

'Avaliação e recomendação nutricional do idoso' é a segunda unidade do Módulo Eletivo 01 do Curso de Especialização em Saúde da Pessoa Idosa da UNA-SUS/UERJ "Nutriçao da pessoa idosa". Nesta unidade conheceremos os métodos objetivos e subjetivos de avaliação nutricional que podem ser utilizados no paciente idoso, suas possibilidades e limitações, e sobre algumas recomendações nutricionais importantes para a saúde do paciente idoso.

Cuidado nutricional nas principais patologias e em condições especiais

'Cuidado nutricional nas principais patologias e em condições especiais' é a terceira unidade do Módulo Eletivo 01 do Curso de Especialização em Saúde da Pessoa Idosa da UNA-SUS/UERJ "Nutriçao da pessoa idosa". Nesta unidade enfatizaremos a importância da avaliação nutricional e conheceremos os cuidados nutricionais necessários para as principais patologias que acometem os idosos, bem como para algumas condições especiais comuns às pessoas na terceira idade.

Educação nutricional e práticas educativas com idosos

'Educação nutricional e práticas educativas com idosos' é a quarta e última unidade do Módulo Eletivo 01 do Curso de Especialização em Saúde da Pessoa Idosa da UNA-SUS/UERJ "Nutrição da pessoa idosa". Nesta unidade abordaremos as práticas educativas necessárias para que a implementação de novos hábitos nutricionais ocorra com sucesso e seja aceita pelo paciente idoso, conheceremos as concepções pedagógicas que norteiam as concepções de práticas educativas focando na aprendizagem de adultos e idosos e apontaremos as diferenças entre educação nutricional e orientação nutricional, bem como as etapas necessárias para a implantação de uma ação educativa com idosos e algumas estratégias que nos ajudarão nesse processo.

Integrating medical and health multiprofessional residency programs: the experience in building an interprofessional curriculum for health professionals in Brazil.

BACKGROUND: The aging of the population demands a development of the skills of different health professionals working in teams due to the complexity of the problems arising from this population. This article discusses the integration of two residency programs: medical and multiprofessional. The challenge was to construct a curriculum with practical and theoretical activities that develop competencies within the scope of interprofessional education, ensuring the necessary depth and detail of study in all the professional areas involved in the development of specific skills. METHODS: The curricular integration was accomplished by conducting workshops with the participation of coordinators from both programs and service areas, preceptors of medicine, nursing, nutrition, psychology, physiotherapy, and social services. In these workshops, we agreed upon the goals, general and specific competencies, the standard weekly schedule, practice scenarios, evaluation, and selection. RESULTS: The interprofessional program has 26 residents, of which 6 are physicians 4 each from the other areas, with 25 preceptors from the 6 areas that comprise the program. The residents develop their training in six practical scenarios distributed between the first and second years with increasing complexity. DISCUSSION: The program is based on guidelines, physical conditions and human resources that allow for the overcoming of barriers to the development of interprofessional education and collaborative practice.

A saúde no diálogo com a vida cotidiana: a experiência do trabalho educativo com idosos no grupo roda da saúde / Health in the dialogue with daily life: experience of an educational work with an elderly population of the roda da saúde group

Ações educativas em promoção da saúde no envelhecimento são um dos eixos de atuação do Núcleo de Atenção ao Idoso da Universidade Aberta da Terceira Idade/UERJ, no sentido de orientação do serviço pelo norte de integralidade da atenção à saúde e fomento da participação popular. Baseadas em premissas da Educação Popular em Saúde, diversas atividades grupais e de comunicação em saúde são desenvolvidas com objetivo de ampliar espaços de interação e participação no âmbito assistencial. O objetivo deste artigo é apresentar a proposta metodológica do grupo aberto Roda da Saúde e apontar alguns dados de avaliação do trabalho. O grupo caracteriza-se como "chá da tarde" e a dinâmica dos encontros busca estimular a reflexão e a produção coletiva sobre temas relacionados à saúde e qualidade de vida. A programação é definida no próprio grupo, com temas emergentes no processo e/ou sugeridos pelos participantes. A experiência tem sido valiosa para profissionais e idosos pela partilha de saberes e a construção de vínculos. Espera-se que a proposta educativa, exemplificada em sua dinâmica, possa servir de referência ao desenvolvimento do potencial dos serviços de saúde para práticas articuladas, criativas e politizantes, centradas no usuário e no direito à vida.

