O trauma de face submetido a cirurgia: Uma análise epidemiológica de 10 anos no interior do Brasil / Facial trauma undergoing surgery: A 10-year epidemiological analysis in the interior of Brazil

Introdução: O trauma de face representa significativa incapacitação para a vítima, além de um desafio para as equipes de saúde devido a sua complexidade e envolvimento de estruturas nobres. Analisar a sua epidemiologia permite coordenar medidas em saúde pública para melhorar o atendimento e a prevenção. Método: Estudo observacional, descritivo, longitudinal, com abordagem retrospectiva a partir dos prontuários dos pacientes vítimas de trauma de face atendidos pela clínica cirúrgica no período entre 2010 e 2019. Resultados: Dentre os 529 prontuários incluídos no estudo e analisados, 71,08% tratava-se de cirurgias eletivas e o restante, 28,92%, de cirurgias de urgência. O trauma foi mais frequente em indivíduos de 20 a 29 anos, o que corresponde a 31,76% do total de casos. Também foi mais frequente em indivíduos do sexo masculino, correspondendo a 78,45% do total de casos. Acidentes automobilísticos foram a causa mais comum, descrita em 22,31% dos prontuários, e a principal fratura, presente em 85,83% dos casos, foi dos ossos próprios do nariz. Conclusão: As vítimas de traumatismo bucomaxilofacial atendidas no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro são predominantemente homens na terceira década de vida, envolvidos em acidentes automobilísticos, com lesões em ossos do nariz que foram abordadas de forma eletiva.

Introduction: Facial trauma represents significant incapacitation for the victim, as well as a challenge for healthcare teams due to its complexity and involvement of important structures. Analyzing its epidemiology allows us to coordinate public health measures to improve care and prevention. Method: Observational, descriptive, longitudinal study with a retrospective approach based on the medical records of patients who suffered facial trauma treated by the surgical clinic between 2010 and 2019. Results: Among in individuals aged 20 to 29 years, which corresponds to 31.76% of total cases. It was also more common in males, corresponding to 78.45% of total cases. Car accidents were the most common cause, described in 22.31% of medical records, and the main fracture, present in 85.83% of cases, was of the bones of the nose. Conclusion: Victims of oral and maxillofacial trauma treated at the Hospital de Clínicas da Universidade Federal do Triângulo Mineiro are predominantly men in their third decade of life, involved in automobile accidents, with injuries to the bones of the nose that were treated electively.

Perfil clínico e epidemiológico de pacientes vítimas de queimaduras, um estudo retrospectivo / Clinical and epidemiological profile of burn victims, a retrospective study

Introdução: No Brasil, queimaduras acometem cerca de um milhão de pessoas/ano, a maioria do sexo masculino. Além de prejuízos físicos e emocionais, há impacto econômico, com gastos para o sistema de saúde, indenizações e incapacidades laborais. Por estas razões, estudos epidemiológicos são importantes para traçar o perfil da população mais acometida, orientando a prevenção dessa afecção. Método: Revisão dos prontuários de 398 vítimas de queimaduras, internados na Santa Casa de Santos, de janeiro de 2016 até dezembro de 2019. Resultados: Os principais acometidos são homens, jovens, em ambiente doméstico, por líquidos aquecidos, causando em sua maioria queimaduras de segundo grau, atendidos em até 24 horas, considerados grandes queimados e internados em enfermaria por até duas semanas. Aproximadamente 90% recebeu alta com melhora, necessitando apenas de desbridamento e curativos. Conclusão: Nosso trabalho concorda com maioria das revisões em relação à prevalência do sexo masculino, jovens, economicamente ativos, em suas residências, com líquidos aquecidos, acidentalmente. Outros estudos apontaram crianças como as mais afetadas, mostrando necessidade de políticas voltadas a ambas as faixas etárias. Com relação à internação, a maioria permaneceu em enfermaria, com queimaduras de segundo grau, prevalecendo os grandes queimados, o que acarreta maior gravidade e custos. Esse dado vai contra alguns trabalhos, que apontam queimadura de segundo grau como principal, porém com menos de 10% da superfície corporal queimada. A maior parte dos pacientes, tanto neste quanto na maioria dos estudos, apresentou bom desfecho, sem necessidade de Unidade de Terapia Intensiva ou procedimentos cirúrgicos, mostrando a importância do desbridamento precoce e cuidados com curativos.

Introduction: In Brazil, burns affect around one million people/year, the majority of whom are male. In addition to physical and emotional losses, there is an economic impact, with costs for the health system, compensation, and work disabilities. For these reasons, epidemiological studies are important to outline the profile of the most affected population, guiding the prevention of this condition. Method: Review the medical records of 398 burn victims admitted to Santa Casa de Santos from January 2016 to December 2019. Results: The main victims were young men in a domestic environment, by heated liquids, mostly causing second degree burns, treated within 24 hours, considered major burns, and admitted to the infirmary for up to two weeks. Approximately 90% were discharged with improvement, requiring only debridement and dressings. Conclusion: Our work agrees with most reviews regarding the prevalence of young, economically active males with accidentally heated liquids in their homes. Other studies highlighted children as the most affected, showing the need for policies for both age groups. Regarding hospitalization, the majority remained in the ward, with second-degree burns, with major burns prevailing, which leads to greater severity and costs. This data goes against some studies, which indicate second-degree burns as the main burn, with less than 10% of the body surface burned. In both this and most studies, most patients had a good outcome, without needing an Intensive Care Unit or surgical procedures, showing the importance of early debridement and care with dressings.

Case-control and case-cohort study designs: methodological considerations / Delineamentos caso-controle e caso-coorte: considerações metodológicas

The "case-control" study is not a homogeneous entity in epidemiology. This article presents a narrative review of characteristics that differentiate "traditional case-control", "population-based case-control", "nested case-control", and "case-cohort" studies. The use of a secondary basis for the choice of controls makes case-control studies particularly vulnerable to selection biases and limits the representativeness of the control group relative to the study population base. The choice of prevalent cases, although useful for maximizing statistical power, undermines the interpretation of associations since determinants of incidence are mixed with determinants of disease duration. "Nested case-control" and "case-cohort" studies partly overcome these limitations because they are based on a true cohort and often use incident cases. "Case-cohort" studies give emphasis to the contrast between case exposure experience and population-based exposure experience, providing additional benefits when there is temporal matching between cases and the reference group. This article provides insights into the methodological arsenal of case-control studies and highlights some of the methodologies discussed - particularly those in which controls are included - favors the use of secondary databases without the need for a key variable that correlates them.

