¿Es posible la detección temprana por ecografía del hemotórax coagulado postraumático? / Is the early detection of post-traumatic retained clotted hemothorax possible?

El propósito de este estudio fue determinar la presencia de la coagulación del hemotórax como un fenómeno temprano y visible por ecografía, en los pacientes con derrame posterior al trauma de tórax. Se evaluaron, de manera descriptiva y prospectiva, las características clínicas y ecográficas de los pacientes que presentaron hemotórax o hemoneumotórax traumático, entre enero de 2011 y marzo de 2014. Se practicó ecografía de tórax a 68 pacientes que presentaron este tipo de lesiones y se encontró la presencia temprana de coágulos en 9 de ellos, de los cuales solo uno presento hemotórax retenido como complicación. El 1/9 de los pacientes con coágulos desarrollan hemotórax coagulado, en tanto que 4/59 de aquellos sin coágulos lo desarrollan (riesgo relativo, RR=1,65; IC95% 0,20-1,31). Se concluyó que no había relación entre la aparición temprana de coágulos y el desarrollo de hemotórax. Se requieren estudios con un mayor número de pacientes para demostrar esta asociación

The objective of this study was to determine the presence of retained clotted hemothorax as an early phenomenon visible by ultrasound in patients with pleural effusion posterior to thoracic trauma. We prospectively and descriptively assessed the clinical and ultrasound characteristics of patients who presented traumatic hemothorax or hemopneumothorax in the period January 2011 to March 2014. Ultrasound was performed on 68 patients with this type of injury, and early clots were found in nine patients, of whom only one developed retained hemothorax. We conclude that there is no direct relation between the occurrence of blood clots in the early hemothorax and the development of retained clotted hemothorax. Studies with large numbers of patients are required to demonstrate this association

[Aspirin use in cardiovascular disease prevention: a population-based study]. / Utilização de ácido acetilsalicílico (AAS) na prevenção de doenças cardiovasculares: um estudo de base populacional.

The objective of this study was to estimate the prevalence of aspirin use in primary and secondary prevention of cardiovascular disease. A population-based cross-sectional study was conducted in Pelotas, Rio Grande do Sul State, Brazil, from January to May 2010. The study had two outcomes: 1) aspirin use in primary prevention (individuals > 40 years of age with at least two risk factors: hypertension, diabetes mellitus, and/or hyperlipidemia) and 2) aspirin use in secondary prevention (history of stroke and/or angina/myocardial infarction). The outcomes were analyzed based on demographic, socioeconomic, and lifestyle variables. Prevalence of aspirin use was 24.8% for primary prevention and 34.3% for secondary prevention. In primary prevention, aspirin use was more common in non-whites and older individuals and among those with worse self-rated health. For secondary prevention, aspirin use was more frequent among older and higher-income individuals and former smokers. Prevalence of aspirin use was well below recommended levels for prevention of cardiovascular diseases.

Utilização de ácido acetilsalicílico (AAS) na prevenção de doenças cardiovasculares: um estudo de base populacional / Aspirin use in cardiovascular disease prevention: a population-based study

O objetivo foi estimar a prevalência de uso de ácido acetilsalicílico (AAS) na prevenção das doenças cardiovasculares (DCV). Estudo transversal de base populacional, realizado em Pelotas, Rio Grande do Sul, Brasil, em 2010. Dois desfechos foram considerados: uso de AAS na prevenção primária (indivíduos > 40 anos com pelo menos dois fatores de risco (hipertensão arterial sistêmica, diabetes mellitus e/ou dislipidemia) e uso de AAS na prevenção secundária (história de angina/infarto e/ou acidente vascular encefálico). Os desfechos foram analisados de acordo com variáveis demográficas, socioeconômicas e de estilo de vida. A prevalência de uso de AAS foi de 24,8% na prevenção primária e 34,3% na prevenção secundária. Na prevenção primária o uso de AAS foi maior nos indivíduos de cor não branca, maior faixa etária e com pior autopercepção de saúde. Na prevenção secundária, a prevalência de uso foi maior nos indivíduos com maior faixa etária, maior classe social e ex-fumantes. As prevalências de uso de AAS encontradas estão muito abaixo do recomendado para prevenção das DCV.

The objective of this study was to estimate the prevalence of aspirin use in primary and secondary prevention of cardiovascular disease. A population-based cross-sectional study was conducted in Pelotas, Rio Grande do Sul State, Brazil, from January to May 2010. The study had two outcomes: 1) aspirin use in primary prevention (individuals > 40 years of age with at least two risk factors: hypertension, diabetes mellitus, and/or hyperlipidemia) and 2) aspirin use in secondary prevention (history of stroke and/or angina/myocardial infarction). The outcomes were analyzed based on demographic, socioeconomic, and lifestyle variables. Prevalence of aspirin use was 24.8% for primary prevention and 34.3% for secondary prevention. In primary prevention, aspirin use was more common in non-whites and older individuals and among those with worse self-rated health. For secondary prevention, aspirin use was more frequent among older and higher-income individuals and former smokers. Prevalence of aspirin use was well below recommended levels for prevention of cardiovascular diseases.

