Prevenção e controle da covid-19: estudo multicêntrico sobre a percepção e práticas no cotidiano das orientações médico-científicas pela população dos territórios de abrangência da Atenção Primária à Saúde / Prevention and control of covid-19: multicenter study on the perception and daily practices of medical-scientific guidelines by the population of territories covered by Primary Health Care

Quando pensamos no Estudo Multicêntrico, pensamos no científico e no popular (de povo, de tradição, de memória e experiência), em diálogo nos territórios da Atenção Básica em Saúde do país. Como prevenir e promover saúde em meio a uma doença que ocupou quase todos os espaços da vida social? A covid-19 estava nas conversas sérias da ciência, no jornal das televisões, nas mensagens de Whatsapp™, nas orientações dos profissionais da saúde, nas trocas de receitas caseiras, no debate político. Assim, iniciamos com a pergunta: como a população está "traduzindo" as orientações médico-científicas, como estão se prevenindo e, ao mesmo tempo, estão se informando sobre a pandemia? Foram convidados a fazer parte do estudo os alunos, docentes e coordenadores do Mestrado Profissional em Saúde da Família ­ PROFSAÚDE, sendo um projeto estruturante do Programa, que deu origem ao grupo de pesquisa do CNPq "Territórios, Modelagens e Práticas em Saúde da Família". O estudo envolveu 21 instituições da Rede, de todas as regiões do país, com a aplicação em 128 Unidades Básicas de Saúde, nos 88 municípios de atuação dos mestrandos no país. Assim, participaram mais de 200 alunos e, pelo menos, 100 docentes e orientadores, tendo sido entrevistadas 7.085 famílias. Foi um verdadeiro mutirão nacional, enriquecido com as nuances locais e regionais. Os resultados da pesquisa mostram que a dinâmica territorial que aproxima as ações de saúde à vida das pessoas foi fundamental no enfrentamento e na mitigação de impactos de emergências sanitárias como a pandemia da covid-19. O estudo multicêntrico desenvolvido pelo Programa reitera a grande capilaridade da Rede PROFSÁUDE no território nacional, na produção de conhecimento técnico e científico para o aprimoramento da Estratégia de Saúde da Família e confirma seu compromisso com a formação de profissionais de saúde e com o fortalecimento do Sistema Único de Saúde.

Chronic inflammatory periapical diseases: a Brazilian multicenter study of 10, 381 cases and literature review

Abstract The aim of this study was to investigate the epidemiological and clinical characteristics of chronic inflammatory periapical diseases in different regions of Brazil and to compare with data from the literature. A multicenter study was carried out in four Brazilian referral centers in oral diagnosis. Histopathological records were reviewed, and all cases diagnosed microscopically as periapical granuloma, radicular cyst, and periapical abscess were included. Demographic and clinical data were collected. Descriptive statistics and Pearson's chi-square test were performed. A total of 10,381 cases of chronic inflammatory periapical diseases were found (13.8% of 74,931 archived specimens) over a period of 65 years. Radicular cysts were the most common lesion (59.9%). Women (56.1%) with a mean age of 37.01 years old (range 13 to 100 ± 14.42) and people of white skin color (59.2%) were the most affected individuals by chronic inflammatory periapical diseases. The lesions were generally asymptomatic (28.1%), located in the maxilla (60.1%), and posterior region (49.8%). The radicular cysts were larger when compared to periapical granulomas (p < 0.001). The disagreement between the clinical and histopathological diagnoses was higher when the final diagnosis was a periapical granuloma (p < 0.001). Chronic inflammatory periapical diseases continue to be common lesions affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst was the most common lesion.

Coronary artery bypass graft surgery improves survival without increasing the risk of stroke in patients with ischemic heart failure in comparison to percutaneous coronary intervention: a meta-analysis with 54, 173 patients

Abstract Objective: To evaluate whether there is any difference on the results of patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in the setting of ischemic heart failure (HF). Methods: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke. Results: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459). Conclusion: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke.