O delineamento tipo "caso-controle" não é uma entidade homogênea em Epidemiologia. Este artigo apresenta uma revisão narrativa de características que diferenciam os estudos caso-controle, tradicional e de base populacional, caso-controle aninhado e caso-coorte. O uso de uma base secundária para a escolha dos controles deixa os estudos caso-controle particularmente vulneráveis ao viés de seleção e limita a representatividade do grupo controle em relação à base populacional do estudo. A opção por casos prevalentes, útil para maximizar o poder estatístico, prejudica a interpretação das associações já que determinantes da incidência são mesclados com os determinantes da duração da doença. Os "casos e controles aninhados" e "caso-coorte", superam em parte essas limitações, pois são baseados em uma coorte verdadeira e usam frequentemente casos incidentes. Os "caso-coorte" enfatizam o contraste entre a experiência de exposição dos casos e de exposição da base populacional, fornecendo benefícios adicionais quando existe pareamento temporal entre casos e controles. Este artigo oferece elementos para a discussão sobre o arsenal metodológico dos estudos "caso-controle" e destaca as metodologias discutidas ­ particularmente aqueles em que os controles são inclusivos - favorece o uso de bases de dados secundários sem que haja a necessidade de uma variável chave que as correlacione.

Visceral Leishmaniasis Associated with HIV Coinfection in Pará, Brazil.

Introduction: Human visceral leishmaniasis (VL) is a zoonosis of great importance to public health due to its epidemiological diversity, with emphasis on the possibility of aggravation by coinfection with the human immunodeficiency virus (HIV). Objective: The aim was to study the epidemiological characteristics of VL cases associated with HIV coinfection in Pará. Methods. Reported cases of VL from January 2006 to December 2016 were investigated. A descriptive epidemiological method related to age, gender, area of residence and coinfection with HIV was used. To calculate variance and test equity, the F-test (Fisher) was performed. To observe the influence of one aspect on another, the chi-square was used to verify if there was dependence or independence between the variables. Results: A total of 1171 cases of VL were reported during the study period. There was an annual mean of LV of 94.9, with a statistical difference (p<0.05) between age groups, with the highest number of cases being observed in children aged 1 to 4 years (27.16%). Males and the urban area had a higher number of cases. There were 57 cases of VL/HIV coinfection, with emphasis on the year 2013 and the municipality of Santarém, which had the highest number of cases. During the ten years studied, there was a correlation between coinfection VL/ HIV, with significant differences between patients with and without HIV who contracted VL (p<0.001). Conclusion: The data reveal the endemic nature of VL in the region, with a high percentage of infection in children living in urban areas. Although the studied region is not identified as a predominant area of HIV cases, this study showed a high annual average (10.3) of cases of VL/HIV coinfection being the first time that cases of VL/HIV coinfection were reported in the Mesoregion of the Lower Amazon and Southwest Pará.

Risk factors related to preventable infant mortality in Espirito Santo, Brazil.

Objective: To analyse the factors associated with preventable of infant mortality, in Espirito Santo, Brazil. Methods: Data were collected from records of notifiable of infant death of the Mortality Information System. A total of 5,089 infant deaths were classified as preventable and non-preventable according to the International Collaborative Effort on Infant Mortality (ICE) and the State System of Data Analysis Foundation (SEADE) methods. To investigate the factors associated with preventable of deaths, it was applied the logistic regression. Results: Approximately, 73% of the deaths were preventable according to the ICE, while 76% were preventable according to the SEADE method. Using to both methods, it was observed that preterm birth, postneonatal death and birth weight between 3000 and above 4,000 g represented higher chances for preventable infant deaths. Furthermore, the medical care was more likely to preventable infant death only for ICE method. Conclusions: The factors related to the quality of care offered in the prenatal, prepartum and childbirth periods were more relevant for the occurrence of preventable infant death. Accordingly, it is recommended to strengthen mother-child care to detect risk pregnancies during prenatal care, as well as a hierarchical, regionalized and integrated perinatal network.

Early diagnosis of autism and other developmental disorders, Brazil, 2013-2019 / Diagnóstico precoce do autismo e outros transtornos do desenvolvimento, Brasil, 2013-2019

ABSTRACT OBJECTIVE To investigate the factors associated with the early diagnosis of autism and other types of pervasive developmental disorder (PDD) in children treated at the Psychosocial Care Center for Children and Adolescents of the Unified Health System, from 2013 to 2019,in Brazil. METHODS An exploratory cross-sectional study, based on data from the Record of Outpatient Health Actions (RAAS) of the first appointment of children aged 1 to 12 years. The gross (RRg) and adjusted (RRa) relative risks and respective 95% confidence intervals (95%CI) were estimated using the Poisson regression model with robust variance estimation. RESULTS Of the 22,483 children included in the study, the majority were male (81.9%), lived in the same municipality where they were diagnosed (96.8%) and in the Southeast region (57.7%). Early diagnosis was higher for childhood autism (RRg = 1.48; 95%CI 1.27-1.71) , PDD without subtype designation (RRg = 1.55; 95%CI 1.34-1.80), other PDD (RRg = 1.48; 95%CI 1.21-1.81) and PDD not otherwise specified (RRg = 1.44; 95%CI 1.22-1.69) than for atypical autism. Children residing in the same municipality where the diagnosis was made had a higher rate of early diagnosis (RRg = 1.31; 95%CI 1.10-1.55) than the others; as well as those referred by primary care (RRg = 1.51; 95%CI 1.37-1.68) and by spontaneous demand (RRg = 1.45; 95%CI 1.31-1.61) than those from other types of referral. Early diagnosis was higher from 2014 and lower in the North region than in the other regions. In the multiple analysis, the magnitude of RRa was similar to that of RRg. CONCLUSIONS Early identification of autism and other PDD has improved in Brazil, but it still represents about 30% of the diagnoses made. The variables included in the model were significant, but still explain little of the early diagnosis of children with autism and other PDD.

