WITHDRAWN: Adherence to European guidelines for the use of aspirin in primary health care

The Publisher regrets that this article is an accidental duplication of an article that has already been published, 10.1016/j.repc.2022.03.007. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Adherence to European guidelines for the use of aspirin in primary health care.

INTRODUCTION AND OBJECTIVES: Cardiovascular disease remains a leading cause of global morbidity and mortality. The administration of low doses of aspirin in secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has been clearly established. However, the most recent guidelines do not recommend aspirin in primary prevention, reserving it for high-risk patients and after a risk/benefit assessment. The aim of this study was to assess adherence to European guidelines for the use of aspirin in primary and secondary prevention of ASCVD in primary health care. METHODS: The study population consisted of individuals aged >50 years registered at two primary health care units without (primary prevention) and with previous ASCVD events (secondary prevention). RESULTS: We studied a total of 1262 individuals, 720 in primary prevention and 542 in secondary prevention. A total of 61 individuals (8.5%) were under aspirin therapy in primary prevention, most of them taking 150 mg/day (57%). In secondary prevention, 195 patients (27%) were receiving aspirin only, most taking 150 mg/day (52%), and 166 patients (31%) were not under any antithrombotic or anticoagulant therapy. The 100 mg dosage was predominant in patients with ischemic heart disease with (64%) and without (64%) angina, as well as those with myocardial infarction (61.5%) and peripheral vascular disease (62%). CONCLUSIONS: In this study, the prevalence of aspirin use in primary prevention was 8.5%. We found that 30% of patients were not taking either antithrombotic or anticoagulation therapy in secondary prevention. In both primary and secondary prevention, the 150 mg dosage was predominant.

Transcription factor 21 gene and prognosis in a coronary population.

INTRODUCTION AND OBJECTIVES: Transcription factor 21 (TCF21) is a member of the basic helix-loop-helix (bHLH) transcription factor family, and is critical for embryogenesis of the heart. It regulates differentiation of epicardium-derived cells into smooth muscle cell (SMC) and fibroblast lineages. The biological role of TCF21 in the progression of atherosclerosis is the subject of debate. The aim of this study was to investigate the impact of the TCF21 rs12190287 gene variant on the prognosis of coronary artery disease (CAD) in a Portuguese population from Madeira island. METHODS: We analyzed major adverse cardiovascular events (MACE) in 1713 CAD patients, mean age 53.3±7.8, 78.7% male, for 5.0±4.3 years. Genotype and allele distribution between groups with and without MACE was determined. The dominant genetic model (heterozygous GC plus homozygous CC) was used and compared with the wild GG to assess survival probability. Cox regression with risk factors and genetic models assessed variables associated with MACE. Kaplan-Meier analysis was used to estimate survival. RESULTS: The wild homozygous GG, heterozygous GC and risk CC genotypes were found in 9.5%, 43.2% and 47.3% of the population, respectively. The dominant genetic model remained in the equation as an independent risk factor for MACE (HR 1.41; p=0.033), together with multivessel disease, chronic kidney disease, low physical activity and type 2 diabetes. The C allele in the dominant genetic model showed worse survival (22.5% vs. 44.3%) at 15 years of follow-up. CONCLUSION: The TCF21 rs12190287 variant is a risk factor for CAD events. This gene may influence fundamental SMC processes in response to vascular stress, accelerating atherosclerosis progression, and may represent a target for future therapies.

Clinical experience of a cardio-oncology consultation at a tertiary university hospital in Portugal: An observational study.

