Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study.

BACKGROUND: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia. METHODS: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events. RESULTS: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups. CONCLUSION: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.

COVID-19 outcomes in people living with HIV: Peering through the waves.

OBJECTIVE: To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. METHODS: This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. RESULTS: Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). CONCLUSIONS: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry. / Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19.

BACKGROUND: Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. OBJECTIVES: To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. METHODS: This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. RESULTS: Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. CONCLUSION: Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

FUNDAMENTO: As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. OBJETIVOS: Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. MÉTODOS: Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. RESULTADOS: Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. CONCLUSÃO: Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19 / Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

COVID-19 outcomes in people living with HIV: Peering through the waves

Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort.

BACKGROUND: Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection and outcomes in the Brazilian population. METHODS: This study is part of the Brazilian COVID-19 Registry, a multicentric cohort, including data from 37 hospitals. For the present analysis, patients were grouped according to the presence of reported symptoms (i.e., headache; anosmia and ageusia; syncope and dizziness) vs. clinically-diagnosed neurological manifestations (clinically-defined neurological syndrome: neurological signs or diagnoses captured by clinical evaluation) and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital of admission, and whether or not patients had underlying neurological disease. RESULTS: From 6,635 hospitalized patients with COVID-19, 30.8% presented reported neurological manifestations, 10.3% were diagnosed with a neurological syndrome and 60.1% did not show any neurological manifestations. In patients with reported symptoms, the most common ones were headache (20.7%), ageusia (11.1%) and anosmia (8.0%). In patients with neurological syndromes, acute encephalopathy was the most common diagnosis (9.7%). In the matched analysis, patients with neurological syndromes presented more cases of septic shock (17.0 vs. 13.0%, p = 0.045), intensive care unit admission (45.3 vs. 38.9%, p = 0.023), and mortality (38.7 vs. 32.6%, p = 0.026; and 39.2 vs. 30.3%, p < 0.001) when compared to controls. CONCLUSION: COVID-19 in-hospital patients with clinically defined neurological syndromes presented a higher incidence of septic shock, ICU admission and death when compared to controls.

Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry.

BACKGROUND: It is not clear whether previous thyroid diseases influence the course and outcomes of COVID-19. METHODS: The study is a part of a multicentric cohort of patients with confirmed COVID-19 diagnosis from 37 hospitals. Matching for age, sex, number of comorbidities, and hospital was performed for the paired analysis. RESULTS: Of 7,762 patients with COVID-19, 526 had previously diagnosed hypothyroidism and 526 were matched controls. The median age was 70 years, and 68.3% were females. The prevalence of comorbidities was similar, except for coronary and chronic kidney diseases that were higher in the hypothyroidism group (p=0.015 and p=0.001). D-dimer levels were lower in patients with hypothyroid (p=0.037). In-hospital management was similar, but hospital length-of-stay (p=0.029) and mechanical ventilation requirement (p=0.006) were lower for patients with hypothyroidism. There was a trend of lower in-hospital mortality in patients with hypothyroidism (22.1% vs 27.0%; p=0.062). CONCLUSION: Patients with hypothyroidism had a lower requirement of mechanical ventilation and showed a trend of lower in-hospital mortality. Therefore, hypothyroidism does not seem to be associated with a worse prognosis.

Processos de encaminhamento a serviços especializados em cardiologia e endocrinologia pela Atenção Primária à Saúde / Referral processes to services specialized in cardiology and endocrinology for Primary Health Care

RESUMO Este estudo objetivou analisar encaminhamentos de pessoas a serviços de cardiologia e endocrinologia pelos médicos da Atenção Primária à Saúde (APS) de um município do Rio Grande do Sul. Estudo transversal com questionários a 25 médicos da APS, 2 cardiologistas, 2 endocrinologistas e 1 médico regulador. A análise estatística foi realizada no SPSS, sendo as variáveis contínuas apresentadas como média ou mediana; e as variáveis categóricas, como frequência absoluta e relativa. Entre os médicos da APS, 96% conhecem, 84% utilizam protocolos de encaminhamento e 92% encaminham os pacientes principalmente para manejo de doenças complicadas que necessitam de avaliação do especialista. Entre os especialistas, 50% conhecem os protocolos, e todos apontam que o principal motivo de encaminhamentos para eles ocorre devido a condições crônicas prevalentes mal controladas na APS, sendo considerados pelos endocrinologistas como mal indicados. O médico regulador avalia que a maioria dos documentos de encaminhamento é incompleta e não permite verificar a gravidade do problema. Conclui-se que os protocolos de encaminhamento não estão sendo utilizados de forma a otimizar os fluxos dos usuários na rede de atenção à saúde, indicando a necessidade de revisão de processos de trabalho, capacitação dos profissionais e articulação entre APS, regulação e Atenção Especializada.