RESUMO OBJETIVO Investigar os fatores associados ao diagnóstico precoce do autismo e de outros tipos de transtorno global do desenvolvimento (TGD) de crianças atendidas no Centro de Atenção Psicossocial Infantojuvenil do Sistema Único de Saúde, no período de 2013 a 2019, no Brasil. MÉTODOS Estudo transversal exploratório, com base nos dados do Registro das Ações Ambulatoriais de Saúde (RAAS) do primeiro atendimento de crianças de 1 a 12 anos. Foram estimados o risco relativo bruto (RRb) e ajustado (RRa), e respectivo intervalo de confiança de 95% (IC95%), utilizando o modelo de regressão de Poisson com estimativa de variância robusta. RESULTADOS Das 22.483 crianças incluídas no estudo, a maioria era do sexo masculino (81,9%), residia no mesmo município em que foi diagnosticada (96,8%) e na região Sudeste (57,7%). O diagnóstico precoce foi maior para autismo infantil (RRb= 1,48; IC95% 1,27-1,71), TGD sem designação de subtipo (RRb= 1,55; IC95% 1,34-1,80), outros TGD (RRb= 1,48; IC95% 1,21-1,81) e TGD não especificado (RRb= 1,44; IC95% 1,22-1,69) do que para autismo atípico. As crianças que residiam no mesmo município onde foi realizado o diagnóstico tiveram maior índice de diagnóstico precoce (RRb= 1,31; IC95% 1,10-1,55) do que as demais; bem como aquelas encaminhadas pela atenção básica (RRb= 1,51; IC95% 1,37-1,68) e por demanda espontânea (RRb= 1,45; IC95% 1,31-1,61) do que as oriundas de outros tipos de encaminhamento. O diagnóstico precoce foi maior a partir de 2014 e menor na região Norte quando comparada às demais. Na análise múltipla, a magnitude do RRafoi similar ao do RRb. CONCLUSÕES A identificação precoce de autismo e outros TGD tem melhorado no país, mas ainda representa cerca de 30% dos diagnósticos realizados. As variáveis incluídas no modelo foram significativas, mas ainda explicam pouco do diagnóstico precoce de crianças com autismo e outros TGD.

EPIDEMIOLOGICAL STUDY OF SURGICALLY TREATED HUMERAL SHAFT FRACTURES - A 10-YEAR REVIEW.

Most epidemiological studies do not exclusively address fractures treated surgically but include those with conservative treatment. In Brazil, few epidemiological studies address fractures prevalence undergoing surgical treatment. Objective: To assess the prevalence, demographics, and associated injuries of surgically treated humeral shaft fractures. Methods: A retrospective study between 2009 and 2019 with patients undergoing osteosynthesis of humeral shaft fracture. Categorical variables were assessed using Fisher's chi-square or exact test, and non-categorical variables were assessed using the unpaired t-test. A significance level of 5% was adopted. Results: A total of 115 patients were evaluated. Mean age was 37.9 ± 15.6 years, with a male predominance (66.9%) due to car accidents. The most prevalent fracture type was 12 A3. Open fracture prevalence was 11.3%. Radial nerve damage prevalence was 33% and low-energy trauma was twice as likely. Conclusion: Surgically treated humeral shaft fractures were more prevalent in men, young, and related to high-energy trauma, with a transverse line pattern. Fractures secondary to low-energy trauma had a greater association with radial nerve injury. Level of Evidence III, Epidemiological, Retrospective Study.

A maior parcela dos estudos epidemiológicos não aborda exclusivamente as fraturas tratadas cirurgicamente, mas engloba as de tratamento conservador. No Brasil existem poucos estudos epidemiológicos que versam sobre a prevalência das fraturas submetidas ao tratamento cirúrgico. Objetivo: Avaliar a prevalência, os dados demográficos e as lesões associadas das fraturas da diáfise do úmero tratadas cirurgicamente. Métodos: Estudo retrospectivo conduzido entre 2009 e 2019, com pacientes submetidos a osteossíntese de fratura diafisária do úmero. As variáveis categóricas foram testadas pelo teste qui-quadrado ou teste exato de Fisher, enquanto as não categóricas foram medidas pelo teste t não pareado. Adotou-se nível de significância de 5%. Resultados: Foram avaliados 115 pacientes. A média de idade foi de 37,9 ± 15,6 anos, com uma predominância de pacientes do sexo masculino (66,9%) devido a acidentes automobilísticos. A fratura tipo 12 A3 foi a mais prevalente. A prevalência de fratura exposta foi de 11,3%. A lesão nervo radial ocorreu em 33%, principalmente em traumas de baixa energia. Conclusão: As fraturas diafisárias do úmero tratadas cirurgicamente foram mais prevalentes em homens jovens e relacionadas a traumas de alta energia, com padrão de traço transverso. Fraturas secundárias e traumas de baixa energia tiveram maior associação com lesão do nervo radial. Nível de Evidência III, Estudo Epidemiológico, Retrospectivo.

Análise dos fatores associados ao retransplante de células-tronco hematopoiéticas: estudo caso-controle / Analysis of factors associated with hematopoietic stem-cell retransplantation: a case-control study / Análisis de factores asociados al Retrasplante de Células Madre Hematopoyéticas: un estudio de caso-control

Resumo Objetivo: analisar os fatores associados ao insucesso do Transplante de Células-Tronco Hematopoiéticas (TCTH) em pacientes submetidos ao retransplante de Células-Tronco Hematopoiéticas (RCTH). Método: estudo quantitativo do tipo caso-controle para avaliar pacientes submetidos ao RCTH. Para tanto, utilizou-se amostra pareada de dois controles para cada caso (2:1). O grupo caso foi constituído pelos prontuários de saúde com todos os pacientes que foram submetidos ao RCTH (28) e o grupo controle (56) incluiu pacientes que receberam apenas um transplante. Três variáveis nortearam o pareamento: sexo, diagnóstico e tipo de transplante. Resultados: vinte e quatro (85,71%) pacientes do grupo caso receberam retransplante devido a recidiva da doença e quatro (14.29%) devido a falha do enxerto. Uma diferença estatística foi encontrada na análise entre os pacientes que não usaram o ácido ursodesoxicólico, analgésicos opioides ou imunossupressores. A necessidade de um RCTH entre aqueles que usaram estes medicamentos de forma inapropriada foi 16,12, 12,79 e 4,5 vezes maior, respectivamente, do que entre os que as usaram corretamente. Conclusão: houve uma diferença relacionada ao motivo que levou ao retransplante e os indivíduos analisados. A conclusão é que a razão preditiva para retransplante nesta amostra foi a recidiva da doença.

Abstract Objective: to analyze the factors associated with the failure of Hematopoietic Stem Cell Transplantation (HSCT) in patients undergoing Hematopoietic Stem Cell Retransplantation (HSCR). Method: this study implemented a quantitative approach and was a case-control type which addressed patients undergoing HSCR. To do so, a paired sample of two controls was used for each case (2:1). The case group consisted of the medical records of all patients who underwent HSCR (28) and the control group (56) of those who underwent only one transplant. Three variables guided the pairing: gender, diagnosis and type of transplant. Results: a total of 24 (85.71%) patients in the case group were re-transplanted due to disease relapse and four (14.29%) due to graft failure. There was a statistical difference in the analysis between patients who did not use ursodeoxycholic acid, opioid analgesics and immunosuppressants. The need for HSCR among those who used these medications inappropriately was 16.12, 12.79 and 4.5 times more likely, respectively, than those who used them correctly. Conclusion: there was a difference regarding the reasons which led to the retransplantation and the analyzed subjects, and this study concluded that the predictive reason for retransplantation in the studied sample was disease relapse.