INTRODUCTION: Heart disease and cancer are the two leading causes of morbidity and mortality worldwide. Advances in cancer screening and management have led to longer survival and better quality of life. Despite this progress, many cancer patients experience cardiovascular complications during and after cancer treatment. This study describes the experience of a cardio-oncology program at tertiary academic hospital. METHODS: In this retrospective observational study, cancer patients referred to the CHULN cardio-oncology consultation (COC) between January 2016 and December of 2019 were included. Data collected included: patient demographics, cancer type, reason for referral, cardiovascular risk factors, cardiac and oncologic treatments and clinical outcomes. RESULTS: A total of 520 patients (mean age: 65 ± 14 years; 65% women) were referred to the COC. The main reasons for referral were suspected heart failure (26%), pre-high risk chemotherapy assessment (20%) and decreased LVEF (15%). Pre-existing cardiovascular risk factors were common (79%) and 309 (59%) were taking cardiac medications. The most common type of malignancy was breast cancer (216, 41%) followed by gastrointestinal (139, 27%). More than half received anthracycline-based regimens (303, 58%). Most patients (401; 77%) successfully completed cancer therapy. At the time of last data collection, the majority of patients were alive (430, 83%). Cardiac-related mortality was observed in 16%. CONCLUSIONS: The close collaboration between cardiology and oncology teams and timely cardiac monitoring was the key to the majority of patients to completing their prescribed cancer therapy.

Low back pain in adolescents and association with sociodemographic factors, electronic devices, physical activity and mental health.

OBJECTIVES: To determine the prevalence of low back pain and to analyze the association with the individual, sociodemographic variables, electronic devices, habitual practice of physical activity, and mental health problems. METHODS: Cross-sectional study with 1,628 students in public schools in the city of Bauru, SP, Brazil. The following data were collected: 1. demographic and socioeconomic aspects; 2. Use of electronic devices; 3. habitual physical activity level (Baecke); 3. mental health (SDQ). 4. low back pain (Nordic Questionnaire). Descriptive analyzes and bivariate and multivariate logistic regression were used. RESULTS: The overall prevalence of low back pain was 46.7% (95% CI: 44.27 to 49.11); men showed a prevalence of 42.0% (95% CI: 36.63 to 43.41) and women 58.0% (95% CI: 49.73 to 56.51), a statistically significant difference. The variables associated with pain in the low back region were: female gender (PR=1.70), daily TV use for more than 3hours (PR=1.17), use of laptop computer (PR=1.40), use of the cell phone in the supine position (PR=1.23), use of the cell phone in semi-supine position (PR=1.49), daily cell phone use for more than 3hours (PR=1.36), use of tablet (PR=1.67), daily tablet use for more than above 3hours (PR=1.46), and clinically important mental health problems (PR=2.62). CONCLUSION: There is a high prevalence of low back pain in high school students and striking association with female sex, electronic devices, and mental health problems.

[Risk factors for post-caesarean nausea and vomiting: a prospective prognostic study]. / Fatores de risco para náusea e vômitos após cesariana: estudo prognóstico prospectivo.

BACKGROUND: Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia. METHODS: One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized using chi-squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV. RESULTS: Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49-5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4-inf]), lower spinal morphine dose (< 80 mg, 0.03 [0-0.97]), history of motion sickness (2.5 [1.27-5.25]), significant nausea during the first trimester (0.3 [0.16-0.64]), intraoperative nausea and vomiting (8.2 [3.67-20.47]), and lower gestational age (< 38 weeks, 2.0 [1.01-4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV. CONCLUSIONS: Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self-reported nausea during the first trimester was a protective factor for post-cesarean nausea and vomiting.

Factors associated with leprosy in children contacts of notified adults in an endemic region of Midwest Brazil.

OBJECTIVES: To analyze the factors associated with leprosy in children who were intradomiciliary contacts of notified adults with the disease in an endemic municipality in Mato Grosso, Brazil. METHOD: Case-control study with 204 children under 15 years of age, living in an endemic municipality. Cases (n=40) were considered as the children with leprosy registered at the National Information System of Notifiable Diseases in 2014 and 2015, who were intradomiciliary contacts of at least one adult diagnosed with the disease in the family, and as a control group (n=164) of children living within a radius of up to 100m of the notified cases. Data were obtained through medical file analysis, interviews, and blood samples for anti-PGL-I serological test by the ELISA method. The binary logistic regression technique was used, with p≤0.05. RESULTS: After adjustments, the following were associated with leprosy: age (95% CI: 1.24-9.39, p=0.018), area of residence (95% CI: 1.11-6.09, p=0.027), waste disposal (95% CI: 1.91-27.98, p=0.004), family history of the disease (95% CI: 3.41-22.50, p=0.000), and time of residence (95% CI: 1.45-7.78, p=0.005). CONCLUSION: Factors associated with the disease indicate greater vulnerability of children aged 8-14 years, associated with living conditions and time of residence, as well as the family history of the disease.