ABSTRACT This study aimed to analyze referrals of people to cardiology and endocrinology services by doctors in Primary Health Care (PHC) in a city in Rio Grande do Sul. Cross-sectional study with questionnaires applied to 25 PHC doctors, 2 cardiologists, 2 endocrinologists and 1 regulatory doctor. Statistical analysis was performed in SPSS, with continuous variables being presented as mean or median; and categorical variables, such as absolute and relative frequencies. Among PHC doctors, 96% know, 84% use referral protocols, and 92% refer patients mainly to manage complicated diseases that require specialist evaluation. Among the specialists, 50% know the protocols, and all point out that the main reason for referrals to them occurs due to prevalent chronic conditions poorly controlled in PHC, being considered by endocrinologists as poorly indicated. The regulatory doctor assesses that most referral documents is incomplete and does not allow to verify the seriousness of the problem. It is concluded that the referral protocols are not being used in order to optimize the flow of users in the health care network, indicating the need for review of work processes, training of professionals and articulation between PHC, regulation and Specialized Care.

School health promotion and use of drugs among students in Southern Brazil.

OBJECTIVE: To analyze the relationship between the health promotion conditions in schools and the consumption of alcohol and other drugs by students. METHODS: This is a cross-sectional study with a probabilistic sample of 3,464 students aged 12 to 17 from all schools of the cities of Lajeado and Sapiranga, state of Rio Grande do Sul, Brazil, and 53 managers from the same schools; the data was collected in 2012. Reports of the use of tobacco, alcohol, and illicit drugs in 2012 were used as outcomes, and the health promotion score in the school environment was used as the exposure of interest. We submitted the data to multilevel analysis. RESULTS: The prevalence of the annual use of tobacco was 9.8% (95%CI 8.8-10.8), alcohol was 46.2% (95%CI 44.5-47.8), and other drugs was 10.9% (95%CI 9.9-12.0). In the crude analysis, only the use of tobacco was associated with less health promoting schools (OR = 1.89, 95%CI 1.16-3.09) when compared to those with better conditions. This association lost statistical significance in the adjusted analysis (OR = 1.27, 95%CI 0.74-2.19). CONCLUSIONS: The effects of the school environment on the use of drugs, especially tobacco and alcohol, are manifested mainly by the individual and family conditions of the adolescents.

School health promotion and use of drugs among students in Southern Brazil / Promoção de saúde escolar e uso de drogas em escolares no Sul do Brasil

ABSTRACT OBJECTIVE: To analyze the relationship between the health promotion conditions in schools and the consumption of alcohol and other drugs by students. METHODS: This is a cross-sectional study with a probabilistic sample of 3,464 students aged 12 to 17 from all schools of the cities of Lajeado and Sapiranga, state of Rio Grande do Sul, Brazil, and 53 managers from the same schools; the data was collected in 2012. Reports of the use of tobacco, alcohol, and illicit drugs in 2012 were used as outcomes, and the health promotion score in the school environment was used as the exposure of interest. We submitted the data to multilevel analysis. RESULTS: The prevalence of the annual use of tobacco was 9.8% (95%CI 8.8-10.8), alcohol was 46.2% (95%CI 44.5-47.8), and other drugs was 10.9% (95%CI 9.9-12.0). In the crude analysis, only the use of tobacco was associated with less health promoting schools (OR = 1.89, 95%CI 1.16-3.09) when compared to those with better conditions. This association lost statistical significance in the adjusted analysis (OR = 1.27, 95%CI 0.74-2.19). CONCLUSIONS: The effects of the school environment on the use of drugs, especially tobacco and alcohol, are manifested mainly by the individual and family conditions of the adolescents.