Resumen Objetivo: analizar los factores asociados con el fracaso del Trasplante de Células Madre Hematopoyéticas (TCMH) en pacientes sometidos al Retrasplante de Células Madre Hematopoyéticas (RCMH). Método: estudio cuantitativo de tipo caso-control que abordó pacientes sometidos al RCMH. Para esto, se utilizó una muestra pareada de dos controles para cada caso (2:1). El grupo caso estuvo formado por los registros médicos de todos los pacientes que fueron sometidos al RCMH (28) y el grupo control (56) por los que fueron sometidos a un solo trasplante. Tres variables guiaron el emparejamiento: género, diagnóstico y tipo de trasplante. Resultados: un total de 24 (85.71%) pacientes en el grupo caso fueron retransplantados debido a la recaída de la enfermedad y 4 (14.29%) por el fracaso del injerto. Hubo una diferencia estadística en el análisis entre los pacientes que no usaron ácido ursodesoxicólico, analgésicos opioides e inmunosupresores. La necesidad de RCMH entre los que usaron estos medicamentos de manera inapropiada se encontraba 16,12 - 12,79 y 4,5 veces más probable, respectivamente, que aquellos que los usaron correctamente. Conclusión: hubo diferencia en cuanto a las razones que llevaron al retrasplante de los sujetos analizados. Este estudio concluyó que la razón predictiva del retrasplante, en la muestra estudiada, fue la recidiva de la enfermedad.

Necesidad de superación en modelos matemáticos de epidemiología / Need for improvement in mathematical models of epidemiology

RESUMEN Introducción: En Cuba, se formulan modelos matemáticos, pero no están contemplados para la superación de posgrado ni en pregrado. Aunque los modelos idealizan la realidad, permiten, de manera sencilla, hacer predicciones sobre el comportamiento futuro de una enfermedad y tomar las medidas necesarias. Objetivo: Identificar necesidad de superación en modelos matemáticos de epidemiología. Métodos: Se utilizó un modelo estocástico presente en el paquete EpiModel del programa R. Se simularon tres situaciones diferentes, la primera con violaciones del distanciamiento y la higiene general, la segunda con mejoras en estos dos aspectos, más la inmunidad lograda al 70 % de la población por vacunación y la tercera con mejoras notables en higiene y distanciamiento junto a la vacunación. Se calculó, además, el comportamiento del número reproductivo con el paquete earlyR a partir de la incidencia. Resultados: Se valoró como las trayectorias con los modelos estocásticos tienen más variabilidad y como la reducción de contactos aplana la curva. Se evaluó la dispersión de la epidemia en situaciones de violaciones de la prevención y en otras donde hay prevención y además vacunación. La línea roja de cada modelo varía según las circunstancias, claramente en los casos de violaciones de distanciamiento e higiene esta curva se amplia y se aplana en el caso contrario. Conclusiones: Se identificaron suficientes evidencias sobre el uso y la necesidad de modelos matemáticos para apoyar la toma de decisiones en la epidemiología, se identificó la necesidad de superación en posgrado sobre la teoría de epidemias, que puede extenderse a pregrado.

ABSTRACT Introduction: In Cuba mathematical models are formulated, but they are not contemplated for passing graduate or undergraduate degrees. Objective: To identify the need to work with mathematical simulations. Methods: A stochastic model present in the EpiModel package of the R program was used. Three different situations were simulated, the first with violations of distancing and general hygiene, the second with improvements in these two aspects, plus the immunity achieved to 70% of the population by vaccination and the third with notable improvements in hygiene and distancing together with vaccination. The behavior of the reproductive number with the early R package was also calculated from the incidence. Results: It is assessed how the trajectories with the stochastic models have more variability and how the reduction of contacts flattens the curve. The spread of the epidemic is valued in situations of prevention violations and in others where there is prevention and also vaccination. Conclusions: Sufficient evidence is presented on the use and need of mathematical models to support decision-making in epidemiology, the need to improve the theory of epidemics in graduate school is identified, which can be extended to undergraduate.

Epidemiological study of surgically treated humeral shaft fractures - a 10-year review / Estudo epidemiológico das fraturas diafisárias do úmero tratadas cirurgicamente - uma revisão de 10 anos

ABSTRACT Most epidemiological studies do not exclusively address fractures treated surgically but include those with conservative treatment. In Brazil, few epidemiological studies address fractures prevalence undergoing surgical treatment. Objective: To assess the prevalence, demographics, and associated injuries of surgically treated humeral shaft fractures. Methods: A retrospective study between 2009 and 2019 with patients undergoing osteosynthesis of humeral shaft fracture. Categorical variables were assessed using Fisher's chi-square or exact test, and non-categorical variables were assessed using the unpaired t-test. A significance level of 5% was adopted. Results: A total of 115 patients were evaluated. Mean age was 37.9 ± 15.6 years, with a male predominance (66.9%) due to car accidents. The most prevalent fracture type was 12 A3. Open fracture prevalence was 11.3%. Radial nerve damage prevalence was 33% and low-energy trauma was twice as likely. Conclusion: Surgically treated humeral shaft fractures were more prevalent in men, young, and related to high-energy trauma, with a transverse line pattern. Fractures secondary to low-energy trauma had a greater association with radial nerve injury. Level of Evidence III, Epidemiological, Retrospective Study.

RESUMO A maior parcela dos estudos epidemiológicos não aborda exclusivamente as fraturas tratadas cirurgicamente, mas engloba as de tratamento conservador. No Brasil existem poucos estudos epidemiológicos que versam sobre a prevalência das fraturas submetidas ao tratamento cirúrgico. Objetivo: Avaliar a prevalência, os dados demográficos e as lesões associadas das fraturas da diáfise do úmero tratadas cirurgicamente. Métodos: Estudo retrospectivo conduzido entre 2009 e 2019, com pacientes submetidos a osteossíntese de fratura diafisária do úmero. As variáveis categóricas foram testadas pelo teste qui-quadrado ou teste exato de Fisher, enquanto as não categóricas foram medidas pelo teste t não pareado. Adotou-se nível de significância de 5%. Resultados: Foram avaliados 115 pacientes. A média de idade foi de 37,9 ± 15,6 anos, com uma predominância de pacientes do sexo masculino (66,9%) devido a acidentes automobilísticos. A fratura tipo 12 A3 foi a mais prevalente. A prevalência de fratura exposta foi de 11,3%. A lesão nervo radial ocorreu em 33%, principalmente em traumas de baixa energia. Conclusão: As fraturas diafisárias do úmero tratadas cirurgicamente foram mais prevalentes em homens jovens e relacionadas a traumas de alta energia, com padrão de traço transverso. Fraturas secundárias e traumas de baixa energia tiveram maior associação com lesão do nervo radial. Nível de Evidência III, Estudo Epidemiológico, Retrospectivo.