Neck circumference cutoff points to identify excess android fat.

OBJECTIVE: To evaluate the ability of neck circumference to identify excess android fat and to propose cutoff points for Brazilian children. METHOD: This was a cross-sectional study with 376 children aged 8 and 9 years enrolled in public and private schools in the urban area of the municipality of Viçosa, Minas Gerais. A semi-structured questionnaire containing sociodemographic and lifestyle information was applied. The following were collected: neck circumference, weight, and height for the calculation of body mass index. The percentage of fat in the android region was determined by dual energy X-ray absorptiometry. Linear regression analysis was used to evaluate the association between neck circumference and android fat, adopting a significance level of 5%. Receiver operating characteristic curves were used to evaluate the capacity of neck circumference to determine the excess android fat, as well as to estimate the cutoff points of neck circumference according to gender. RESULTS: Multiple linear regression showed an association between neck circumference and android fat (ß: 2.94, 95% CI: 2.41, 3.47). Neck circumference was able to identify excess android fat in girls (AUC: 0.909, 95% CI: 0.999, 0.945) and boys (AUC: 0.938, 95% CI: 0.892, 0.968). The proposed cutoff points showed satisfactory sensitivity, specificity, and predictive values. CONCLUSIONS: Neck circumference is capable of identifying excess android fat in children and can be used in clinical practice and in population studies to determine central adiposity. The proposed cutoff points were satisfactory, but should be validated for other populations.

Effects of early interventions focused on the family in the development of children born preterm and/or at social risk: a meta-analysis.

OBJECTIVE: To verify whether early intervention focused on the family improves the cognitive, motor, and language development of children born preterm and/or at social risk in the first 3 years of life. SOURCE OF DATA: Meta-analysis of clinical trials published between 2008 and 2018, in the following databases: CINAHL, MEDLINE - PubMed, MEDLINE - BVS, LILACS - BVS, IBECS - BVS, PEDro and Cochrane Reviews. Experimental studies on early interventions focused on the family, whose target groups were children born preterm and/or at social risk, with assessment of cognitive and/or motor and/or language development up to 3 years were included. The studies were rated using the PEDro Scale. DATA SYNTHESIS: Twelve studies were included from a total of 3378 articles. Early intervention focused on the family contributed to the development of the cognitive (Standardized Mean Difference - SMD=0.48, 95% CI: 0.34-0.61) and motor (SMD=0.76, 95% CI: 0.55-0.96) domains of preterm infants. Regarding cognitive development, performance improvement was observed at 12, 24 and 36 months, while in the motor domain, the effect was observed only at 12 months in preterm infants. There was no benefit of the intervention in the cognitive, motor, and language outcomes of children with the social risk factor associated to biological risk. CONCLUSION: Early intervention focused on the family has a positive effect on the cognition of preterm infants. The effect on motor development was lower, possibly due to the emphasis on interventions in family-child interaction. The effect of interventions on the development of children at social risk and on the language domain was inconclusive, due to the scarcity of studies in the area.

Impact of the development of acute kidney injury on patients admitted to the pediatric intensive care unit.

OBJECTIVE: To identify the risk factors for the development of acute kidney injury and for short and long-term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit. MATERIALS AND METHODS: Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in-hospital, and long-term mortality were obtained through multivariate logistic regression analysis. Long-term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients' family members. RESULTS: A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in-hospital mortality. Long-term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long-term mortality after admission to the Pediatric Intensive Care Unit. CONCLUSION: Acute kidney injury was a frequent, early event, and was associated with in-hospital mortality and long-term mortality after admission to the Pediatric Intensive Care Unit.

Urinary tract infection in pediatrics: an overview.