Educational initiatives towards health promotion of theelderly population, one of the aims of the Division for theCare of the Elderly Population, of the Rio de Janeiro StateUniversity, aim to promote integral health care and fosterpopular participation. Based on the principles of PopularHealth Education, several group and health communicationactivities are developed to increase interaction andparticipation in health care. The objective of this articleis to present the methodological approach of the Rodada Saúde open group and discuss some assessment data.The group characterizes itself as an ?afternoon tea?, andthe dynamics of the meetings are designed to stimulatethe reflection and collective production on issues relatedto health and quality of life. The agenda is defined by thegroup itself, with issues arising during the process and/orbeing suggested by the participants. The experience hasbeen invaluable for professionals and elders alike, due toknowledge sharing and link building. We expect that thiseducational proposal, herein exemplified by its dynamics,may serve as a reference to the development of the fullpotential of articulated, creative and empowering healthservices, centered on the users and the right to life.

Avaliação do projeto de promoção da saúde do Núcleo de Atenção ao Idoso: um estudo exploratório / Evaluation of a health promotion project at the Elderly People's Care Center: an exploratory study / Evaluación del proyecto de promoción de la salud del Núcleo de Atención al Anciano: un estudio exploratorio

Health promotion evaluation among elderly people is an emerging topic because of the expansion of programs driven by the aging of the population. Here, data from an exploratory assessment of a health promotion project at the Elderly People's Care Center of the Elderly People's Open University, Rio de Janeiro State University are presented. The study was guided by analysis on how the project was implemented and was based on documentary sources, revaluation of the elderly people and participant observation. It was observed that the objectives of socialization and discussion of information, enhancement of self-esteem and expansion of social contacts were attained. In the revaluation, small changes in self-care, health and subjective wellbeing indicators were seen, thus inferring that the participants' profile was positive and stable. It is concluded that the project contributed towards reorientation of health practices aimed at comprehensive care, grounded in humanization and strengthening of individuals' participation in issues that affect individual and collective health and wellbeing.

A avaliação em promoção da saúde do idoso é temática emergente com a expansão de programas impulsionados pelo envelhecimento populacional. Apresentamse dados da avaliação exploratória do Projeto de Promoção da Saúde do Núcleo de Atenção ao Idoso da Universidade Aberta da Terceira Idade da Universidade do Estado do Rio de Janeiro, orientada pela análise de implantação e baseada em fontes documentais, reavaliação dos idosos e observação participante. Observouse alcance dos objetivos de socialização e debate de informações, reforço da autoestima e ampliação dos contatos sociais. Na reavaliação foram constatadas pequenas mudanças em indicadores de autocuidado e de saúde e bem-estar subjetivo, inferindo-se estabilidade positiva pelo perfil dos participantes. Conclui-se que o projeto contribui com a reorientação das práticas de saúde em direção à atenção integral, pautada na humanização e no fortalecimento da participação dos sujeitos sobre questões que afetam a saúde e bemestar, nos planos individual e coletivo.

La evaluación en promoción de la salud del anciano es temática emergente con la expansión de programas impulsados por el envejecimiento de la población. Se presentan datos de la evaluación exploratoria del Proyecto de Promoción de la Salud del Núcleo de Atención al Anciano de la Universidad de la Tercer Edad, Universidad Estatal de Rio de Janeiro orientada por el análisis de implantación y basada en fuentes documentales, re-evaluación de los ancianos y observación participante. Se observa el ancance de los objetivos de socialización y debate de informaciones, refuerzo de la autoestima y ampliación de los contactos sociales. En la re-evaluación se han constatado pequeños cambios en indicadores de auto-cuidado y de salud y bienestar subjetivo, deduciéndose estabilidad positiva por el perfil de los participantes. Se concluye que el proyecto contribuye con la re-orientación de las prácticas de salud en dirección a la atención integral, pautada en la humanización y en el fortalecimiento de la participación de los sujetos sobre cuestiones que afectan a la salud y al bienestar en los planos individual y colectivo.

Ações educativas em promoção da saúde no envelhecimento: a experiência do núcleo de atenção ao idoso da UNATI/UERJ / Acciones educativas en la promoción de la salud para el envejecimiento: la experiencia del núcleo de ayuda a los envejecidos de UNATI/UERJ / Educative actions in health promotion for aging: the experience of UNATI/UERJ elderly assistance nucleus