RESUMO OBJETIVO: Analisar a relação entre condições de promoção de saúde nas escolas e o consumo de álcool e outras drogas pelos escolares. MÉTODOS: Estudo transversal de base escolar, com amostra probabilística de 3.464 escolares de 12 a 17 anos de todas as escolas de Lajeado e Sapiranga, RS, e 53 gestores das mesmas escolas; dados coletados em 2012. Os relatos do uso de 2012 de tabaco, álcool e drogas ilícitas foram tomados como desfechos e o escore de promoção de saúde no ambiente das escolas, como exposição de interesse. Os dados foram submetidos à análise multinível. RESULTADOS: A prevalência do uso anual de tabaco foi 9,8% (IC95% 8,8-10,8), álcool 46,2% (IC95% 44,5-47,8) e outras drogas 10,9% (IC95% 9,9-12,0). Na análise bruta, apenas o uso de tabaco esteve associado a escolas menos promotoras (OR = 1,89; IC95% 1,16-3,09) quando comparado as com melhores condições. Essa associação perdeu significância estatística na análise ajustada (OR = 1,27; IC95% 0,74-2,19). CONCLUSÕES: Os efeitos do ambiente escolar quanto ao uso de drogas, especialmente tabaco e álcool, manifestam-se principalmente pelas condições individuais e familiares dos adolescentes.

Exposure to physical and sexual violence and suicidal ideation among schoolchildren / Exposição à violência física e sexual e ideação suicida entre escolares

ABSTRACT Objective The purpose of this study was to estimate the association between exposure to physical and sexual violence, and suicidal ideation in Brazilian Schoolchildren, accounting for confounding variables of religious practice, and problems with alcohol and other drugs. Methods This study consists of a cross-sectional analytical approach of a larger school-based study conducted in 2012 in two medium-sized municipalities in south of Brazil. Participants were 3,547 students aging 12 to 17 years old who answered an assembled questionnaire. Descriptive and Logistic Regression analyses were conducted with suicide ideation outcome testing prediction models stratified by sex. Results Suicide ideation prevalence in the sample was of 21.7%, and regression analysis indicated that girls and boys exposed to physical or sexual violence had 3.42 and 3.14 times more probability of referring suicidal ideation in the past 30 days. Adjusted analyses showed little interference of religious practice, while problems with alcohol and other drugs seemed to also explain suicidal ideation in the sample. Conclusion We highlight the importance of future longitudinal studies to investigate the mechanisms through which exposure to physical or sexual abuse influence suicidal ideation among boys and girls, as well as mediation studies that could enlighten the role of drug and alcohol use in this relationship.

RESUMO Objetivo O objetivo deste estudo foi estimar a associação entre exposição à violência física e sexual e ideação suicida em escolares brasileiros, controlando para variáveis relacionadas a prática religiosa e problemas com álcool e outras drogas. Métodos Este estudo consiste de um recorte transversal de um estudo maior realizado em 2012 em dois municípios de médio porte no sul do Brasil. No total, 3.547 alunos de 12 a 17 anos responderam a um questionário desenvolvido para o estudo em questão. Análises descritivas e de regressão logística foram conduzidas testando modelos preditores de ideação suicida estratrificados por sexo. Resultados A prevalência de ideação suicida na amostra foi de 21,7% e a análise de regressão indicou que meninas e meninos expostos à violência física ou sexual tinham 3,42 e 3,14 vezes mais probabilidade de referir ideação suicida nos últimos 30 dias. As análises ajustadas mostraram pouca interferência da prática religiosa, enquanto problemas com álcool e outras drogas também parecem explicar ideação suicida na amostra. Conclusão Destacamos a importância de futuros estudos longitudinais para investigar os mecanismos por meio dos quais a exposição ao abuso físico ou sexual influencia a ideação suicida em meninos e meninas, bem como estudos de mediação que possam esclarecer o papel do uso de drogas e álcool nessa relação.

Planejamento regional integrado: a governança em região de pequenos municípios / Integrated regional planning: governance in region of small municipalities

