PREVALÊNCIA E FATORES DE RISCOS ASSOCIADOS À HIPERTENSÃO ARTERIAL EM IDOSOS HOSPITALIZADOS / PREVALENCE AND RISK FACTORS ASSOCIATED WITH HYPERTENSION IN HOSPITALIZED ELDERLY

Introdução: A hipertensão é o principal fator contribuidor para todas as causas de morte e invalidez. Alterações fisiopatológicas em razão do envelhecimento justificam alta incidência da hipertensão no idoso. Objetivo: Verificar a prevalência e fatores associados a hipertensão em idosos hospitalizados. Método: Estudo transversal, quantitativo, realizado com 233 idosos em hospital de ensino brasileiro de grande porte. Dados sociodemográficos/clínicos e hábitos de vida foram coletados. Análise bivariada e regressão logística foram realizadas, sendo considerado significativo p<0,05. Resultados: A média de idade foi 70,9±8,1anos, com prevalência do sexo masculino (63,1%), brancos (62,2%) e hipertensos (67%). Idade ≥80anos (OR:3,965, IC 95%:1,430- 10,995) e diabetes (OR:4,196, IC 95%:1,968-8,946) foram significativos para ocorrência de hipertensão. Conclusão: Indivíduos muito idosos e diabetes foram fatores significativos para hipertensão em idosos hospitalizados.

Introduction: Hypertension is the main contributing factor to all causes of death and disability. Pathophysiological changes due to aging justify a high incidence of hypertension in the elderly. Objective: To verify the prevalence and factors associated with hypertension in hospitalized elderly. Method: Cross-sectional, quantitative study conducted with 233 elderly people in a large Brazilian teaching hospital. Sociodemographic/clinical data and lifestyle habits were collected. Bivariate analysis and logistic regression were performed, and p<0.05 was considered significant. Results: The mean age was 70.9±8.1 years, with prevalence of males (63.1%), whites (62.2%) and hypertensive (67%). Age ≥80 years (OR:3.965, 95% CI:1.430-10.995) and diabetes (OR:4.196, 95% CI:1.968-8.946) were significant for the occurrence of hypertension. Conclusion: Very elderly individuals and diabetes were significant factors for hypertension in hospitalized elderly.

High mortality by nosocomial infections caused by carbapenem-resistant P. aeruginosa in a referral hospital in Brazil: facing the perfect storm.

Introduction. Carbapenem-resistant Pseudomonas aeruginosa is responsible for increased patient mortality.Gap Statement. Five and 30 day in-hospital all-cause mortality in patients with P. aeruginosa infections were assessed, followed by evaluations concerning potential correlations between the type III secretion system (TTSS) genotype and the production of metallo-ß-lactamase (MBL).Methodology. This assessment comprised a retrospective cohort study including consecutive patients with carbapenem-resistant infections hospitalized in Brazil from January 2009 to June 2019. PCR analyses were performed to determine the presence of TTSS-encoding genes and MBL genes.Results. The 30-day and 5-day mortality rates for 262 patients were 36.6 and 17.9 %, respectively. The unadjusted survival probabilities for up to 5 days were 70.55 % for patients presenting exoU-positive isolates and 86 % for those presenting exo-negative isolates. The use of urinary catheters, as well as the presence of comorbidity conditions, secondary bacteremia related to the respiratory tract, were independently associated with death at 5 and 30 days. The exoS gene was detected in 64.8 % of the isolates, the presence of the exoT and exoY genes varied and exoU genes occurred in 19.3 % of the isolates. The exoU genotype was significantly more frequent among multiresistant strains. MBL genes were not detected in 92 % of the isolates.Conclusions. Inappropriate therapy is a crucial factor regarding the worse prognosis among patients with infections caused by multiresistant P. aeruginosa, especially those who died within 5 days of diagnosis, regardless of the genotype associated with TTSS virulence.

Fadiga secundária à quimioterapia na perspectiva da mulher com câncer de mama / Chemotherapy-related fatigue: the perspective of women with breast câncer / La fatiga secundaria a la quimioterapia en la perspectiva de la mujer con cáncer de mama