Carga económica de la varicela en niños en Perú, entre 2011 y 2016 / Economic Burden of Varicella in Children in Peru from 2011 to 2016

Objetivo: Describir las complicaciones más frecuentes y la carga económica asociada con la varicela en el Perú. Material y métodos: Estudio multicéntrico de revisión de historias clínicas de pacientes de 1 a 14 años con diagnóstico de varicela entre 2011 y 2016. El uso de recursos de atención médica (URAM) asociados con la varicela, los costos unitarios y la pérdida de trabajo se utilizaron para estimar los costos directos e indirectos, presentados en USD ($). Los datos de costos y URAM se combinaron con estimaciones de carga de enfermedad para calcular el costo total anual de la varicela en el Perú. Resultados: Se incluyeron un total de 179 niños con varicela (101 ambulatorios, 78 hospitalizados). Entre los pacientes ambulatorios, el 5,9 % presentó una o más complicaciones, en comparación con 96,2 % de pacientes hospitalizados. El URAM incluyó el uso de medicamentos de venta libre (72,3 % frente a 89,7 % de pacientes ambulatorios y hospitalizados, respectivamente), medicamentos con receta (30,7 % frente a 94,9 %) y análisis y procedimientos (0,0 % frente a 80,8 %). Los costos directos e indirectos por caso ambulatorio fueron $36 y $62 respectivamente y por caso hospitalizado fueron $548 y $222. El costo anual total asociado con la varicela se estimó en $13 907 146. Conclusión: La varicela está asociada con complicaciones clínicas importantes y elevado URAM en Perú, lo que respalda la necesidad de implementación de un plan de vacunación universal. (AU)

Objective: The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Peru. Methods: This was a multicenter, retrospective chart review study of patients aged 1-14 years with a varicella diagnosis between 2011 and 2016. Healthcare resource utilization (HCRU) associated with varicella, unit costs, and work loss were used to estimate direct and indirect costs, presented in USD ($). The cost and HCRU data was combined with estimates of varicella disease burden to estimate the overall annual costs of management of varicella in Peru. Results: A total of 179 children with varicella (101 outpatients, 78 inpatients) were included. Among outpatients, 5.9% experienced ≥1 complication, compared with 96.2% of inpatients. HCRU estimates included use of over-the-counter (OTC) medications (72.3% vs. 89.7% of outpatient and inpatients, respectively), prescription medications (30.7% vs. 94.9%), tests/procedures (0.0% vs. 80.8%). Among outpatients, direct and indirect costs per case were $36 and $62, respectively; among inpatients, respective costs were $548 and $222. The total annual cost associated with varicella was estimated at $ 13 907 146. Conclusion: Varicella is associated with substantial clinical complications and high HCRU in Peru, supporting the need for implementation of a routine childhood varicella vaccination plan. (AU)

The brazilian registry of adult patient undergoing cardiovascular surgery, the bypass project: results of the first 1,722 patients

Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

Capital social, características do local de residência e autopercepção do estado de Saúde / Social capital, neighborhood characteristics and self rated health

