Early vs. Standard Loop Ileostomy Closure: An Unmatched Case-Control Study / Cierre Temprano vs Estándar de Ileostomía en Asa. Estudio de Casos y Controles no Emparejado

SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.

El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.

Factores de riesgo relacionados con el síndrome poscovid-19 en pobladores pinareños / Risk factors related to postcovid­19 syndrome in residents from Pinar del Río i: en

Introducción: Las posibilidades de padecer el síndrome poscovid-19 crecen en la medida en que se expande la pandemia. Objetivo: Identificar los factores de riesgo relacionados con el síndrome poscovid-19 en pobladores pinareños. Métodos: Se realizó un estudio de casos y controles, que incluyó a convalecientes de covid-19, atendidos en la consulta multidisciplinaria del Policlínico Luis Augusto Turcios Lima de la provincia de Pinar del Río durante el 2022, quienes fueron incluidos de forma aleatoria en 2 grupos, a razón de 1:2 (100 casos y 200 controles). El análisis estadístico se basó en una estrategia univariada, que consistió en la determinación del odds ratio para cada factor de riesgo, así como en la estimación de los intervalos de confianza al 95 % y la prueba de la Χ2, con un nivel de significación de p<0,05. Resultados: En el estudio predominaron el sexo femenino, la diabetes mellitus, el tratamiento farmacológico, el soporte ventilatorio, la presencia de secuelas establecidas y las complicaciones. Conclusiones: A pesar de identificar los factores de riesgo más frecuentes relacionados con el síndrome poscovid-19, este continúa siendo un desafío para los profesionales de la salud.

Introduction: The possibilities to suffer from the postcovid-19 syndrome grow as the pandemic expands. Objective: To identify the risk factors related to the postcovid-19 syndrome in residents from Pinar del Río. Methods: A cases and controls study that included covid-19 convalescents was carried out. They were assisted in the multidisciplinary service of Luis Augusto Turcios Lima Polyclinic of Pinar del Rio province during 2022 that were included in 2 groups at random, at a ratio of 1:2 (100 cases and 200 controls). The statistical analysis was based on an univaried strategy, for which the odds ratio was determined for each risk factor and the confidence intervals were considered at 95 %, as well as the chi-square test, with a significance level of p<0,05. Results: In the study there was a prevalence of the female sex, diabetes mellitus, pharmacological treatment, ventilation support, the presence of established sequels and complications. Conclusions: In spite of identifying the most frequent risk factors related to the postcovid-19 syndrome, it is still a challenge for health professionals.

Drug-resistant tuberculosis in Colombia, 2013-2018: Case-control study

Abtract Introduction. Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. Objective. To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. Materials and methods. A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. Results. The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. Conclusion. In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.

Introducción. La tuberculosis multirresistente-resistente a la rifampicina (TB-MDR/RR) es difícil de controlar, tiene una alta morbilidad y mortalidad y exige una intervención prioritaria en salud pública. En Colombia, la TB-MDR/RR se ha ido extendiendo cada año. Antes de la pandemia de COVID-19, en un periodo de 8 años, el número de casos de TB-MDR/RR en Colombia se acercaba a los mil. La identificación oportuna de los diferentes factores de riesgo de TB-MDR/RR contribuirá de manera fundamental al manejo sistemático de la enfermedad. Objetivo. Determinar los factores de riesgo que se asociaron a la presentación de la TB- MDR/RR en Colombia entre 2013 y 2018. Materiales y métodos. Se realizó un estudio retrospectivo de casos y controles, para el cual se utilizaron los datos de la vigilancia rutinaria de eventos de TB MDR/RR en el país. Resultados. Los casos de TB MDR se presentaron principalmente en jóvenes, afrodescendientes y varones. De las condiciones clínicas, fueron factores de riesgo las comorbilidades como la desnutrición, la diabetes y el VIH, y la presencia de, al menos, un factor como la farmacodependencia, el consumo de medicamentos inmunosupresores, el ser de raza negra o afro y el vivir en una zona del país de alta carga de tuberculosis. Conclusiones. Además del diagnóstico y la provisión oportuna del tratamiento de la TB MDR, es necesario que los programas de salud pública a nivel local presten especial atención a los pacientes con los factores de riesgo identificados.