O artigo apresenta a experiência do Programa de Ações Educativas em Promoção de Saúde no Envelhecimento do Núcleo de Atenção ao Idoso, ambulatório da Universidade Aberta da Terceira Idade, da UERJ. O programa é interdisciplinar e inclui várias modalidades educativas, abertas aos idosos e usuários em geral. As atividades incluem grupos de sala de espera, grupo fechado (Encontros com a Saúde), grupo aberto (Roda da Saúde) e produção de materiais educativos (folders e mural). O trabalho pauta-se numa visão de saúde articulada à qualidade de vida e concebe a educação como diálogo, troca de experiências, parceria, respeito ao outro, reflexão, problematização da realidade e busca de alternativas/escolhas possíveis. As necessidades do idoso são consideradas no processo educativo, potencializando sua capacidade de aprender, criar, decidir, respeitando as particularidades do envelhecimento. A experiência valoriza e trás ao debate a complexidade e riqueza da dimensão educativa da saúde, consolidando-se como campo estratégico para a formação profissional e o desenvolvimento de modelo de atenção pautado no cuidado integral e no aprofundamento da articulação teórico-prática em promoção da saúde. No plano do ensino, o trabalho estimula uma nova sensibilidade na cultura profissional, capaz de incluir o outro e seus saberes, considerando as condições socioeconômicas e culturais e sua relação com a saúde. Na dinâmica do serviço, o programa representa um “abrir portas” à participação, aproximando profissionais e população, fortalecendo o compromisso com assistência de qualidade, centrada no vínculo, na responsabilização e na partilha dos desafios à qualidade de vida e saúde no envelhecimento. PALAVRAS-CHAVE: Envelhecimento - promoção da Saúde. Educação em Saúde - idosos. Educação Popular em Saúde.

This paper presents the experience of the Program of Educative Actions in Health Promotion for Aging, maintained by the Elderly Assistance Nucleus, an outpatient clinic of UERJ’s (Rio de Janeiro State University) Third Age Open University. It is an interdisciplinary program that includes several educational activities, open to the elderly and users in general. Its activities include waiting room groups, closed groups (Meetings with Health), open groups (Health “Wheel”) and the production of educational material, such as folders and boards. The work is based on a view of health integrated to quality of life, and sees education as a dialogue, interchange of experiences, partnership, respect to others, reflection, the questioning of reality and the search for possible alternatives and choices. Elderly needs are considered in the educational process, boosting their capacity to learn, create, decide, respecting the particularities of the aging process. The experience honors and brings to discussion the complexity and richness of the educational dimension of health, consolidating itself as a strategic field for professional training and development of a model of assistance based on comprehensive care and practical-theoretical articulation for health promotion. On a teaching level, the work stimulates a new sensibility on the professional culture, capable of including others and their knowledge, considering the social, economic and cultural conditions and their relationships with health. On a service level, the program represents a “door opening” to participation, bringing together professionals and the population, strengthening the vow to quality assistance, centered on human bonding, on responsibility and on sharing the challenges to quality of life and health on aging. KEYWORDS: Ageing - health Promotion. Health Education - elderly. Communitarian Education.

Perfil lipídico e estado nutricional de idosos da Universidade Aberta da Terceira Idade/Universidade do Estado do Rio de Janeiro / Lipid profile and nutritional state of seniors in Universidade Aberta da Terceira Idade/Universidade do Estado do Rio de Janeiro

Tem como objetivo correlacionar as variáveis idade, sexo, índice de massa corporal (IMC) e atividade física com os níveis séricos de lipídios e lipoproteínas de idosos participantes dos Grupos Encontros com a Saúde da UNATI/UERJ.

Saúde e qualidade de vida na terceira idade / Health and life quality in the old age

Apresenta os primeiros resultados da pesquisa Saúde e Qualidade de Vida na Terceira Idade, realizada com idosos que participam do Projeto de Promoção da saúde, desenvolvido pela equipe interdisciplinar do Núcleo de Atenção ao Idoso (NAI), da Universidade Aberta da Terceira Idade - UnATI/UERJ. O objetivo é apresentar um perfil de saúde desses idosos e as interfaces com o trabalho educativo a eles destinado. A partir desta primeira etapa, serão delineadas linhas de pesquisa setoriais e/ou interdisciplinares que aprofundem questões relevantes no campo da saúde e envelhecimento, ao mesmo tempo em que contribuam para o aprimoramento das ações educativas.

Nutrição da pessoa idosa

'Nutrição da pessoa idosa' um recurso em texto do Módulo Eletivo 01 do Curso de Especialização em Saúde da Pessoa Idosa da UNA-SUS/UERJ. Dividido em 04 unidades, o Módulo aborda os aspectos mais relevantes sobre alimentação saudável e nutrição para a pessoa idosa, os tipos de avaliações, recomendações e cuidados nutricionais de acordo com as principais patologias e condições especiais que acometem esta população e, por fim, a questão da educação nutricional e as práticas educativas com idosos.