Introdução. Capital social é definido como as características das associações e cooperações humanas que podem ter efeito na saúde. Estudos realizados na última década apontam para uma associação positiva entre maior capital social e melhores indicadores de saúde. Entretanto, algumas características da vizinhança de residência podem atuar como mediadores dessa associação, um tema ainda pouco analisado na literatura científica. Estudos nessa área podem ajudar a melhor entender o efeito do capital social em uma sociedade com altos índices de desigualdade e violência, como é o caso da brasileira. Objetivo. Analisar se as características da vizinhança atuam como mediadores da associação entre o capital social e a autopercepção de saúde. Metodologia. Foram usados os dados da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). O ELSA-Brasil é uma coorte multicêntrica, composta por 15.105 funcionários públicos, ativos e aposentados, de ambos os sexos e com idades entre 35-74 anos vinculados a seis diferentes instituições de ensino e pesquisa brasileiras. As variáveis independentes de interesse foram os domínios de apoio social e de prestígio e educação e de coesão social de vizinhança individual, todos analisados no nível individual. Para a análise dos efeitos da vizinhança foram considerados apenas os indivíduos residentes no mesmo endereço há pelo menos cinco anos. As características de vizinhança estudadas foram: ambiente para atividade física, disponibilidade de alimentos saudáveis, segurança, violência percebida e vitimização. Modelos regressão logísticos foram sequencialmente ajustados para cada uma das características de vizinhança de interesse. Resultados. Os modelos apontam para uma associação consistente entre indicadores mais elevados de apoio e coesão social de vizinhança e melhor autopercepção de saúde, mesmo após o ajuste pelas características do local de residência. Por outro lado, a dimensão referente a prestigio e educação não apresentou uma associação significativa com a situação de saúde em nenhum dos modelos. O apoio social apresentou, na maioria dos modelos, um odds ratio (OR) de 0,81 (95 por cento , IC: 0,69-0,95) em indivíduos com apoio social moderado e OR de 0,62 (95 por cento , IC: 0,52-0,74) em indivíduos com apoio social elevado, mesmo após o controle pelas características da vizinhança. A coesão social da vizinhança também não apresentou modificação em seus efeitos e manteve para a maioria dos modelos um OR de 0,76 (95 por cento , IC: 0,67 0,85) para os indivíduos com coesão social moderada e OR de 0,82 (95 por cento , IC: 0,72 0,93) para os indivíduos com coesão social elevada. Apesar de todas as características de vizinhança terem apresentado associação significativa com a autopercepção de saúde, nenhuma causou modificação significante na associação entre os domínios de capital social e autopercepção de saúde. Conclusão. As características de vizinhança não alteraram significativamente a associação entre capital social e autopercepção de saúde, o que aponta para um efeito do capital social na saúde independentemente das características do local de residência. Entretanto, novos estudos são necessários para que os detalhes dos mecanismos envolvidos, principalmente em relação à possibilidade de causalidade reversa e ao tempo de exposição à vizinhança, sejam plenamente elucidados

Introduction. Social capital can be defined as the characteristics of human associations and cooperation that may have an effect on people\'s health. Studies conducted in the last decade point to a positive association between higher social capital and better health indicators. However, some characteristics of the neighborhood in which people live can act as mediators of this association, an area not yet analyzed in the scientific literature. Studies that analyze this association can help to improve the understanding of the effect of social capital in a society with high levels of inequality and violence, as is the Brazilian society. Objective. The aim of this thesis is to analyze whether neighborhood characteristics act as mediators of the association between social capital and self-perception of health. Methodology. Baseline data (2008-2010) from the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) was analyzed. ELSA-Brasil is a multi-center cohort of 15,105 active and retired civil servants of both sexes aged between 35-74 years linked to six different Brazilian teaching and research institutions. The multiple variables were the domains of social support, prestige and education and social cohesion of individual neighborhood, all analyzed at the individual level. For the analysis of neighborhood effects, only individuals residing at the same postal address for at least five years were included. The neighborhood characteristics studied were: physical activity environment, availability of healthy foods, safety, perceived violence and victimization. Logistic regression models were sequentially adjusted for each of the neighborhood characteristics of interest. Results. The models point to a consistent association between both higher support indicators and social neighborhood cohesion with better health status, even after adjusting for neighborhood characteristics. On the other hand, the dimension of prestige and education did not present a significant association with health situation in any of the models. Social support presented an odds ratio (OR) of 0.81 (95 per cent , CI: 0.69-0.95) for individuals with moderate social support and an OR of 0.62 (95 per cent CI, CI: 0.52-0.74) for individuals with high social support, even after controlling for neighborhood characteristics. Neighborhood social cohesion also did not presented modifications in its effects and remained stable in most OR models: 0.76 (95 per cent CI 0.67-0.85) for individuals with moderate social cohesion and 0,82 (95 per cent , CI: 0.72-0.93) for individuals with high social cohesion. Although all neighborhood characteristics presented a significant association with self-perception of health, none caused a change in the association between social capital domains and self- perception of health. Conclusions. The results indicate that neighborhood characteristics did not significantly alter the association between social capital and self-perception of health, which points to an effect of social capital on health regardless of neighborhood characteristics. However, new studies are needed in order to fully elucidate the details of the mechanisms involved, especially in relation to reverse causation and exposure time within a neighborhood