[Self-reported discrimination by adolescents in a Brazilian birth cohort: prevalence and associations]. / Discriminação autorrelatada por adolescentes de uma coorte de nascimentos brasileira: prevalência e associações.

OBJECTIVE: To evaluate the prevalence of and factors associated with discrimination self-reported by adolescents. METHODS: Cross-sectional analysis of adolescents belonging to a cohort of live births in 1993 in the city of Pelotas, Brazil. From the 5 249 members of the cohort, information was collected from 4 452 adolescents in 2004 and 2005 regarding self-reported discrimination, sociodemographic variables, physical attributes, and nutritional status. A Poisson regression was utilized in the raw and adjusted analyses to estimate prevalence rates (RP). RESULTS: The global prevalence of self-reported discrimination was 16.4%. In the adjusted analysis, discrimination was reported more by the following groups: girls (RP = 1.27, 95%CI: 1.10-1.48), people identified by others as black (RP = 1.28, 95%CI: 1.04-1.57), poorer adolescents (RP = 1.58, 95%CI: 1.23-2.02), those who perceived themselves to be very thin or very fat (RP = 1.81 and 1.54 respectively), those whose families had financial trouble (RP = 1.76, 95%CI: 1.49-2.08), those who wore glasses (RP = 1.74, 95%CI: 1.45-2.10), those who thought their teeth looked bad (RP = 1.58, 95%CI: 1.21-2.07), those who had been reprimanded in school (RP = 1.23, 95%CI: 1.01- 1.51), and those who had been involved in fights in the past year (RP = 1.62, 95%CI: 1.36-1.94). The association between discrimination and nutritional status varied by sex (interaction P = 0.009). Thin children reported greater discrimination than those who were overweight or obese. Discrimination on the basis of obesity was higher among girls, with this effect more strongly felt among rich girls than among poor ones. CONCLUSIONS: Self-reported discrimination was prevalent and unequally distributed among the population. Actions to reduce experiences of discrimination must be implemented during the initial stages of life.

Discriminação autorrelatada por adolescentes de uma coorte de nascimentos brasileira: prevalência e associações / Self-reported discrimination by adolescents in a Brazilian birth cohort: prevalence and associations

OBJETIVO: Avaliar a prevalência e os fatores associados à discriminação autorrelatada por adolescentes. MÉTODOS: Análise transversal dos adolescentes pertencentes à coorte de nascidos vivos em 1993 na cidade de Pelotas, Rio Grande do Sul, Brasil. Dos 5 249 membros da coorte, foram coletadas informações em 2004 e 2005 sobre discriminação autorrelatada, variáveis sociodemográficas, atributos físicos e estado nutricional em 4 452 adolescentes. Regressão de Poisson foi utilizada nas análises bruta e ajustada para estimar as razões de prevalência (RP). RESULTADOS: A prevalência global de discriminação autorrelatada foi de 16,4 por cento. Na análise ajustada, a discriminação foi mais relatada por meninas (RP = 1,27, IC95 por cento: 1,10 a 1,48); heteroclassificados pretos (RP = 1,28, IC95 por cento: 1,04 a 1,57); pelos mais pobres (RP = 1,58, IC95 por cento: 1,23 a 2,02); os que se perceberam como muito magros ou muito gordos (RP = 1,81 e 1,54, respectivamente), com dificuldades financeiras familiares (RP = 1,76, IC95 por cento: 1,49 a 2,08); que usavam óculos (RP = 1,74, IC95 por cento: 1,45 a 2,10), com autopercepção negativa da aparência dental (RP = 1,58, IC95 por cento: 1,21 a 2,07), com reprovação escolar (RP = 1,23, IC95 por cento: 1,01 a 1,51) ou que participaram em brigas no último ano (RP = 1,62, IC95 por cento: 1,36 a 1,94). A associação entre discriminação e estado nutricional foi diferente conforme o sexo (P de interação = 0,009). Meninos magros relataram maior discriminação, enquanto aqueles com sobrepeso e obesidade apresentaram menor prevalência. Em meninas, a prevalência de discriminação foi maior entre as obesas, sendo esse efeito mais forte entre as ricas do que nas pobres. CONCLUSÕES: A discriminação autorrelatada foi prevalente e desigualmente distribuída na população. Intervenções para reduzir experiências discriminatórias devem ser implementadas em fases iniciais da vida.