Association Between Infections and Risk of Ankylosing Spondylitis: A Systematic Review and Meta-Analysis.

Background: Previous literature on the association between infections and the risk of developing ankylosing spondylitis (AS) presented controversial results. This meta-analysis aimed to quantitatively investigate the effect of infections on the risk of AS. Methods: We searched the PubMed, Embase, and Web of Science databases until March 26, 2021 for analytical epidemiological studies on the association between infections and the risk of AS. Fixed or random effect models were used to calculate total risk estimates based on study heterogeneity. Subgroup analysis, and sensitivity analysis were also performed. Publication bias was estimated using funnel plots and Begg's test. Results: Six case-control articles (n=1,296,239) and seven cohort articles (n=7,618,524) were incorporated into our meta-analysis. The pooled odds ratio (OR) from these case-control studies showed that infections were associated with an increased risk of AS (OR=1.46, 95% confidence interval [CI], 1.23-1.73), and the pooled relative risk (RR) from the cohort studies showed the same findings (RR=1.35, 95% CI, 1.12-1.63). Subgroup analysis showed that infections in participants with unadjusted comorbidities (OR=1.66, 95% CI, 1.35-2.03), other types of infection (OR=1.40, 95% CI, 1.15-1.70), and infection of the immune system (OR=1.46, 95% CI, 1.42-1.49) were associated with the risk of AS in case-control studies. In cohort studies, infections with adjusted comorbidities (RR=1.39, 95% CI, 1.15-1.68), viral infection (RR=1.43, 95% CI, 1.22-1.66), other types of infection (RR=1.44, 95% CI, 1.12-1.86), and other sites of infection (RR=1.36, 95% CI, 1.11-1.67) were associated with an increased risk of AS. Conclusions: The findings of this meta-analysis confirm that infections significantly increase the risks of AS. This is helpful in providing an essential basis for the prevention of AS via the avoidance of infections.

Questionnaire-based epidemiological analysis of acute gastroenteritis outbreak among employees of two neighbouring institutions sharing canteen in Prague 2019.

OBJECTIVES: On 17th Dec 2019 gastroenteritis outbreak occurred in two Pragues neighbouring institutions. Investigation aimed to describe outbreak, identify etiological agent, vehicle and propose control measures. METHODS: Routine outbreak investigation and retrospective cohort study was done. Data collected via online questionnaire were analysed using descriptive, univariate and stratified analysis. RESULTS: Of 960 employees, 276 responded (29%). We identified 39 (14%) cases, one tested norovirus positive. Canteen staff didnt report illness. No food item or environmental sample was tested. Sichuan pork served for lunch on 17th Dec was the most likely vehicle of outbreak (odds ratio (OR) 5.02, 95% confidence interval (CI) 1.98-12.64). Eating Sichuan pork and Chinese soup showed OR 31.5, 95% CI 5.0-320.7. Twenty-two (56%) cases can be explained by consumption of these food items. CONCLUSIONS: Epidemiological analytical method provided evidence of likely vehicle. We did not find the source. Control measures were early ensured and outbreak ceased. We emphasise full outbreak investigation using analytical epidemiology, environmental screening and microbiological testing of cases and possibly all kitchen staff.

Gravidade e lesões traumáticas em vítimas de acidente de trânsito internadas em um hospital público / La gravedad y las lesiones traumáticas en las víctimas de accidente de tráfico de pacientes internados en un hospital público / Severity and traumatic injuries in traffic accident victims in a public hospital

Objetivo: Identificar as principais lesões das categorias de vítimas em acidentes de trânsito e sua gravidade. Método: Estudo quantitativo, transversal, com 276 vítimas internadas e, a partir de dados de prontuários e entrevistas, foi realizada associação logística para análises. Resultados: Houve maior frequência do sexo masculino (78,9%), na faixa etária de 21 a 39 anos (50,3%) e motociclistas (74,6%). A lesão mais comum: fratura fechada (44,5%) em membros inferiores (41,9%). A ocorrência de lesão cerebral, lesão torácica e idade aumentam a chance de trauma grave, enquanto o estado civil casado diminui a chance, independente do sexo. Conclusão: Assim, vale destacar que os dados apresentados são fundamentais, para o processo de enfermagem no trauma, visto que as lesões de membros inferiores com fraturas são destaques na categoria de motociclistas e que juntamente com as lesões cerebrais e torácicas incrementam a mortalidade nessas ocorrências(AU)

Objective: To identify the main injuries and their severity in the categories of traffic accidents victims. Method: This is a quantitative, cross-sectional study, with 276 hospitalized victims, based on data from medical records and interviews, with a logistical association for analysis. Results: There was a higher frequency of males (78.9%), aged 21 to 39 years (50.3%) and motorcyclists (74.6%). The most common injury: closed fracture (44.5%) in the lower limbs (41.9%). The occurrence of brain injury, chest injury and age increase the chance of serious trauma, while married marital status decreases the chance, regardless of sex. Conclusion: These data are fundamental for the nursing process in trauma, since lower limb injuries with fractures are the most common in the category of motorcyclists and that, together with brain and thoracic injuries, increases mortality in these occurrences.(AU)

Objetivo: Identificar las principales lesiones de las categorías de víctimas en accidentes de tráfico y su gravedad. Método: Estudio cuantitativo, transversal, con 276 víctimas hospitalizadas, basado en datos de historias clínicas y entrevistas, con una asociación logística para análisis. Resultados: Hubo una mayor frecuencia de hombres (78,9%), de 21 a 39 años (50,3%) y motociclistas (74,6%). La lesión más común: fractura cerrada (44,5%) en miembros inferiores (41,9%). La aparición de lesiones cerebrales, lesiones en el pecho y la edad aumentan la posibilidad de un traumatismo grave, mientras que el estado civil casado disminuye la posibilidad, independientemente del sexo. Conclusión: Por lo tanto, cabe destacar que los datos presentados son fundamentales para el proceso de enfermería en traumatismo, ya que las lesiones en las extremidades inferiores con fracturas se destacan en la categoría de motociclistas y que junto con las lesiones cerebrales y torácicas aumentan la mortalidad en estos sucesos(AU)

Valor de la colangiografía transcística videolaparoscópica en pacientes con sospecha de coledocolitiasis / Value of the intraoperatory cholangiography videolaparoscopic in patient with choledocholithiasis suspicion