Resumo As diretrizes do Decreto nº 7508, de 28 de junho de 2011, têm contribuído para ampliar a capacidade de governança dos pequenos municípios nas regiões de saúde. O objetivo do estudo foi identificar potencialidades e entraves no processo do planejamento regional integrado na região de saúde 29, do Rio Grande do Sul. Consiste em um estudo de caso, realizado mediante informações provenientes de entrevistas semiestruturadas, observações de campo e registros documentais, analisados pelo método de Análise de Conteúdo. Participaram do estudo gestores de saúde de cinco municípios e três servidores estaduais vinculados à 16ª Coordenadoria Regional de Saúde, selecionados intencionalmente. Emergiram cinco categorias de análise: a Comissão Intergestores Regional (CIR) como espaço de articulação; o fortalecimento do Sistema Único de Saúde; a fragilidade da gestão; individualismo ao olhar o processo; e o que tem pautado as reuniões da CIR. Os resultados apontam que o processo de planejamento regional integrado tem avançado, no sentido da CIR constituir-se como um espaço de apoio mútuo entre a gestão municipal e estadual. No entanto, as decisões são tomadas com embasamento mais político do que técnico, com pouco monitoramento do acesso às ações e aos serviços de saúde, dificultando a capacidade de controle e negociação com os prestadores. Considera-se que a CIR necessita ser fortalecida e consolidada por meio da qualificação da gestão e da participação efetiva dos gestores municipais e estaduais de saúde, a fim de possibilitar a governança regional.

Abstract The guidelines of Decree No. 7508 - June 28, 2011 - have contributed to enhance the capacity of governance of small municipalities in health regions. The objective of this study was to identify the potential and the obstacles in the process of integrated regional planning in health region 29, Rio Grande do Sul. This is a case study carried out through information from semi-structured interviews, field observations, and documentary records, analyzed according to Content Analysis method. The study had participation of health managers of five municipalities and three state public servants linked to the 16th Regional Health Coordination, selected intentionally. Five categories of analysis emerged: the Regional Intermanagers Committee (CIR) as a space of coordination; the strengthening of the Brazilian Unified Health System; the weakness of the management; individualism in observing the process; and what has guided the meetings of the CIR. Results indicate that the integrated regional planning process has advanced, in the sense of CIR being constituted as a space of mutual support between the municipal and state management. However, decisions are made with more political than technical basis, with little monitoring of the access to health actions and health services, hindering the ability of control and negotiation in relation to service providers. It is considered that the CIR needs to be strengthened and consolidated through improvement of the management and through effective participation of state and municipal health managers in order to enable regional governance.

Relacionamento entre pai e mãe e consumo de álcool segundo relato de escolares de 12 a 14 anos do sul do Brasil / Parents’ relationship and their alcohol consumption as reported by 12 to 14 years old schoolchildren from southern Brazil

RESUMO Objetivo Investigar a relação entre uma avaliação negativa do relacionamento entre pai e mãe e seu consumo de álcool segundo o relato de escolares de 12 a 14 anos do sul do Brasil. Métodos Estudo transversal de base escolar, no qual foram visitadas todas as escolas dos municípios de Lajeado e Sapiranga, no interior do Rio Grande do Sul, em 2012, com amostragem aleatória, estratificada por sexo, idade, município e rede de ensino (pública estadual, pública municipal ou privada). Os dados foram submetidos a análise descritiva e a regressão de Poisson, com controle de efeito de delineamento para a variável escola. Resultados A amostra foi composta por 2.189 escolares, sendo 1.351 (61,7%) da cidade de Lajeado e 838 (38,3%) de Sapiranga. Não se identificou associação estatisticamente significativa entre consumo de álcool da mãe e relacionamento entre pai e mãe percebido como negativo. Já o consumo de álcool do pai reduziu a probabilidade de a relação entre ele e a mãe do escolar ser referida de modo negativo, na análise bruta [RP = 0,857 (IC95%: 0,744-0,988)]. Essa associação também desaparece na análise ajustada para sexo, idade e escolaridade do principal responsável. Conclusão Do conjunto dos relatos dos escolares, não se mantém qualquer associação entre o consumo de álcool dos adultos e relacionamentos avaliados pelos jovens como negativos. Há risco de haver dissonância entre essas evidências e as que embasam discursos que indicam riscos decorrentes do consumo de álcool para as relações familiares. Aprofundar estudos como esse pode ser oportuno para qualificar políticas públicas na área.

ABSTRACT Objective To examine the relationship between parents’ relationship and their alcohol consumption as reported by students from 12 to 14 years old. Methods A cross-sectional school-based study was performed, visiting all schools of two towns in the state of Rio Grande do Sul, southern Brazil (2012), involving a sample stratified by gender, age, municipality and type of school (public or private). Data were submitted to descriptive and Poisson regression analysis with design effect control for the variable school. Results The sample consisted of 2,189 students who were 1,351 (61.7%) from the city of Lajeado and 838 (38.3%) from Sapiranga. No statistically significant association between mother’s alcohol consumption and relationship between father and mother perceived as negative was found. Father’s alcohol consumption reduced the likelihood of the relationship between him and the mother being reported as negative in the crude analysis [PR = 0.857 (95%CI: 0.744-0.988)]. This association also disappears when the analysis was adjusted by sex, age and education level of the main responsible in the family house. Conclusion There is a risk of strong dissonance between the perception the students have about the influence of adults’ alcohol beverage on the relationships in their homes and speeches aiming to show to schoolchildren that alcohol consumption is harmful to loving relationships and care.