OBJECTIVE: To evaluate the prevalence of and factors associated with discrimination self-reported by adolescents. METHODS: Cross-sectional analysis of adolescents belonging to a cohort of live births in 1993 in the city of Pelotas, Brazil. From the 5 249 members of the cohort, information was collected from 4 452 adolescents in 2004 and 2005 regarding self-reported discrimination, sociodemographic variables, physical attributes, and nutritional status. A Poisson regression was utilized in the raw and adjusted analyses to estimate prevalence rates (RP). RESULTS: The global prevalence of self-reported discrimination was 16.4 percent. In the adjusted analysis, discrimination was reported more by the following groups: girls (RP = 1.27, 95 percentCI: 1.10-1.48), people identified by others as black (RP = 1.28, 95 percentCI: 1.04-1.57), poorer adolescents (RP = 1.58, 95 percentCI: 1.23-2.02), those who perceived themselves to be very thin or very fat (RP = 1.81 and 1.54 respectively), those whose families had financial trouble (RP = 1.76, 95 percentCI: 1.49-2.08), those who wore glasses (RP = 1.74, 95 percentCI: 1.45-2.10), those who thought their teeth looked bad (RP = 1.58, 95 percentCI: 1.21-2.07), those who had been reprimanded in school (RP = 1.23, 95 percentCI: 1.01- 1.51), and those who had been involved in fights in the past year (RP = 1.62, 95 percentCI: 1.36-1.94). The association between discrimination and nutritional status varied by sex (interaction P = 0.009). Thin children reported greater discrimination than those who were overweight or obese. Discrimination on the basis of obesity was higher among girls, with this effect more strongly felt among rich girls than among poor ones. CONCLUSIONS: Self-reported discrimination was prevalent and unequally distributed among the population. Actions to reduce experiences of discrimination must be implemented during the initial stages of life.

Pulmonary rehabilitation programs for patients with COPD.

Pulmonary rehabilitation programs are aimed at providing benefits to COPD patients, in various aspects. Our objective was to review the literature on COPD patient rehabilitation. This systematic review involved articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). The outcome measures were exercise, quality of life, symptoms, exacerbations, mortality, and pulmonary function. Treatments were classified as standard rehabilitation, partial rehabilitation, strength exercises, and resistance exercises. Of the 40 articles selected, 4, 18, and 18 were classified as grades A, B, and C, respectively. Of the 181 analyses made in these articles, 61, 50, 23, 23, 20, and 4, respectively, were related to the outcome measures quality of life, exercise, symptoms, exacerbations, pulmonary function, and mortality. The standard rehabilitation programs showed positive effects on all of the outcomes evaluated, except for mortality (because of the small number of analyses). However, we found no differences among the various rehabilitation programs regarding their effects on the outcomes studied. Rehabilitation programs can be considered important tools for the treatment of COPD. Therefore, health administrators should implement public policies including such programs in the routine of health care facilities.

Programas de reabilitação pulmonar em pacientes com DPOC / Pulmonary rehabilitation programs for patients with COPD

Programas de reabilitação pulmonar visam à melhora do paciente com DPOC em vários aspectos. Esta revisão teve como objetivo avaliar a literatura sobre reabilitação em pacientes com DPOC. Foi realizada uma revisão sistemática incluindo artigos publicados entre 2005 e 2009, indexados em bases de dados nacionais e internacionais e escritos em inglês, espanhol ou português. Os artigos foram classificados segundo o critério da Global Initiative for Chronic Obstructive Lung Disease para nível de evidência científica (grau de recomendação A, B e C). Os desfechos exercício, qualidade de vida, sintomas, exacerbações, mortalidade e função pulmonar foram pesquisados. Os tratamentos foram classificados como reabilitação padrão, reabilitação parcial, exercícios de força e exercícios de resistência. Dos 40 artigos selecionados, 4, 18 e 18 foram classificados com graus A, B e C, respectivamente. Das 181 análises oriundas desses artigos, 61, 50, 23, 23, 20 e 4, respectivamente, foram relacionadas aos desfechos qualidade de vida, exercício, sintomas, exacerbação, função pulmonar e mortalidade. Em todos os desfechos avaliados, os programas de reabilitação padrão tiveram efeitos positivos sobre os desfechos estudados, exceto para mortalidade pelo reduzido número de análises. Entretanto, não foram verificadas diferenças nos efeitos sobre os desfechos estudados quando os diferentes programas de reabilitação foram comparados. Programas de reabilitação pulmonar podem ser considerados importantes ferramentas no arsenal do tratamento da DPOC, merecendo atenção dos gestores em saúde para a implementação de políticas públicas que os incluam como rotina nos serviços de saúde.