RESUMEN Fundamento: la colangiografía videolaparoscópica se ha convertido en un método diagnóstico y terapéutico en la coledocolitiasis. Objetivos: evaluar el valor de la colangiografía transcística en pacientes con sospecha de coledocolitiasis. Métodos: se realizó un estudio de tipo analítico para interpretar y verificar resultado con el objetivo de analizar la correspondencia entre sospecha de coledocolitiasis y resultado de la colangiografía transcística videolaparoscópica, en el Hospital Militar Clínico Quirúrgico Docente Octavio de la Concepción de la Pedraja, desde abril de 2012 hasta diciembre de 2018. La muestra estuvo compuesta por 62 pacientes con sospecha de coledocolitiasis. Resultados: en el estudio, predominó la sospecha moderada de coledocolitiasis en el sexo femenino a expensas de los estudios ecográficos y de laboratorio, específicamente el aumento en el valor de la fosfatasa alcalina y la dilatación del conducto biliar común entre 8 y 10 mm. Los resultados más frecuentes del proceder fueron; el conducto biliar principal sin alteraciones y adherencias vesiculares. El proceder se extendió por más de 60 minutos en más de la mitad de los casos. La estadía en el hospital después del procedimiento fue menos de tres días y prevaleció un excelente resultado. Conclusiones: las mujeres poseen un índice mayor de sospecha de coledocolitiasis y en un rango moderado. Los criterios de laboratorios y ecográficos prevalecen en estos pacientes, sin embargo, no son específicos de coledocolitiasis. La vía biliar principal sin alteraciones y las adherencias vesiculares son los resultados más frecuentes durante el proceder. El tiempo quirúrgico promedio en este proceder es mayor a 60 minutos. La estadía hospitalaria después del proceder es por lo general menor de tres días. El resultado final con este proceder fue excelente.

ABSTRACT Background: videolaparoscopic cholangiography has become a diagnostic and therapeutic method in choledocholithiasis. Objective: to evaluate the value of transcystic cholangiography in patients with suspected choledocholithiasis. Methods: an analytical study was carried out to interpret and verify the result with the objective of analyzing the correspondence between suspected choledocolithiasis and the result of translastic videolaparoscopic cholangiography, at the Octavio Teaching Surgical Clinical Military Hospital of La Concepción de la Pedraja, since April, 2012 to December, 2018. The sample consisted of 62 patients with suspected choledocolithiasis. Results: in the study, moderate suspicion of choledocholithiasis prevailed in the female sex at the expense of ultrasound and laboratory studies, specifically the increase in the value of alkaline phosphatase and dilation of the common bile duct between 8 and 10 millimeters. The most frequent results of the procedure were; the main bile duct without alterations and vesicular adhesions. The procedure extended for more than 60 minutes in more than half of the cases. The hospital stay after the procedure was less than three days and an excellent result prevailed. Conclusions: women have a higher index of suspicion of choledocholithiasis and in a moderate range. Laboratory and ultrasound criteria prevail in these patients, however, they are not specific to choledocholithiasis. The main bile duct without alterations and vesicular adhesions are the most frequent results during the procedure. The average surgical time in this procedure is more than 60 minutes. The hospital stay after proceeding is usually less than three days. The final result with this procedure is excellent.

Brazilian cohorts with potential for life-course studies: a scoping review / Coortes no Brasil com potencial para estudos do ciclo vital: uma revisão de escopo

ABSTRACT OBJECTIVE To identify the Brazilian cohorts that started either in the prenatal period or at birth, to describe their characteristics and the explored variables, and to map the cohorts with potential for studies on early determinants on health and the risk of falling ill on later stages of the life cycle. METHODS A scoping review was carried out. The articles were searched in the electronic databases PubMed and Virtual Health Library (VHL). The descriptors used were [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND (Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. The inclusion criteria were Brazilian cohorts that started the baseline in the prenatal period or at birth and with at least two follow-ups with the participants. In order to meet the concept of LCE, we excluded those cohorts whose follow-ups were restricted to the first year of life, as well as those that did not address biological, behavioral and psychosocial aspects, and cohorts with data collection of a single stage of the life cycle. RESULTS The search step identified 5,010 articles. Eighteen cohorts were selected for descriptive synthesis. The median number of baseline participants was 2,000 individuals and the median age at the last follow-up was 9 years. Sample loss at the last follow-up ranged from 9.2 to 87.5%. Most cohorts monitored two phases of the life cycle (the perinatal period and childhood). The Southern region had the highest number of cohorts. The main variables collected were sociodemographic and environmental aspects of the family, morbidity aspects, nutritional practices and lifestyle. CONCLUSIONS We recommend the continuity of these cohorts, the approach to different social contexts and the performance of follow-ups with participants in different phases of the life cycle for the strengthening and expansion of life course epidemiology analyses in Brazil.

RESUMO OBJETIVO Identificar as coortes brasileiras iniciadas no período pré-natal ou no nascimento, descrever suas características e as variáveis exploradas, além de mapear as coortes com potencial para se estudar os determinantes precoces de saúde e doença e o risco de adoecer em etapas posteriores do ciclo vital. MÉTODOS Realizou-se uma revisão de escopo. A busca dos artigos foi realizada nas bases de dados PubMed e Biblioteca Virtual em Saúde em 16 de junho de 2018. Os descritores utilizados foram [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND ("Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. Os critérios de inclusão foram coortes brasileiras que iniciaram a linha de base no período pré-natal ou no nascimento e com pelo menos dois acompanhamentos com os participantes. Foram excluídas as coortes cujos acompanhamentos foram restritos ao primeiro ano de vida, as que não abordaram aspectos biológicos, comportamentais e psicossociais e também aquelas com coleta de informações em um único estágio do ciclo vital. RESULTADOS A etapa de busca identificou 5.010 artigos. Foram selecionadas 18 coortes para a síntese descritiva. A mediana do número de participantes na linha de base foi 2.000 indivíduos e a mediana de idade no último acompanhamento foi 9 anos. A perda amostral no último acompanhamento variou de 9,2 a 87,5%. A maioria das coortes realizou acompanhamentos em duas fases do ciclo vital (período perinatal e infância). A região Sul contemplou o maior número de coortes. As principais variáveis coletadas foram sociodemográficas e ambientais da família, aspectos de morbidade, práticas alimentares e estilo de vida dos participantes. CONCLUSÕES Recomenda-se a continuidade dessas coortes, a abordagem de diferentes contextos sociais e a realização de acompanhamentos com os participantes em diferentes fases do ciclo vital para o fortalecimento e ampliação das análises de epidemiologia do ciclo vital no Brasil.