OBJECTIVE: This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications of urinary tract infection in pediatric patients. SOURCE OF DATA: Data were obtained independently by two authors, who carried out a comprehensive and non-systematic search in public databases. SUMMARY OF FINDINGS: Urinary tract infection is the most common bacterial infection in children. Urinary tract infection in pediatric patients can be the early clinical manifestation of congenital anomalies of the kidney and urinary tract (CAKUT) or be related to bladder dysfunctions. E. coli is responsible for 80-90% of community-acquired acute pyelonephritis episodes, especially in children. Bacterial virulence factors and the innate host immune systems may contribute to the occurrence and severity of urinary tract infection. The clinical presentation of urinary tract infections in children is highly heterogeneous, with symptoms that can be quite obscure. Urine culture is still the gold standard for diagnosing urinary tract infection and methods of urine collection in individual centers should be determined based on the accuracy of voided specimens. The debate on the ideal imaging protocol is still ongoing and there is tendency of less use of prophylaxis. Alternative measures and management of risk factors for recurrent urinary tract infection should be emphasized. However, in selected patients, prophylaxis can protect from recurrent urinary tract infection and long-term consequences. According to population-based studies, hypertension and chronic kidney disease are rarely associated with urinary tract infection. CONCLUSION: Many aspects regarding urinary tract infection in children are still matters of debate, especially imaging investigation and indication of antibiotic prophylaxis. Further longitudinal studies are needed to establish tailored approach of urinary tract infection in childhood.

Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil.

OBJECTIVES: To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate. METHOD: Data were extracted from a historical cohort with 15,879 live births. A model was used that included socioeconomic, behavioral, and health service use risk factors, as well as the Apgar score and biological factors. Risk factors were analyzed by hierarchical logistic regression. RESULTS: Based on the multivariate analysis, socioeconomic factors showed no association with death. Insufficient prenatal consultations showed an OR of 3.25 (95% CI: 1.70-6.48) for death. Low birth weight (OR 8.42; 95% CI: 3.45-21.93); prematurity (OR 5.40; 95% CI: 2.22-13.88); malformations (OR 4.42; 95% CI: 1.37-12.43); and low Apgar score at the first (OR 6.65; 95% CI: 3.36-12.94) and at the fifth (OR 19.78; 95% CI: 9.12-44.50) minutes, were associated with death. CONCLUSION: Differing from other studies, socioeconomic conditions were not associated with neonatal death. Insufficient prenatal consultations, low Apgar score, prematurity, low birth weight, and malformations showed an association, reinforcing the importance of prenatal access universalization and its integration with medium and high-complexity neonatal care services.

Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers.

INTRODUCTION: An air traffic controller is a professional who performs air traffic control functions in air traffic control units and is responsible for controlling the various stages of a flight. OBJECTIVE: To compare hoarseness and vocal tract discomfort and their risk factors among air traffic controllers in the approach control of São Paulo. METHODS: In a cross-sectional survey, a voice self-evaluation adapted from to self-evaluation prepared by the Brazilian Ministry of Labor for teachers was administered to 76 air traffic controllers at approach control of São Paulo, Brazil. RESULTS: The percentage of hoarseness and vocal tract discomfort was 19.7% and 38.2%, respectively. In relation to air pollution, the percentages of hoarseness and vocal tract discomfort were higher among those who consider their working environment to be intolerable than among those in a comfortable or disturbing environment. The percentage of hoarseness was higher among those who seek medical advice due to vocal complaints and among those who experience difficulty using their voice at work than among those who experience mild or no difficulty. The percentage of vocal tract discomfort was higher among those in a very tense and stressful environment than among those who consider their work environment to be mild or moderately tense and stressful. The percentage of vocal tract discomfort was higher among those who describe themselves as very tense and stressed or tense and stressed than among those who describe themselves as calm. Additionally, the percentage of vocal tract discomfort was higher among those who care about their health. CONCLUSION: Among air traffic controllers, the percentage of vocal tract discomfort was almost twice that of hoarseness. Both symptoms are prevalent among air traffic controllers who considered their workplace intolerable in terms of air pollution. Vocal tract discomfort was related to a tense and stressful environment, and hoarseness was related to difficulty using the voice at work.

Fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas: Pesquisa Nacional de Saúde do Escolar 2019 / Factors associated with concurrent alcohol, tobacco and illicit drug use: 2019 National School-Based Health Survey

Resumo Objetivou-se analisar os fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas, entre adolescentes escolares brasileiros de 13 a 17 anos. Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar (2019). A variável desfecho foi o relato de consumo das três substâncias nos últimos 30 dias. As variáveis independentes foram agrupadas em quatro blocos: características sociodemográficas; contexto familiar; situações estressoras; aspectos comportamentais. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final as variáveis com p<0,05. A prevalência de policonsumo em adolescentes escolares foi 3,3%. No modelo final, sexo masculino, morar na região Centro-Oeste, Sul e Sudeste, faltar a escola sem permissão, pais não saberem o que fazem no tempo livre, ter pais fumantes, sofrer agressão física pelos pais, sentir que a vida não vale a pena ser vivida, experimentar bebida alcoólica e drogas ilícitas antes dos 13 anos, ter amigos que bebem bebida alcoólica, fumam e usam drogas na sua presença permaneceram associados ao desfecho. Os dados mostram alta prevalência de policonsumo de três substâncias entre adolescentes e sua associação a fatores sociodemográficos, familiares, comportamentais e a eventos estressantes.

Abstract The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Evaluation of cervical posture and smartphone use in young adults / Avaliação da postura cervical e do uso de smartphone em adultos jovens

Abstract Introduction The smartphone, a popular mobile device, has become attractive because it is easy to use and due to it multifunctionality. Its prolonged use, with anterior flexion of the neck and repetitive movements of the upper limbs, contributes to musculoskeletal symptoms. Objective To evaluate changes in cervical posture due to smartphone use in adults, as well as verify the association of posture with health-related factors. Methods Cross-sectional study, carried out at two universities in Fortaleza, Ceará, Brasil, between 2018 and 2019. A total of 769 adults (>18 years old) who routinely used smartphones participated. Data on socioeconomic variables, health conditions and smartphone use were collected. The cervical postural alignment was assessed, with the vertical head alignment (VHA) being measured using photogrammetry, in the anatomical position (baseline) and while typing on the smartphone. Results The mean age was 23 years (± 6.7), with a higher proportion of females (72.1%; n = 559) and an average of 7.9h (± 4.4) using the device. Smartphone use led to the forward head movement related to males (p < 0.05 by ΔVHA), time spent using the device (p < 0.05 by ΔVHA), functional disability in the cervical region (p < 0.05 by ΔVHA) and not sleeping well (p = 0.019 by ΔVHA on the R side). Conclusion Using a smartphone in the typing position causes the head to tilt forward, being related to longer usage time, male gender, cervical region dysfunction and sleep.

Resumo Introdução O smartphone, dispositivo móvel e popular, tornou-se atrativo pela facilidade de utilização e multifuncionalidade. Seu uso prolongado, com flexão anterior do pescoço e movimentos repetitivos dos membros superiores, contribui para sintomas musculoesqueléticos. Objetivo Avaliar as alterações da postura cervical pelo uso do smartphone em adultos, bem como verificar a associação da postura com fatores relacionados à saúde. Métodos Estudo transversal, em duas universidades em Fortaleza, Ceará, Brasil, entre 2018 e 2019. Participaram 769 adultos (>18 anos) que usavam rotineiramente o smartphone. Foram coletadas variáveis socioeconômicas, condições de saúde e uso do smartphone. Realizou-se a avaliação do alinhamento postural da cervical, sendo mensurado o alinhamento vertical da cabeça (AVC) pela fotogrametria, na posição anatômica (baseline) e digitando no smartphone. Resultados A idade média foi de 23 anos (± 6,7), com maior proporção do sexo feminino (72,1 %; n = 559) e média de 7,9h (± 4,4) utilizando o dispositivo. O uso do smartphone gerou anteriorização de cabeça relacionada ao sexo masculino (p < 0,05 pelo ΔAVC), tempo de uso do dispositivo (p < 0,05 pela ΔAVC), incapacidade funcional na região cervical (p < 0,05 pela ΔAVC) e não dormir bem (p = 0,019 pela ΔAVC lado D). Conclusão O uso do smartphone na posição de digitação causa anteriorização de cabeça, estando relacionado ao maior tempo de uso, ao sexo masculino, à disfunção da região cervical e ao sono.

