Performance of a Hematological Scoring System in Predicting All-Cause Mortality in Patients with Acute Myocardial Infarction

Abstract Background: The presence of nucleated red blood cells (NRBCs) and increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) in peripheral circulation are associated with poorer prognosis in patients with acute coronary disease. Objective: We developed a scoring system for in-hospital surveillance of all-cause mortality using hematological laboratory parameters in patients with acute myocardial infarction (AMI). Methods: Patients admitted for AMI were recruited in this prospective study. Exclusion criteria were age younger than 18 years, glucocorticoid therapy, cancer or hematological diseases and readmissions. NRBCs, MPV and NLR were measured during hospitalization. The scoring system was developed in three steps: first, the magnitude of the association of clinical and laboratory parameters with in-hospital mortality was measured by odds ratio (OR), second, a multivariate logistic regression model was conducted with all variables significantly (p < 0.05) associated with the outcome, and third, a β-coefficient was estimated by multivariate logistic regression with hematological parameters with a p < 0.05. Results: A total of 466 patients (mean age were 64.2 ± 12.8 years, 61.6% male) were included in this study. A hematological scoring system ranging from 0 to 49, where higher values were associated with higher risk of in-hospital death. The best performance was registered for a cut-off value of 26 with sensitivity of 89.1% and specificity of 67.2%, positive predictive value of 26.8% (95% CI: 0.204 - 0.332) and negative predictive value of 97.9% (95% CI: 0.962 - 0.996). The area under the curve for the scoring system was 0.868 (95% CI: 0.818 - 0.918). Conclusions: Here we propose a hematological scoring system for surveillance tool during hospitalization of patients with acute myocardial infarction. Based on total blood count parameters, the instrument can evaluate inflammation and hypoxemia due to in-hospital complications and, consequently, predict in-hospital mortality.

Estigma social e estigma internalizado: a voz das pessoas com transtorno mental e os enfrentamentos necessários / Social stigma and internalized stigma: the voice of persons with mental disorders and the confrontations required

Resumo O estigma internalizado ocorre quando o indivíduo tem consciência do estigma a ele atribuído, concordando e aplicando a si próprio os estereótipos negativos sobre sua doença. A internalização do estigma agrava os sintomas do transtorno mental, levando a isolamento, sentimentos de baixa autoestima, culpa e autorreprovação. Buscou-se produzir mais conhecimentos acerca dessa temática, a partir da visão das pessoas com transtorno mental que participam de ações visando construir coletivamente soluções no cuidado em saúde mental. Com o objetivo de analisar o processo de estigma e estigma internalizado, realizou-se pesquisa qualitativa, com entrevistas semiestruturadas. Os resultados revelaram que o estigma internalizado tem efeitos negativos no indivíduo, e que a família tem forte influência nesse processo.

Abstract Internalized stigma occurs when individuals become aware of the stigma assigned to them, agree, and apply these negative stereotypes about their illness to themselves. The internalization of stigma aggravates the symptoms of mental disorders, leading to isolation, feelings of low self-esteem, guilt, and self-condemnation. Our goal was to produce more knowledge on this topic from the point of view of people with mental disorders who participate in activities aimed at collectively building mental health care solutions. With the objective of analyzing the process of stigma and internalized stigma, we carried out qualitative research using semi-structured interviews. The results showed that internalized stigma has negative effects on individuals, and that the family has a strong influence on this process.