Caídas múltiples y factores asociados en adultos mayores funcionales no institucionalizados de Villahermosa, Tabasco, México / Multiple falls and associated factors in non-institutionalized functional elderlies from Villahermosa, Tabasco, Mexico / Quedas múltiplas e fatores associados em idosos não institucionalizados com capacidade funcional de Villahermosa, Tabasco, México

Resumen: Objetivo: Evaluar el efecto de tres fuentes de alimentación sanguínea: conejo Nueva Zelanda, rata egipcia y humana, sobre el número de huevos colocados por ovipuesta y porcentaje de eclosión de las larvas Aedes aegypti en condiciones de insectario. Material y Métodos: Se realizó un estudio transversal en los 17 Consejos de Adultos Mayores de la Ciudad de Villahermosa, Centro, Tabasco, México, en 2008. Se estudió un universo de N = 526 personas adultas mayores, del que se tomó una muestra probabilística simple con 95% de confianza de n = 110, que fueron seleccionadas propositivamente. Se incluyeron adultos de 60 años o más, de cualquier sexo, sin deterioro cognitivo conocido, que aceptaron participar en el estudio. Se registraron variables sociosanitarias junto con las caídas durante los últimos seis meses previos al estudio, que se obtuvieron mediante anamnesis directa. Los datos se analizaron mediante estadística descriptiva y odds ratio (OR) con intervalos de confianza al 95% (IC95%), que se obtuvieron con Epi Info© 3.3.2 para Windows©. Resultados: 110 personas adultas mayores con edad media de 71.5 ± 4.8 años en un intervalo de 60-86 años, 58% masculinos y 42% femeninos. El 100% tuvieron al menos una caída, 82% fueron de primera vez durante los seis meses previos al estudio y 18% fueron caídas múltiples. Se encontraron asociaciones estadísticamente significativas entre caídas múltiples y estado civil no unido OR = 0.21 (IC95% 0.08, 0.54), y caída de primera vez OR = 0.08 (IC95% 0.01, 0.59). Conclusiones: Las prevalencias de caídas generales y de primera vez fueron mayores a las reportadas en la literatura internacional, y la de caídas múltiples estuvo dentro de lo esperado de acuerdo con las referencias. La asociación protectora entre caídas múltiples y estado civil no unido y caídas de primera vez, sugieren la existencia de miedo a caer. Se requiere estudiar las características extrínsecas e intrínsecas de las caídas.

Abstract: Objetive: To determine the prevalence of multiple falls and your associated factors in functional elderlies non-institutionalized from Villahermosa, Centro, Tabasco, Mexico. Materials and methods: We achieved a cross-sectional study in the 17 Consejos de Adultos Mayores from Villahermosa City, Centro, Tabasco, México, in 2008. We studied a universe of N = 526 elderlies and we took a simple randomized sample with 95% of confidence of n = 110, which were pourpositively selected. We included elderlies of 60 years-old or more, of any gender, without cognitive deterioration known which agree participate in the study. We registered sociosanitary variables along with the falls during the last six months before the research, that we obtained by mean of direct anamnesis. The data were analyzed by mean of descriptive statistics and odds ratio (OR) with confidence intervals to 95% (CI95%) that we obtained with Epi Info© 3.3.2 for Windows©. Results: 110 elderlies with mean age 71.5 ± 4.8 years-old in an interval of 60-86 years, 58% were males and 42% females. The 100% they had at least one fall, 82% were first time during the six months before the study and 18% were multiple falls. We found associations statistically significant among multiple falls and non-united married status OR = 0.21 (IC95% 0.08, 0.54), and first time fall OR = 0.08 (IC95% 0.01, 0.59). Conclusions: The prevalence of general and first-time falls were major than reported in the international literature, and of multiple falls within what was expected accord to the references. The protector association between multiple falls and no-married civil status and first- time falls suggest the existence of fear of falling. To study the extrinsic and intrinsic characteristics of the falls are required.

Resumo: Objetivo: Determinar a prevalência das múltiplas quedas e fatores associados em idosos não institucionalizados com capacidade funcional, de Villahermosa, Centro, Tabasco, México. Materiais e métodos: Realizou-se um estudo transversal em 17 Conselhos de Idosos da Cidade de Villahermosa, Centro, Tabasco, México, em 2008. Estudou-se um universo de N = 526 idosos, do qual se escolheu uma amostra probabilística simples de n = 110, com um intervalo de confiança de 95%, que foram selecionados intencionalmente. Foram incluídos adultos com 60 ou mais anos, de ambos os sexos, sem comprometimento cognitivo conhecido, que concordaram participar no estudo. Variáveis sócio sanitárias foram obtidas por meio de anamnese direta e registradas juntamente com as quedas nos últimos seis meses anteriores ao estudo. Os dados foram analisados por estatística descritiva e odds ratio (OR) com intervalos de confiança de 95% (IC95%), obtidos com o Epi Info © 3.3.2 for Windows ©. Resultados: 110 idosos com idade média de 71,5 ± 4,8 anos num intervalo de 60-86 anos, 58% homens e 42% mulheres. 100% da amostra tiveram pelo menos uma queda, em 82% as quedas aconteceram pela primeira vez nos seis meses anteriores ao estudo e 18% tiveram múltiplas quedas. Encontrou-se associações estatisticamente significativas entre as múltiplas quedas e o estado civil de solteiros OR = 0,21 (IC 95% 0,08, 0,54), e a primeira queda OR = 0,08 (IC 95% 0,01, 0,59). Conclusão: A prevalência das primeiras quedas foi maior do que a relatada na literatura internacional, e a de múltiplas quedas encontra-se dentro do esperado com base nas referências encontradas. A associação protetora entre as múltiplas quedas e o estado civil de solteiros e as primeiras quedas sugere a existência de medo. Torna-se necessário estudar as características extrínsecas e intrínsecas das quedas.