Mortalidade por COVID-19 em um município do Oeste Baiano: incidência e fatores de risco / Mortality by COVID-19 in a municipality in Western Bahia: incidence and risk factors

Objetivo: descrever e analisar os fatores de risco associados aos óbitos por COVID-19 no município de Barreiras-BA. Método: estudo de coorte em que foram analisadas as notificações de casos positivos da doença no período de março de 2020 a dezembro de 2022. As variáveis incluídas foram: sexo, idade, raça/cor, sintomas apresentados e condições de saúde. Para verificar a associação entre as variáveis, foi utilizada Regressão de Poisson, com estimativa do risco relativo. Resultados: Ocorreram 348 óbitos no período analisado, sendo estes mais frequentes em homens (60,6%), idosos (58,9%), pretos/pardos (88,1%). Os principais sintomas apresentados pelos indivíduos que vieram a óbito foram a tosse (67,8%), a dispneia (62,9%) e a febre (53,4%), e as principais comorbidades as doenças cardíacas (39,1%) e o diabetes (21,8%). Foram encontrados como fatores de risco associados à ocorrência do óbito ser do sexo masculino e idoso e ter apresentado sintomas como dispneia e febre, além de apresentar comorbidades como doenças respiratórias, cardíacas, diabetes, renais, imunossupressão, doenças cromossômicas e obesidade (p < 0,05). Ter tido sintomas como dor de garganta, dor de cabeça, coriza e distúrbios olfativos demonstraram menor risco de morte (p < 0,05). Conclusão: O número de mortes ocorridas por COVID-19 foi considerado baixo, com risco maior para homens e idosos e indivíduos com outras doenças prévias. Apresentação de sintomas mais graves, como febre e dispneia, também aumentam o risco de morte.

Objective: the objective of this study was to describe and analyze the risk factors associated with deaths from COVID-19 in the city of Barreiras-BA. Methods: a cohort study in which notifications of positive cases of the disease were analyzed from March 2020 to December 2022. The variables included were sex, age, race/color, presented symptoms, and health conditions. Poisson Regression was used to verify the association between variables with relative risk estimation. Results: There were 348 deaths in the period analyzed, these being more frequent in men (60.6%), elderly people (58.9%), black/brown people (88.1%). The main symptoms presented by the individuals who died were cough (67.8%), dyspnea (62.9%) and fever (53.4%), and the main comorbidities were heart disease (39.1%) and diabetes (21.8%). Risk factors associated with the occurrence of death were found to be male and elderly and having symptoms such as dyspnea and fever, in addition to presenting comorbidities such as respiratory, cardiac, diabetes, kidney diseases, immunosuppression, chromosomal diseases and obesity (p < 0 .05). Having had symptoms such as sore throat, headache, runny nose and olfactory disorders demonstrated a lower risk of death (p < 0.05). Conclusion: The number of deaths caused by COVID-19 was considered low, with a higher risk for men and the elderly and individuals with other previous illnesses. Presentation of more serious symptoms, such as fever and dyspnea, also increases the risk of death.

[Perioperative complications and mortality in elderly patients following surgery for femoral fracture: prospective observational study]. / Complicações perioperatórias e mortalidade em pacientes idosos submetidos a cirurgia para correção de fratura de fêmur: estudo prospectivo observacional.

BACKGROUND AND OBJECTIVES: Perioperative management of femoral fractures in elderly patients has been studied to determine modifiable causes of complications and death. The aim of this study was to evaluate the mortality rate and its causes in the elderly population with FF. We also evaluated perioperative complications and their association with postoperative mortality. METHOD: In this prospective and observational study, we evaluated 182 patients, by questionnaire and electronic medical record, from the moment of hospitalization to one year after surgery. Statistical analyzes using the multivariate Cox proportional hazards model and Kaplan-Meier curves were performed to detect independent mortality factors. RESULTS: Fifty-six patients (30.8%) died within one year after surgery, and the main cause of death was infection followed by septic shock. The main complication, both preoperatively and postoperatively, was hydroelectrolytic disorder. For every one-unit (one-year) increase in age, the odds ratio for death increased by 4%. With each new preoperative complication, the odds ratio for death increased by 28%. Patients ASA III or IV had a 95% higher odds ratio for death than patiets ASA I or II. CONCLUSIONS: Increasing age and number of preoperative complications, in addition to ASA classification III or IV, were independent factors of increased risk of death in the population studied. The mortality rate was 30.8%, and infection followed by septic shock was the leading cause of death.