Objetivo: Descrever os fatores coadjuvantes para ocorrência da fadiga secundária à quimioterapia e os recursos do conhecimento cultural, utilizados para seu alívio. Método: Estudo prospectivo, misto, realizado com 47 mulheres com câncer de mama e fadiga, em um hospital universitário. Foram analisadas as respostas das questões abertas da Escala de Fadiga de Piper Revisada, que foram submetidas à Análise de Conteúdo. Resultados: Como causas para a fadiga foram descritas seis categorias: medo e preocupação; quimioterapia; estado emocional/psicológico; desajustes no relacionamento familiar; alteração na autoimagem; esforço físico/atividades diárias. Cinco categorias foram apontadas como recursos para alívio: buscar a Deus; banho; repouso; medidas de distração; chorar. Considerações finais: Diante da subvalorização das queixas, relacionadas à fadiga, pelos profissionais, as mulheres passam a buscar por estratégias de alívio no conhecimento cultural. A valorização dos saberes é essencial para definição de condutas efetivas, que possibilitem melhoria da qualidade de vida e redução dos efeitos negativos da fadiga

Objective: to describe contributing factors for the occurrence of chemotherapy-related fatigue and relief strategies derived from cultural knowledge. Methods: a prospective and mixed study, with 47 women with breast cancer and fatigue, conducted at a University Hospital. We analyzed answers to the open questions of the revised Piper Fatigue Scale and submitted to the Content Analysis. Results: six categories were described as causes for fatigue: Fear and worry; chemotherapy; emotional and psychological states; problems in family relationships; changes in self-image; and physical effort to perform daily activities. Five categories were identified as relief: Seek God; bath; rest; entertain; and cry. Conclusion: in the face of underestimating patients' complaints by professionals, women start seeking relief strategies based on their cultural knowledge. The appreciation of knowledge is essential for definition of effective actions, that can improve quality of life and decrease negative effects of fatigue

Objetivo: describir factores coadyuvantes para la ocurrencia de fatiga secundaria a la quimioterapia y recursos del conocimiento cultural, utilizados para alivio. Método: estudio prospectivo, mixto, con 47 mujeres con cáncer de mama y fatiga, realizado en un hospital universitario. Se analizaron las respuestas de las preguntas de la Escala de Fatiga de Piper Revisada, que fueron sometidas al Análisis de Contenido. Resultados: como causas se describieron seis categorías: Miedo y preocupación; quimioterapia; estado emocional/psicológico; desajustes en la relación familiar; cambio en la autoimagen; esfuerzo físico / actividades diarias. Cinco categorías fueron apuntadas como alivio: Buscar a Dios; baño; descanso; medidas de distracción; llorar. Conclusión: frente a la subvaloración de las quejas, por los profesionales, las mujeres pasan a buscar estrategias en conocimiento cultural. La valorización del conocimiento es esencial para conductas efectivas, que permiten mejorar la calidad de vida y reducir los efectos negativos de la fatiga

Experiência do cônjuge diante da mulher com câncer de mama e em quimioterapia: estudo de caso qualitativo / Experience of the spouse of a woman with breast cancer undergoing chemotherapy: a qualitative case study

Objective: To identify the meaning attributed to the experience of a spouse of a woman with breast cancer undergoing chemotherapy. Methods: Descriptive study, with a theoretical-methodological orientation based on medical anthropology and utilizing an ethnographic case study strategy. Data were collected through semi-structured interviews and participant observation. Results: The meanings revealed that the diagnosis cause suffering. Chemotherapy was seen as giving hope of healing the wife's cancer. During this process, the spouse had to deal with the strong adverse effects of the treatment and subordinate to his wife to reduce the conflict experienced by the couple, which violated the rules of his masculinity. Religion and family were important support networks on this path. Final considerations and implications for practice: The results showed the importance of considering cultural aspects of spouses when they are faced with disease in their wives. The way spouses deal with breast cancer will depend on their cultural systems. Nursing care must be comprehensive and extend to spouses whose wives have breast cancer.

Objetivo: Identificar sentidos atribuidos a experiencia del cónyuge de mujer con cáncer de mama en quimioterapia. Método: Estudio descriptivo, orientación teórico-metodológica de antropología médica, estudio de caso etnográfico. Datos recolectados mediante entrevistas semiestructuradas y observación participante. Resultados: Se revela un diagnóstico sufrido. La quimioterapia fue recibida como esperanza de cura al cáncer de la esposa. Durante el tratamiento debió lidiar con los fuertes efectos adversos, e inclusive, subordinarse a la esposa para disminuir los conflictos de pareja, violando las normas de su masculinidad. Durante ese período, religión y familia constituyeron importantes redes de apoyo. Consideraciones finales e implicaciones para práctica: Los resultados evidenciaron la importancia de considerar aspectos culturales del compañero ante el padecimiento de la esposa, la forma en que enfrentará al cáncer de mama dependerá de su sistema cultural. Se requerirá atención de enfermería integral, extendiendo el cuidado al cónyuge de la mujer con cáncer de mama.

