Maternal Risk Factors Associated with Negative COVID-19 Outcomes and Their Relation to Socioeconomic Indicators in Brazil.

BACKGROUND: This study aimed to analyze maternal risk factors associated with negative outcomes of COVID-19 and association with socioeconomic indicators in Brazil. METHODS: A cross-sectional study, with data from the Influenza Epidemiological Surveillance Information System (SIVEP-Flu) of pregnant women with COVID-19 and cases of hospitalization and death. For the analysis of risk factors and outcomes, the multiple logistic regression method was used. RESULTS: Pregnant women who had some risk factor represented 47.04%. The chance of death was 2.48 times greater when there was a risk factor, 1.55 for ICU admission and 1.43 for use of ventilatory support. The percentage of cure was 79.64%, 15.46% without any negative outcome, 4.65% death and 0.26% death from other causes. Pregnant women who did not take the vaccine represented 30.08%, 16.74% took it and 53.18% were not specified. The variables HDI, illiteracy, per capita income and urbanization did not influence the cases of COVID-19. CONCLUSIONS: Factors such as age, obesity, asthma and pregnancy were responsible for the increase in hospitalizations, respiratory complications and death. Vaccination reduced the risk of negative outcomes by 50%. There were no correlations between socioeconomic indicators and the negative outcomes of COVID-19 in pregnant women.

A look through Latin America truck drivers' health, a systematic review and meta-analysis.

Heavy truck drivers represent a social group of great importance to any country's economy. Their professional activity requires a high level of dedication. Due to the irregular hours in their work routine and adopted habits, they mostly predispose them to a diversity of health problems. The purpose of this study is to perform a systematic review and meta-analysis aiming to identify the prevalence of diabetes, hypertension, and obesity in Latin American Truck Drivers. We searched the PubMed, Web of Science, Scopus and LILACS databases, for scientific publications articles, as reported by The PRISMA Statement. From 1,382, 7 studies were included according to the established criteria. The hypertension prevalence found was 34.2%, diabetes was of 9.2% and the highest prevalence found was for overweight and obesity (56%). Meta-analysis presented that drivers have a higher prevalence of overweight or obesity when compared to eutrophic individuals and that drivers with diabetes and hyperglycemia have a lower prevalence. Due to their work activity, their access to the health system is compromised limiting any type of monitoring of their health. This study showed that there is, in Latin America, an investment and assistance gap, both in the health sector and in the research section, for this professional category, which is so important to the economy of these countries. These data should help to identify the difficulties faced by this professional in health assistance, road safety, public safety, leisure and social life. This research also highlighted that they are young and already have the first sign of non-transmissible chronic diseases, which is overweight and obesity.

Prevalence and Impact of Academic Violence in Medical Education.

Situations of mistreatment in the academic environment are prevalent worldwide, but research in this area is scarce in middle-low-income countries. This study aimed to estimate the prevalence of mistreatment inflicted against Brazilian medical students. In addition, characterize these situations and analyze their consequences. Cross-sectional study conducted with 831 medical students from public and private institutions. Absolute and relative frequencies of the analyzed variables and possible associations were determined through univariate and multivariate logistic regression. Chi-square test of association with second-order Rao-Scott adjustment was also used. The response rate was 56%. Public institution pointed to a higher prevalence of mistreatment when compared to private (59% versus 43%). Female students were the most affected. Verbal and psychological aggression was more prevalent. The aggressor usually was a faculty member. Mistreatment incidence increased over the years of training, with higher rates in the internship. About 94% of the students felt affected in anyway, with 77% feeling diminished and depressed. More than 50% reported impaired academic performance. Almost 30% sought help from experts. The reporting rate was extremely low. Adequate identification of the situations by the victims, safe reporting mechanisms and, an educational system capable of maintaining an appropriate learning environment are essential to break this destructive cycle.

Predictors of violence against health professionals during the COVID-19 pandemic in Brazil: A cross-sectional study.