Prevalence of cardiovascular risk factors and other comorbidities in patients with hypertension in Portuguese primary health care populations: The PRECISE study. / Prevalência de fatores de risco cardiovascular e outras comorbilidades em doentes com hipertensão arterial assistidos nos Cuidados de Saúde Primários: estudo Precise.

INTRODUCTION: Cardiovascular (CV) disease is the leading cause of death in Portugal. The prevalence of hypertension, the second most important risk factor accounting for overall disability-adjusted life years (DALYs), is significant. Hypertension rarely occurs in isolation, but is usually associated with other determining risk factors that contribute to greater overall CV risk. The main objective of the PRECISE study, a cross-sectional epidemiological study, was to determine the prevalence of other concomitant modulating CV risk factors in hypertensive patients. METHODS: The prevalence of other CV risk factors and target organ damage was assessed in 2848 hypertensive patients of both sexes followed in primary health care centers. Demographic, anthropometric and clinical data and antihypertensive and lipid-lowering therapies prescribed were collected. RESULTS: Of the study population (mean age 65.8±11.0 years, 60.8% women), 98.0% were treated for hypertension, but only 56.7% had controlled blood pressure. Hypercholesterolemia was the most frequent concomitant CV risk factor (82.1%), followed by sedentary behavior (71.4%). Prevalences of concomitant modulating risk factors were significantly different between the sexes and age groups. Overall, 81.7% of hypertensive patients had three or more concomitant CV risk factors. CONCLUSIONS: The study showed that, in Portugal, hypertensive patients have a high prevalence of other CV risk factors, confirming the need to identify these factors, calculate overall CV risk and continuously monitor the care provided and the results obtained.

Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies.

OBJECTIVE: To identify, using a systematic review and meta-analysis of observational studies, which risk factors are significantly associated with neonatal mortality in Brazil, and to build a comprehensive national analysis on neonatal mortality. SOURCES: This review included observational studies on neonatal mortality, performed between 2000 and 2018 in Brazilian cities. The MEDLINE, Elsevier, Cochrane, LILACS, SciELO, and OpenGrey databases were used. For the qualitative analysis, the Newcastle-Ottawa Scale was used. For the quantitative analysis, the natural logarithms of the risk measures and their confidence intervals were used, as well as the DerSimonian and Laird method as a random effects model, and the Mantel-Haenszel model for heterogeneity estimation. A confidence level of 95% was considered. SUMMARY OF FINDINGS: The qualitative analysis resulted in six studies of low and four studies of intermediate-low bias risk. The following exposure factors were significant: absence of partner, maternal age ≥35 years, male gender, multiple gestation, inadequate and absent prenatal care, presence of complications during pregnancy, congenital malformation in the assessed pregnancy, Apgar<7 at the fifth minute, low and very low birth weight, gestational age≤37 weeks, and caesarean delivery. CONCLUSION: The most significant risk factors presented in this study are modifiable, allowing aiming at a real reduction in neonatal deaths, which remain high in the country.

Mortalidade materna: protocolo de um estudo integrado à pesquisa Nascer no Brasil II / Mortalidad materna: protocolo de un estudio integrado a la encuesta Nacer en Brasil II / Maternal mortality: protocol of a study integrated to the Birth in Brazil II survey