Objetivo: Identificar os sentidos atribuídos à experiência do cônjuge diante da mulher com câncer de mama e em quimioterapia. Método: Estudo descritivo, com orientação teórico-metodológica da antropologia médica e estratégia de estudo de caso etnográfico. Os dados foram coletados utilizando entrevistas semiestruturadas e observação participante. Resultados: Os sentidos revelaram um diagnóstico sofrido. A quimioterapia foi recebida como esperança de cura para o câncer da esposa. Na trajetória, precisou lidar com os fortes efeitos adversos do tratamento e ainda se subordinar à esposa para diminuir os conflitos do casal, violando então as regras da sua masculinidade. Nesse percurso, a religião e a família foram importantes redes de apoio. Considerações finais e implicações para prática: Os resultados evidenciaram a importância de se considerar os aspectos culturais do parceiro diante do adoecimento da esposa, a forma como lidará com o câncer de mama dependerá do seu sistema cultural. A assistência de enfermagem deve ser integral e estender o cuidado também ao cônjuge da mulher que tem câncer de mama.

Ação educativa com equipe de enfermagem em serviço de quimioterapia ambulatorial: relato de experiência / Education action with nursing team in outpatient chemotherapy service: case studies / Acción de educación con equipo de enfermería en servicio de quimioterapia ambulatorial: informe de experiencia

Objetivo: relatar a experiência profissional de uma ação educativa em serviço para técnicos e auxiliares de enfermagem relacionada à assistência oncológica ao paciente em tratamento quimioterápico. Método:estudo descritivo, tipo relato de experiência de uma ação educativa desenvolvida no ambulatório de quimioterapia com equipe deEnfermagem. Resultados:primeiramente foi realizada observação no setor, posteriormente foi aplicado um primeiro questionário para avaliar os conhecimentos da equipe sobre o tratamento quimioterápico. Diante das necessidades identificadas, foi implantada a ação educativa em saúde. Ao final da ação foi aplicado novo questionário para avaliar os conhecimentos adquiridos, foi notável a melhora no desempenho, comprovando a relevância da implantação da Política Nacional de Educação Permanente em Saúde. Conclusão:espera-se que esta ação educativa produza efeitos positivos para a atuação dos membros da equipe de enfermagem na assistência ao paciente em quimioterapia.(AU)

Objective: reporting the professional experience of an educational activity in service to technicians and nursing assistants related to cancer care to patients undergoing chemotherapy. Method: a descriptive study of experience type report of an educational program developed in the outpatient chemotherapy clinic with the nursing staff. Results: it was first held observation in the sector; later, there was applied a first questionnaire to assess the knowledge of staff about chemotherapy treatment. Before the needs identified, there was implemented the educational activity in health. At the end of the activity there was applied new questionnaire to assess their knowledge, it was remarkable the improvement on the performance, proving the importance of the implementation of the National Policy of Permanent Education in Health. Conclusion: it is expected that this educational activity produces positive effects on performance of nursing staff members on patient care in chemotherapy.(AU)

Objetivo: reportar la experiencia profesional de una actividad educativa en el servicio a los técnicos y auxiliares de enfermería relacionados con el tratamiento del cáncer a los pacientes sometidos a quimioterapia. Método: un relato de experiencia del tipo estudio descriptivo de un programa educativo desarrollado en la clínica de quimioterapia con el personal de enfermería. Resultados: primeramente, se llevó a cabo la observación en el sector, que se aplicó después un primer cuestionario para evaluar los conocimientos del personal en la quimioterapia. En las necesidades identificadas, fue implementada la acción educativa en salud. Al final de la acción se aplicó nuevo cuestionario para evaluar sus conocimientos; fue notable la mejora en el rendimiento, lo que demuestra la importancia de la implementación de la Política Nacional de Educación Permanente de Salud. Conclusión: se espera que esta actividad educativa produzca efectos positivos en el rendimiento de los miembros del equipo de enfermería en la atención al paciente en la quimioterapia.(AU)

Active surveillance to determine the impact of methicillin resistance on mortality in patients with bacteremia and influences of the use of antibiotics on the development of MRSA infection