O uso de micro-ondas no preparo de emulsão e influência na estabilidade / Use of a microwave oven in preparation of emulsionand effect on stability

O creme base não iônico descrito no Formulário Nacional foi preparado com duas formas de aquecimento: uma clássica, em banho-maria e chapa com as duas fases separadas; e uma alternativa, em forno micro-ondas com as fases juntas. Procedeu-se o estudo da estabilidade preliminar onde foram avaliados variação dos valores de pH, condutividade, viscosidade e espalhabilidade entre as bases. Estas foram armazenadas em diferentes condições como preconizado no Guia de Estabilidade de Produtos Cosméticos. As bases não apresentaram diferença significativa em relação a pH, condutividade e espalhabilidade máxima. A avaliação reológica demonstrou comportamento não newtoniano, com fluxo plástico e tixotropia. A base aquecida em micro-ondas demonstrou maior viscosidade e menor espalhabilidade, provavelmente decorrente da maior homogeneidade das gotículas observadas na análise microscópica. Pode-se observar que a utilização de outra fonte de aquecimento mais rápida não modificou o produto, podendo ser utilizada como forma alternativa.

The non-ionic cream base described in the Brazilian National Formulary was prepared with two heating methods: one conventional, using a water bath and heating plate, with the two phases heated separately, and one alternative, in a microwave oven, with the phases heated together. A preliminary stability study assessed differences between the bases in pH, conductivity, viscosity and spreadability, after exposure to various treatments and at the end of a 15-day period at several temperatures, as recommended by the Cosmetic Products Stability Guide. No significant differences in pH, conductivity or maximum spreadability were observed. Rheological tests showed non-Newtonian behavior, with plastic flow and thixotropy. The base heated in the microwave oven showed higher viscosity and lower spreadability, probably due to the greater homogeneity of the droplets observed under the microscope. Thus, it can be concluded that the faster heating method did not change the product and may be used as an alternative approach to preparation of the cream base.

[The role of the community health agent in control of the in-house stock of medication in communities served by the family health strategy]. / Papel do agente comunitário de saúde no controle do estoque domiciliar de medicamentos em comunidades atendidas pela estratégia de saúde da família.

The scope of this study was to investigate the in-house stock of medication in communities served by the Family Health Strategy (FHS) in a city located in the south of Brazil. A sample of 10% of households in five FHS areas was studied. Data were collected by Community Healthcare Workers using the adapted Fernandes questionnaire (2000). The mean age of the interviewees was 42 years and of the residents was 16 years, 51% of which were female. Low income (1 to 3 minimum wages) was observed (69.1%), and low education levels (0 to 4 years of study) (42%). Of the households visited 98.7% had at least one medication in stock. In 533 of the storage places located, 43.5% of such places were exposed to heat, 39.6% were exposed to humidity and 16.51% to light. Of the 2,717 medicines found, 6.9% were past the validity date, 35.3% were not in the secondary wrapping and 67.9% were without the patient information leaflet. Analgesics were the most common medications in in-house stock (21%). This study revealed the need for a multi-professional team to promote health and the rationalization of in-house stock since the Community Healthcare Worker is an indispensable professional to promote the rational use of medication.

Papel do agente comunitário de saúde no controle do estoque domiciliar de medicamentos em comunidades atendidas pela estratégia de saúde da família / The role of the community health agent in control of the in-house stock of medication in communities served by the family health strategy

The scope of this study was to investigate the in-house stock of medication in communities served by the Family Health Strategy (FHS) in a city located in the south of Brazil. A sample of 10% of households in five FHS areas was studied. Data were collected by Community Healthcare Workers using the adapted Fernandes questionnaire (2000). The mean age of the interviewees was 42 years and of the residents was 16 years, 51% of which were female. Low income (1 to 3 minimum wages) was observed (69.1%), and low education levels (0 to 4 years of study) (42%). Of the households visited 98.7% had at least one medication in stock. In 533 of the storage places located, 43.5% of such places were exposed to heat, 39.6% were exposed to humidity and 16.51% to light. Of the 2,717 medicines found, 6.9% were past the validity date, 35.3% were not in the secondary wrapping and 67.9% were without the patient information leaflet. Analgesics were the most common medications in in-house stock (21%). This study revealed the need for a multi-professional team to promote health and the rationalization of in-house stock since the Community Healthcare Worker is an indispensable professional to promote the rational use of medication.