Pulmonary rehabilitation programs are aimed at providing benefits to COPD patients, in various aspects. Our objective was to review the literature on COPD patient rehabilitation. This systematic review involved articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). The outcome measures were exercise, quality of life, symptoms, exacerbations, mortality, and pulmonary function. Treatments were classified as standard rehabilitation, partial rehabilitation, strength exercises, and resistance exercises. Of the 40 articles selected, 4, 18, and 18 were classified as grades A, B, and C, respectively. Of the 181 analyses made in these articles, 61, 50, 23, 23, 20, and 4, respectively, were related to the outcome measures quality of life, exercise, symptoms, exacerbations, pulmonary function, and mortality. The standard rehabilitation programs showed positive effects on all of the outcomes evaluated, except for mortality (because of the small number of analyses). However, we found no differences among the various rehabilitation programs regarding their effects on the outcomes studied. Rehabilitation programs can be considered important tools for the treatment of COPD. Therefore, health administrators should implement public policies including such programs in the routine of health care facilities.

[The effects of season at time of birth on asthma and pneumonia in childhood and adulthood in a birth cohort in southern Brazil]. / Efeitos das condições climáticas no trimestre de nascimento sobre asma e pneumonia na infância e na vida adulta em uma coorte no Sul do Brasil.

This study evaluated the effects of seasonal weather at time of birth and ambient temperature during the first six months of life on hospitalizations due to asthma and pneumonia in preschool children and on diagnosis of asthma in adulthood among individuals from the 1982 birth cohort in Pelotas, Rio Grande do Sul, Brazil. The cohort included 5,914 live births, of which 77% were followed up until adulthood (23-24 yr). The risk of hospitalization due to pneumonia and asthma among children born from April to June (autumn) was 1.31 (95%CI: 0.99-1.73) to 2.4 (95%CI: 1.11-4.99) times higher than that of children born from January to March (summer). For temperature in the first six months of life, risk of hospitalization was 1.64 (95%CI: 1.26-2.13) to 3.16 (95%CI: 1.63-6.12) times higher for children born in the coldest as compared to the hottest temperature tertile. The effects of seasonality decreased with age, and the association with asthma in adulthood was weak. Hospitalizations in poor children were more frequent, but the effects of seasonality on pneumonia were more evident among the wealthiest.

Efeitos das condições climáticas no trimestre de nascimento sobre asma e pneumonia na infância e na vida adulta em uma coorte no Sul do Brasil / The effects of season at time of birth on asthma and pneumonia in childhood and adulthood in a birth cohort in southern Brazil

Avaliaram-se os efeitos do clima no trimestre do nascimento e nos seis primeiros meses de vida (temperatura média em tercis) sobre as hospitalizações por asma e pneumonia em pré-escolares e sobre o diagnóstico de asma em adultos pertencentes ao estudo de coorte de nascimento de 1982 de Pelotas, Rio Grande do Sul, Brasil. Essa coorte incluiu todos os 5.914 nascidos vivos naquele ano, dos quais, 77 por cento foram acompanhados até a idade adulta (23-24 anos). Os resultados demonstraram que os nascidos entre abril e junho (outono) apresentaram risco de hospitalização por pneumonia e asma/bronquite 1,31 (IC95 por cento: 0,99-1,73) a 2,35 (IC95 por cento: 1,11-4,99) vezes maior do que os nascidos entre janeiro-março (verão). O risco de hospitalizações conforme a temperatura média nos seis primeiros meses de vida foi 1,64 (IC95 por cento: 1,26-2,13) a 3,16 (IC95 por cento: 1,63-6,12) vezes maior no tercil frio do que no quente. Os efeitos da sazonalidade diminuíram com a idade, sendo pouco evidente a associação com asma aos 23-24 anos. As hospitalizações foram mais freqüentes entre crianças pobres, mas os efeitos da sazonalidade sobre a pneumonia foram mais evidentes entre os ricos.

This study evaluated the effects of seasonal weather at time of birth and ambient temperature during the first six months of life on hospitalizations due to asthma and pneumonia in preschool children and on diagnosis of asthma in adulthood among individuals from the 1982 birth cohort in Pelotas, Rio Grande do Sul, Brazil. The cohort included 5,914 live births, of which 77 percent were followed up until adulthood (23-24 yr). The risk of hospitalization due to pneumonia and asthma among children born from April to June (autumn) was 1.31 (95 percentCI: 0.99-1.73) to 2.4 (95 percentCI: 1.11-4.99) times higher than that of children born from January to March (summer). For temperature in the first six months of life, risk of hospitalization was 1.64 (95 percentCI: 1.26-2.13) to 3.16 (95 percentCI: 1.63-6.12) times higher for children born in the coldest as compared to the hottest temperature tertile. The effects of seasonality decreased with age, and the association with asthma in adulthood was weak. Hospitalizations in poor children were more frequent, but the effects of seasonality on pneumonia were more evident among the wealthiest.