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens of nosocomial infections, mainly in intensive care units (ICUs), and accounts for 40-60% of all healthcare-associated S. aureus infections. We evaluated the incidence of nosocomial infection by S. aureus, identified the risk factors for MRSA infection, and evaluated the effect of resistance to methicillin on mortality in patients. Methods We conducted MRSA surveillance at a university hospital in Brazil from January 1, 2010, to December 31, 2010, and performed a retrospective case-control matched study to evaluate the frequency of subsequent MRSA bacteremia and death among patients. We evaluated and compared the risk factors between patients with MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infection. Results Sepsis was the most common cause of infection (17.7/1,000 patient-days), followed by surgical site (11.4/1,000 patient-days), pneumonia (4.1/1,000 patient-days), and urinary tract infection (2.4/1,000 patient-days). The significant risk factors were time of hospitalization, use of central vascular catheter (CVC), urinary catheter, nasogastric tube, parenteral nutrition, tracheostomy, mechanical ventilation, and previous antibiotic administration, the latter of which was the only independent risk factor for MRSA infection. Mortality was significantly higher in patients with MRSA. The number of antibiotics tested was not related to increases in the frequency of MRSA/1,000 patient-days. The incidence of mortality attributable to MRSA (bloodstream infection) BSI was 50%. Conclusions Surveillance results showed that the use of high levels of antibiotics was directly related to the development of MRSA infection, and the mortality attributable to MRSA in patients with bacteremia was significant. .

Active surveillance to determine the impact of methicillin resistance on mortality in patients with bacteremia and influences of the use of antibiotics on the development of MRSA infection.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens of nosocomial infections, mainly in intensive care units (ICUs), and accounts for 40-60% of all healthcare-associated S. aureus infections. We evaluated the incidence of nosocomial infection by S. aureus, identified the risk factors for MRSA infection, and evaluated the effect of resistance to methicillin on mortality in patients. METHODS: We conducted MRSA surveillance at a university hospital in Brazil from January 1, 2010, to December 31, 2010, and performed a retrospective case-control matched study to evaluate the frequency of subsequent MRSA bacteremia and death among patients. We evaluated and compared the risk factors between patients with MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infection. RESULTS: Sepsis was the most common cause of infection (17.7/1,000 patient-days), followed by surgical site (11.4/1,000 patient-days), pneumonia (4.1/1,000 patient-days), and urinary tract infection (2.4/1,000 patient-days). The significant risk factors were time of hospitalization, use of central vascular catheter (CVC), urinary catheter, nasogastric tube, parenteral nutrition, tracheostomy, mechanical ventilation, and previous antibiotic administration, the latter of which was the only independent risk factor for MRSA infection. Mortality was significantly higher in patients with MRSA. The number of antibiotics tested was not related to increases in the frequency of MRSA/1,000 patient-days. The incidence of mortality attributable to MRSA (bloodstream infection) BSI was 50%. CONCLUSIONS: Surveillance results showed that the use of high levels of antibiotics was directly related to the development of MRSA infection, and the mortality attributable to MRSA in patients with bacteremia was significant.

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance / Infecções hospitalares em unidade de terapia intensiva pediátrica de um país em desenvolvimento: vigilância NHSN

INTRODUCTION: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. METHODS: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and children with NI (cases) were compared with a group (matched controls) in a case-control fashion. RESULTS: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. CONCLUSIONS: The incidence of NI acquired in this unit was high and was associated with extrinsic factors.

INTRODUÇÃO: O objetivo deste estudo foi determinar a epidemiologia das três infecções hospitalares (IH) mais comuns - sepse, pneumonia e infecção do trato urinário (ITU) - em uma unidade de terapia intensiva pediátrica (UTIP) de um país em desenvolvimento e definir os fatores de risco associados com IH. MÉTODOS:Nós desenvolvemos um estudo prospectivo de incidência de IH em uma única UTIP, entre agosto/2009 e agosto/2010. Foi conduzida uma vigilância ativa pelo National Healthcare Safety Network (NHSN) na Unidade e as crianças com IH (casos) foram comparadas com um grupo (controles) em um estudo caso-controle. RESULTADOS: Nós analisamos 172 pacientes, 22,1% com IH, 71,1% adquirida na Unidade. A densidade de incidência de sepse, pneumonia e ITU por 1.000 pacientes/dia foram 17,9, 11,4, e 4,3, respectivamente. Os agentes mais comuns na sepse foram Enterococcus faecalis e Escherichia coli (18% cada), e Staphylococcus epidermidis foram isolados em 13% dos casos. Nas pneumonias Staphylococcus aureus foram os agentes mais comuns (3,2%), e nas ITUs os agentes mais frequentes foram os fungos (33,3%). A presença de IH foi associada com tempo de hospitalização prolongado, uso de procedimentos invasivos (CVC, sonda nasogástrica) e uso de antibióticos. Os dois últimos foram fatores independentes para o desenvolvimento de IH. CONCLUSÕES: A incidência de IH adquirida na Unidade foi alta, associada a fatores de risco extrínsecos.

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance.

INTRODUCTION: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. METHODS: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and children with NI (cases) were compared with a group (matched controls) in a case-control fashion. RESULTS: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. CONCLUSIONS: The incidence of NI acquired in this unit was high and was associated with extrinsic factors.