O objetivo deste estudo foi avaliar o estoque domiciliar de medicamentos em comunidades atendidas pela Estratégia de Saúde da Família (ESF) em município localizado no Sul do Brasil. Foram amostrados 10% dos domicílios de cinco ESF. Os dados foram coletados por Agentes Comunitários de Saúde (ACS) através de questionário adaptado. A idade média dos entrevistados foi de 42 anos e dos moradores foi de 16 anos, destes 51% eram mulheres. Foi observada renda de 1 a 3 salários mínimos (69,1%), e escolaridade de 0 a 4 anos de estudo (42%). Dos domicílios visitados, 98,7% apresentavam pelo menos um medicamento estocado. Dos 533 lugares de guarda averiguados, 43,5% estava exposto ao calor, 39,6% a umidade, 16,5% a luz. Dos 2.717 medicamentos encontrados, 6,9% estavam vencidos, 35,3% não estavam dentro da embalagem secundária, quando esta se aplica, 67,9% não continham a presença de bula. Os fármacos analgésicos foram os mais prevalentes no estoque (21%). Os resultados nos levam a concluir que há necessidade de equipe multiprofissional para a promoção de saúde e a racionalização dos estoques domiciliares de medicamentos, sendo que o ACS é um profissional indispensável para a promoção do uso racional de medicamentos.

Analysis of pharmaceutical assistance in the Taquari Valley, Rio Grande do Sul: profile of service users and access to medication / Análise da assistência farmacêutica no Vale do Taquari, Rio Grande do Sul: perfil dos usuários do serviço e acesso à medicação

Pharmaceutical assistance concerns actions developed by the pharmacist and other professionals with the purpose of promoting, protecting and restoring health. Medications are an essential tool in this process that focuses on the access to, and the rational use of, drugs. This study is aimed at evaluating the Pharmaceutical Assistance provided by Municipal Health Offices in the Taquari Valley, Rio Grande do Sul. For this purpose, 2,794 users of public pharmacies were interviewed and data was analyzed using descriptive statistics. The users of the public pharmacies were mainly female and individuals with low educational level and income. On average, 2.41 drugs were prescribed per medical prescription and 1.72 of these were procured. Out of the total medicines prescribed, 76.5 percent were listed in the municipal standard drug list (SDL). Medication was prescribed by its generic name in 81.8 percent of the prescriptions. Antibiotics and injections were prescribed in 11.9 percent and 4.0 percent of the prescriptions, respectively. Users' access to information is partial, which can impair adherence to the treatment. Thus, it is possible to conclude that review of the service is necessary for it to be effective.

A Assistência Farmacêutica se preocupa com ações desenvolvidas pelo farmacêutico ou outros profissionais com o propósito de promover, proteger e restaurar a saúde. Medicamentos são ferramentas essenciais nesse processo, que se concentra no acesso e no uso racional de fármacos. Este estudo objetivou a avaliação da Assitência Farmacêutica suprida pela Secretaria Municipal da Saúde no Vale do Taquari, no Rio Grande do Sul. Com esse propósito, 2.794 usuários das farmácias públicas foram entrevistados e analisaram-se os dados usando estatística descritiva. Os usuários das farmácias públicas eram, principalmente, mulheres e indivíduos com baixo nível educacional e financeiro. Na média, 2,41 fármacos eram prescritos por prescrição médica e 1,72 destes foram obtidos. Do total de medicamentos prescritos, 76,5 por cento estava inscritos na lista de medicamentos padrão do município (SDL). A medicação foi prescrita pelo nome genérico em 81,8 por cento dos casos. Antibióticos e injeções foram prescritas em 11,9 por cento e 4,0 por cento das prescrições, respectivamente. O acesso dos usuários à informação é parcial, o que pode prejudicar a adesão ao tratamento. Dessa forma, é possível concluir que a revisão do serviço é necessária para que seja eficaz.