Resumo: O Estudo da Mortalidade Materna conduz uma investigação hospitalar dos óbitos maternos ocorridos em 2020/2021 nas maternidades amostradas na pesquisa Nascer no Brasil II, com os seguintes objetivos: estimar o sub-registro da mortalidade materna e calcular um fator de correção e a razão de mortalidade materna (RMM) corrigida; validar as causas de mortalidade materna informadas na declaração de óbito (DO); e analisar os fatores associados à mortalidade materna. O Nascer no Brasil II inclui aproximadamente 24.255 puérperas distribuídas em 465 hospitais públicos, privados e mistos com ≥ 100 partos de nascidos vivos/ano nas cinco macrorregiões do país. Os dados do Estudo da Mortalidade Materna serão preenchidos utilizando o mesmo questionário do Nascer no Brasil II, a partir da consulta aos prontuários hospitalares. Obstetras treinados preencherão uma nova DO (DO refeita) a partir de análise independente desse questionário, comparando aos dados oficiais. A base de dados dos óbitos investigados será relacionada com os óbitos constantes no Sistema de Informações sobre Mortalidade do Ministério da Saúde, permitindo a estimativa do sub-registro e cálculo da RMM corrigida. Para o cálculo da confiabilidade das causas de morte, serão utilizados os testes kappa e kappa ajustado à prevalência com intervalo de 95% de confiança. Um estudo de caso-controle para estimar os fatores de risco para mortalidade materna será desenvolvido com os óbitos investigados (casos) e os controles obtidos na pesquisa Nascer no Brasil II, utilizando-se modelos de regressão logística múltipla condicional. Espera-se contribuir para a correção do sub-registro da mortalidade materna e para a melhor compreensão dos fatores determinantes da persistência de RMM elevada no Brasil.

Resumen: El Estudio de Mortalidad Materna evalúa las muertes maternas ocurridas en 2020-2021 en las muestras de maternidades del encuesta Nacer en Brasil II con los objetivos de estimar el subregistro de mortalidad materna y calcular el factor de corrección y la tasa de mortalidad materna corregida (TMM); validar las causas de mortalidad materna reportadas en el certificado de defunción (CD); y analizar los factores asociados a la mortalidad materna. La Nacer en Brasil II incluye aproximadamente 24.250 mujeres puerperales, distribuidas en 465 hospitales públicos, privados y mixtos con ≥ 100 nacidos vivos/año en las cinco macrorregiones de Brasil. Los datos de Estudio de Mortalidad Materna se completarán con la información del cuestionario Nacer en Brasil II a partir de una búsqueda de los registros médicos hospitalarios. Los obstetras capacitados completarán un nuevo CD (CD rehecho) desde un análisis independiente de este cuestionario, comparándolo con los datos oficiales. La base de datos de muertes investigadas se relacionará con las muertes que constan en el Sistema de Informaciones sobre la Mortalidad del Ministerio de Salud para permitir la estimación del subregistro y el cálculo de la TMM corregida. Para calcular la exactitud de las causas de muerte, se utilizarán las pruebas kappa y kappa ajustada a la prevalencia con un intervalo de 95% de confianza. Un estudio de casos y controles se aplicará para estimar los factores de riesgo de las mortalidad materna con las muertes investigadas (casos) y los controles obtenidos en el estudio Nacer en Brasil II utilizando modelos de regresión logística múltiple condicional. Se espera que este estudio pueda contribuir a la corrección del subregistro de la mortalidad materna y a una mejor comprensión de los determinantes de la persistencia de alta TMM en Brasil.

Abstract: The Maternal Mortality Study conducts a hospital investigation of maternal deaths that occurred in 2020/2021 in the maternity hospitals sampled by the Birth in Brazil II survey, with the following objectives: estimate the maternal mortality underreporting; calculate a correction factor and the corrected (MMR); validate the causes of maternal mortality reported in the death certificate (DC); and analyze the factors associated with maternal mortality. The Birth in Brazil II includes approximately 24,250 puerperal women distributed in 465 public, private, and mixed hospitals with ≥ 100 live births/year in the five macroregions of Brazil. The Maternal Mortality Study data will be completed using the same Birth in Brazil II questionnaire, from the consultation of hospital records. Trained obstetricians will fill out a new DC (redone DC) from independent analysis of this questionnaire, comparing it to official data. The database of the investigated deaths will be related to the deaths listed in the Mortality Information System of the Brazilian Ministry of Health, allowing the estimation of underreporting and calculation of the corrected MMR. To calculate the reliability of the causes of death, the kappa test and prevalence-adjusted kappa with 95% confidence interval will be used. A case-control study to estimate the risk factors for maternal mortality will be developed with the investigated deaths (cases) and the controls obtained in the Birth in Brazil II survey, using conditional multiple logistic regression models. We expect this research to contribute to the correction of the underreporting of maternal mortality and to a better understanding of the determinants of the persistence of a high MMR in Brazil.