Autopercepción del estado de salud en pensionados por complicaciones de diabetes mellitus en Guadalajara, México / Self-perception of health status in people retired due to diabetes mellitus complications from Guadalajara, Mexico

RESUMEN Objetivo Evaluar la autopercepción del estado de salud (APES) de los pensionados por complicaciones de la diabetes mellitus, y que características sociodemográficas, familiares, laborales y clínicas de éstos están asociadas a dichas variables. Métodos Estudio transversal analítico en un universo 240 pensionados que aceptaron participar. Se evaluó la APES con el Cuestionario EuroQol-5D en español, y se incluyeron variables sociodemográficas, familiares, laborales y clínicas. Resultados Se estudiaron 240 pensionados con edad media 53,43 ± 8,16 años, 94,3% masculinos y 5,7% femeninos. Se encontró que el 53,4% refiere una APES regular, mala o muy mala. Se halló asociación significativa entre mala APES y vida laboral ≤30 años OR=6,00 (IC95% 1,27, 28,26) e insuficiencia renal crónica OR=7,00 (IC95% 1,39,35,35). No se encontraron modelos explicativos mediante regresión logística. Conclusiones La frecuencia de APES mala fue elevada en la muestra de pensionados por complicaciones de la diabetes mellitus. Se requieren estudios con muestras más amplias para mejores conclusiones.(AU)

ABSTRACT Objective To evaluate self-perception of health status (APES by its Spanish acronym) of people retired due to complications of diabetes mellitus, and what socio-demographic, family, work and clinical characteristics are associated to these variables. Materials and Methods Analytical, cross-sectional study in a universe of 240 pensioners who agreed to participate. The APES was evaluated with the EuroQol-5D questionnaire in Spanish, and socio-demographic, family, work and clinical variables were included. Results 240 pensioners with a mean age of 53.43 ± 8.16 years (94.29% male and 5.71% female) were studied. It was found that 53.4% reported regular, poor or very poor APES. A significant association between poor APES and work life ≤30 years (OR=6.00; 95%CI: 1.27, 28.26) and chronic renal failure (OR=7.00; 95%CI: 1.39, 35.35) was found. No explanatory models were found through logistic regression. No explanatory models were found by logistic regression. Conclusion The frequency of poor APES was high in the sample of patients with diabetes. Studies with larger samples are required for better conclusions.(AU)

Chronic oral infection: An emerging risk factor of cerebral small vessel disease.

Chronic oral infections (gingivitis/periodontitis) have been associated with age-related diseases such as diabetes, coronary heart disease, and acute ischemic stroke. In addition, imaging surrogates of cerebrovascular ischemia beyond acute ischemic stroke (i.e., silent strokes and brain white matter hyperintensities) may also be associated with chronic oral infections. The pathology underlying lacunar strokes and brain white matter hyperintensities (WMH) relates to small vessel disease in the brain. In this review, we highlight recent progress in exploring potential associations of oral infections with cerebral small vessel disease and its surrogates (silent strokes, white matter hyperintensities) and clinical sequelae (i.e., vascular dementia). Recent evidence suggests that periodontitis aggravates cerebral small vessel disease and increases lacunar stroke risk. Moreover, periodontitis interacts with Alzheimer's disease to increase the severity of clinical dementia and to accelerate its manifestations. The results suggest that periodontitis may be an emerging risk factor of small vessel disease-associated cerebrovascular disorders and that the risk increase may be mediated by the systemic inflammation resulting from chronic oral infections. Large cohort studies employing state-of-the-art magnetic resonance techniques to identify specific cerebral pathologies as a function of time, oral health status, and systemic inflammation are needed to further substantiate the hypothesis.

Agreement between subjective and objective measures of sleep duration in a low-middle income country setting.

OBJECTIVES: Describe sleep duration in adult Sri Lankans and determine the bias and agreement of self-report and actigraphic assessments. DESIGN: Validation sub-study nested within the Colombo Twin and Singleton Study (2012-2015). SETTING: Colombo, Sri Lanka. PARTICIPANTS: 175 adults with actigraphy, randomly selected from 3497 participants with self-reported sleep assessed in a population-based cohort. MEASUREMENTS: Self-reported sleep duration, ascertained by the Pittsburgh Sleep Quality Index (PSQI), was compared to a minimum of four days of actigraphy. Bias and agreement were assessed using the Bland-Altman method and a novel application of criterion cut-point analysis. Objective measurements of wake after sleep onset (WASO) and sleep efficiency were evaluated. RESULTS: Sri Lankans have short sleep duration; averaging 6.4h (SD 1.5) self-reported and 6.0h (SD 0.9) actigraphically. Poor sleep quality was prevalent with an average WASO of 49 min., and sleep efficiency <85%. Bias was observed, with self-report consistently over-reporting sleep on average by 27.6 min (95% CI: -0.68, -0.24) compared to objective measures, but wide individual variation in disagreement, ranging from over-reporting by 3.34h to under-reporting by 2.42h. A criterion cut-point method also failed to define agreed definitions of short and long sleep duration. CONCLUSIONS: Sleep in Sri Lankan adults, whether measured subjectively or objectively, is of short duration and suboptimal objective quality by High Income Country consensus standards. Given the high cardiometabolic morbidity in Sri Lanka and poor measurement agreement observed, this warrants further investigation and supports the need for culturally appropriate, reliable, and valid assessment for analytic epidemiology in non-Western settings.

Análise da evolução dos pacientes queimados de acordo com seu perfil epidemiológico na Santa Casa de Misericórdia de Santos, Brasil / Analysis of the evolution of burn patients based on their epidemiological profile in Santa Casa de Misericórdia de Santos, Brazil

Introdução: As queimaduras constituem um importante problema de saúde pública, representando a segunda causa de morte na infância não só nos Estados Unidos como também no Brasil. Porém, existem poucos dados e informações disponíveis para orientar programas de prevenção. O objetivo do trabalho foi de analisar dados epidemiológicos de pacientes com o diagnóstico de queimadura internados traçando um perfil dos pacientes no período estudado. Método: Estudo retrospectivo dos 716 pacientes internados no período de janeiro de 2011 a maio de 2017 na Santa Casa de Misericórdia de Santos (SCMS) para a especialidade de Cirurgia Plástica. Foram analisados o perfil demográfico, tempo de internação e mortalidade. Resultados: Dos 716 pacientes internados, a média de idade total é de 29 anos em ambos sexos e nesse período 28 foram a óbito, com média de idade de 58,6 anos. Conclusão: O estudo mostrou o perfil dos pacientes internados na SCMS e a importância dos cuidados com os pacientes queimados e todos os fatores de mau prognóstico, como a idade mais avançada, que se colocou como um importante fator para a evolução desfavorável dos casos.

Introduction: Burns are an important public health problem, representing the second cause of death in childhood not only in the United States but also in Brazil. However, available data and information for guiding prevention programs are limited. The objective of this study was to analyze the epidemiological data of hospitalized patients diagnosed with burns and to outline a profile of the patients in the study period. Methods: A retrospective study of the 716 hospitalized patients from January 2011 to May 2017 at Santa Casa de Misericórdia de Santos (SCMS) for Plastic Surgery was performed. The demographic profile, length of hospital stay, and mortality were analyzed. Results: Of the 716 hospitalized patients, the mean age was 29 years in both sexes, and 28 patients, with a mean age of 58.6 years, died during the study period. Conclusion: The study showed the profile of hospitalized patients in SCMS and the importance of care in burn patients. All factors of poor prognosis were determined, and older age was considered an important factor for the unfavorable progression of the cases.