BACKGROUND: The increase in violence against health professionals in the COVID-19 pandemic makes it necessary to identify the predictors of violence, in order to prevent these events from happening. OBJECTIVE: Evaluating the prevalence and analyzing the variables involved in the occurrence of violence against health professionals during the COVID-19 pandemic in Brazil. METHOD: This is a cross-sectional study conducted online involving Brazilian health professionals during the COVID-19 pandemic. The data were collected through a structured questionnaire (Google Online Form) sent to health professionals on social networks and analyzed through logistic regression by using sociodemographic variables. The set of grouped variables was assigned to the final model when p <0.05. A network was built using the Mixed Graph Models (MGM) approach. A centrality measurement chart was constructed to determine which nodes have the greatest influence, strength and connectivity between the nodes around them. RESULTS: The predictors of violence in the adjusted regression model were the following: being a nursing technician / assistant; having been working for less than 20 years; working for over 37 hours a week; having suffered violence before the pandemic; having been contaminated with COVID-19; working in direct contact with patients infected by the virus; and having family members who have suffered violence. The network created with professionals who suffered violence demonstrated that the aggressions occurred mainly in the workplace, with an indication of psycho-verbal violence. In cases in which the aggressors were close people, aggressions were non-verbal and happened both in public and private places. The assaults practiced by strangers occurred in public places. CONCLUSIONS: Violence against health professionals occurs implicitly and explicitly, with consequences that can affect both their psychosocial well-being and the assistance given to their patients and families.

Resection of Pulmonary Endometriosis by Video-Assisted Thoracoscopic Surgery Using Bronchoscopy as a Preoperative Strategy.

The presence of parenchymal or intrabronchial endometrial tissue is rare and has been reported in <6% of women of childbearing age with thoracic endometriosis. Hemoptysis during the menstrual cycle is the most common clinical presentation. We report a case of pulmonary endometriosis, treated concurrently with the patient's menstrual period, with wedge resection by video-assisted thoracoscopic surgery. Bronchoscopy, immediately before the start of the surgical procedure, allowed us to identify the pulmonary segment that had active bleeding, which made the surgical procedure feasible.

Laringotraqueoscopia flexível na decanulação de pacientes traqueostomizados: otimização de segurança para o paciente / Flexible laringotracheoscopy in de-cannulation of tracheostomized patients: safety improvements for the patient

Avaliar a decanulação utilizando a laringotraqueoscopia flexível visando o reconhecimento das lesões laringotraqueais não diagnosticadas quando utilizados somente critérios clínicos. Participaram do estudo 100 pacientes, com idade entre 18 e 80 anos, traqueostomizados, com indicação de decanulação que foram submetidos à oclusão da cânula por 03 minutos para avaliar fonação e ventilação seguido da realização do exame. Foi comparada a indicação de decanulação por critérios clínicos com o diagnóstico de lesões laringotraqueais reconhecidas após o término da laringotraqueoscopia flexível. Os critérios de Myer-Cotton foram utilizados como referencial para classificação de doença laringotraqueal. Resultados: 62 (62%) pacientes apresentaram critérios clínicos para decanulação, porém, com doença laringotraqueal identificada pela laringotraqueoscopia flexível. Dentre estes, oito (8%) considerados aptos à decanulação baseados nos critérios clínicos apresentaram contraindicação à retirada da cânula. Apenas 26 (26%) pacientes não apresentaram doença laringotraqueal; 11 (11%) não foram decanulados por não preencherem critérios clínicos e endoscópicos. A laringotraqueoscopia flexível reconheceu doença laringotraqueal nos pacientes que preenchiam critérios clínicos para retirada da cânula traqueal. Este exame como rotina na avaliação de pacientes preenchendo critérios de decanulação mostrou-se útil e seguro.

To evaluate de-cannulation by flexible laringeotracheoscopy for laringeotracheal lesions which are not diagnosed by clinical criteria. One hundred tracheostomized patients, aged between 18 and 80 years old, with indication of de-cannulation submitted to occlusion of the cannula during three minutes to evaluate fonation and ventilation, followed by tests. De-cannulation by clinical criteria was compared with diagnosis of larigeotracheal lesions after the end of flexible laringeotracheoscopy. Myer-Cotton criteria were employed, a referential for the classification of laringeotracheal diseases. Sixty-two (62%) patients had clinical criteria for de-cannulation but with laringeotracheal disease identified by flexible largineotracheoscopy. Eight (8%) could be de-cannulated, based on clinical criteria which counterindicated the removal of the cannula. Only twenty-six (26%) did not present a laringeotracheal disease. Eleven (11%) were not de-cannulated since they did not comply with clinical and endoscopy criteria. Flexible laringeotracheoscopy acknowledged the laringeotracheal disease in patients who complied with clinical criteria for the removal of tracheal cannula. The test, as a routine in patients´ evaluation complying with de-cannulation criteria, was useful and safe.

Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room / Avaliação do atendimento às vítimas de acidentes de trânsito por plantonista clínico e cirurgião na sala de emergência hospitalar

ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of ​​Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n​=187), the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values ​​was performed in greater numbers when compared with cases led by surgeons (n=501). There was a statistically significant relationship (p<0.01) between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28) in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

RESUMO Objetivo: avaliar o atendimento às vítimas de acidentes de trânsito por médicos plantonistas cirurgiões e/ou clínicos na sala de emergência hospitalar. Métodos: estudo retrospectivo, descritivo e exploratório do atendimento às vítimas de acidentes de trânsito da área urbana de Maringá-PR, entre julho de 2013 e julho de 2014, em hospitais referenciados. Questionário aplicado aos médicos plantonistas avaliou dados demográficos e a formação profissional. Resultados: dos 688 prontuários avaliados, 99% apresentavam Revised Trauma Score pré-hospitalar de 12. Análise estatística mostrou que nos atendimentos feitos por Clínicos (n=187), a anotação dos escores da Escala de Coma de Glasgow e a realização de procedimentos cirúrgicos foram feitas em menor número e, em contrapartida, a anotação dos valores de pressão arterial sistêmica foi realizada em maior número quando comparados com atendimentos feitos por Cirurgiões (n=501). Houve relação estatisticamente significativa (p<0,01) entre o tempo de permanência hospitalar e a especialidade cirúrgica, com maior chance (OR bruta=28) observada no período de uma a seis horas para o grupo atendido pelos Clínicos. A maioria dos plantonistas que participaram do estudo eram jovens, com tempo de atividade em sala de emergência hospitalar de um a dois anos e com capacitação no curso do ATLS. Entre os que participaram do curso do ATLS, 60% o fizeram nos últimos quatro anos. Cirurgiões realizaram 73% dos atendimentos hospitalares. Conclusão: nos atendimentos às vítimas de trânsito com lesões leves, a Escala de Coma de Glasgow, os níveis de pressão arterial sistêmica, o tipo de tratamento na sala de emergência e o tempo de internação hospitalar tiveram abordagens diferentes entre Clínicos e Cirurgiões.

Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná / Protocolo institucional para padronizar cuidados com o dreno de tórax, desde a intervenção cirúrgica até os cuidados de enfermagem, em hospital regional do norte do Paraná

The purpose of chest drainage is to allow lung re-expansion and the reestablishment of the subatmospheric pressure in the pleural space. Properly managing the drainage system minimizes procedure -related complications. This prospective observational study evaluated adult patients undergoing water-seal chest drainage, admitted to our hospital and accompanied by residents and tutors, aiming to check their care. One hundred chest drainages were monitored. The average age was 38.8 years old. The average drainage time was 6.7 days. Trauma was the prevalent cause (72%) for the indication of pleural drainage. The obstruction of the system occurred in 6% of the cases; 5% subcutaneous emphysema, 1% infection around the drain; 5% accidental dislodgement of the drain, and in 5% of the patients, there were some complications when removing the drain. Failures in chest drainage technique and management were present, and reflected in some complications that are inherent to the procedure, although it is known that there are intrinsic complications. This study aimed to assess the management of closed chest drainage systems and standardize the care provided in such procedure.

O objetivo da drenagem torácica é possibilitar a reexpansão pulmonar e o restabelecimento da pressão subatmosférica no espaço pleural. O manejo adequado do sistema de drenagem minimiza as complicações relacionadas ao procedimento. O presente estudo observacional prospectivo avaliou pacientes adultos submetidos à drenagem torácica em selo d'água, internados em nosso hospital e acompanhados por médicos residentes e preceptores, com o objetivo de verificar o manejo com eles. Foram observadas 100 drenagens torácicas. A faixa etária média foi de 38,8 anos. O tempo médio de drenagem foi de 6,7 dias. Houve predomínio da causa traumática (72%) na indicação de drenagem pleural. A obstrução do sistema esteve presente em 6% dos casos; em 5%, houve enfisema subcutâneo; em 1%, infecção peridreno; em 5%, deslocamento acidental do dreno e, em 5% dos pacientes, houve complicação na retirada do dreno. Falhas na técnica e no manejo de drenagem torácica estão presentes em nosso serviço, refletidas em algumas complicações inerentes ao procedimento, embora saibamos que haja complicações que lhe são intrínsecas. O objetivo do estudo foi avaliar o manejo dos sistemas de drenagem torácica fechada e padronizar o protocolo para os cuidados com esse procedimento.

Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room.

OBJECTIVE: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. METHODS: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of ​​Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. RESULTS: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n​=187), the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values ​​was performed in greater numbers when compared with cases led by surgeons (n=501). There was a statistically significant relationship (p<0.01) between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28) in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. CONCLUSION: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.