The effect of interventional program underpinned by health belief model on awareness, attitude, and performance of nurses in preventing nosocomial infections: A randomized controlled trial study / Efecto de un programa de intervención basado en el modelo de creencias en salud sobre el conocimiento, la actitud y el desempeño del personal de enfermería en la prevención de las infecciones intrahospitalarias. Ensayo controlado aleatorizado / Efeito de um programa de intervenção baseado no modelo de crenças em saúde no conhecimento, atitude e atuação da equipe de enfermagem na prevenção de infecções hospitalares. Teste controlado e aleatório

Objective. The present study examined the effect of an interventional program underpinned by the Health Belief Model (HBM) on nurses' awareness, attitude, and performance in preventing nosocomialinfections.Methods. This randomized controlled trial study was performed on 60 clinical nurses in lar, Iran. Nurses were selected using the simple random sampling method and assigned to two experimental (n=30) and control (n=30) groups. Data collection tool included the valid and reliable questionnaire was developed by Soleimani et al. The research intervention consisted of five 90-min sessions based on the health belief model in preventing hospital infection for experimental group. Before the intervention, immediately and two months after the intervention, the two groups completed the questionnaire. The control group received no intervention. Results. Data analysis showed that the differences between the two groups was statistically significant immediately and two months after the intervention (p<0.05). In experimental group the changes in the mean score of knowledge, attitude and performance of nurses before, immediately and two months after the intervention were significant (p<0.05), but in the control group, only the changes in the mean score of performance were significant (p<0.05). Conclusion. The results showed that the HBM-based intervention is effective in promoting nurses' knowledge, attitude, and performance in preventing nosocomialinfections. hence, periodical and in-service HBM-based training programs on preventing nosocomialinfections are recommended to be held for nurses.

Objetivo. El presente estudio examinó el efecto de un programa de intervención basado en el modelo de creencias en salud (Health Belief Model -HBM-, en inglés sobre el conocimiento, la actitud y el desempeño de las enfermeras en la prevención de las infecciones intrahospitalarias. Métodos. Este ensayo controlado aleatorizado se realizó en 60 enfermeras clínicas de lar, Irán. Las enfermeras fueron seleccionadas mediante el método de muestreo aleatorio simple y asignadas a dos grupos experimental (n=30) y de control (n=30). La herramienta para la recogida de datos incluyó el cuestionario válido y fiable desarrollado por Soleimani et al.La intervención consistió en cinco sesiones de 90 minutos basadas en el modelo de creencias de salud para prevenir la infección intrahospitalaria en el grupo experimental. Antes de la intervención, inmediatamente y dos meses después de la intervención, los dos grupos completaron el cuestionario. El grupo de control no recibió ninguna intervención. Resultados. El análisis de los datos mostró diferencias estadísticamente significativas entre los dos grupos en los momentos inmediatamente y dos meses después de la intervención (p<0.05). En el grupo experimental, los cambios en la puntuación media de conocimientos, actitudes y rendimiento de las enfermeras se observaron en los momentos de antes, inmediatamente y dos meses después de la intervención (p<0.05); mientras que en el grupo de control solamente los cambios en la puntuación media de desempeño fueron significativos (p<0.05). Conclusión. Los resultados mostraron que la intervención basada en HBM fue eficaz para promover el conocimiento, la actitud y el rendimiento de las enfermeras en la prevención de las infecciones intrahospitalaria, por lo que se recomienda impartir a las enfermeras programas de formación periódicos y en servicio basados en HBM sobre la prevención de las infecciones intrahospitalarias.

Objetivo. Examinar o efeito de um programa de intervenção baseado no Modelo de Crenças em Saúde (MBH) no conhecimento, atitude e desempenho dos enfermeiros na prevenção de infecções hospitalares. Métodos. Este ensaio clínico randomizado foi conduzido em 60 enfermeiras clínicas de lar, Irã. Os enfermeiros foram selecionados pelo método de amostragem aleatória simples e distribuídos em dois grupos experimental (n=30) e controle (n=30). O instrumento de coleta de dados incluiu o questionário válido e confiável desenvolvido por Soleimani et al. A intervenção consistiu em cinco sessões de 90 minutos baseadas no modelo de crenças em saúde para prevenir infecção hospitalar no grupo experimental. Antes, imediatamente e dois meses após a intervenção, ambos os grupos responderam ao questionário. O grupo controle não recebeu nenhuma intervenção. Resultados.A análise dos dados mostrou diferenças estatisticamente significativas entre os dois grupos imediatamente e dois meses após a intervenção (p<0.05). No grupo experimental foram observadas alterações na pontuação média de conhecimentos, atitudes e desempenho dos enfermeiros antes, imediatamente e dois meses após a intervenção (p<0.05); enquanto no grupo controle apenas as alterações na pontuação média de desempenho foram significativas (p<0.05). Conclusão.Os resultados demonstraram que a intervenção baseada no HBM foi eficaz na promoção do conhecimento, atitude e desempenho dos enfermeiros na prevenção de infecções hospitalares, pelo que se recomenda proporcionar aos enfermeiros este tipo de programas de formação em serviço baseados no HBM.

Assessment of depression, stress, anxiety and oral health-related quality of life in individuals with sjögren's syndrome: case control pilot study / Evaluación de la depresión, el estrés, la ansiedad y la calidad de vida relacionada con la salud bucal en personas con síndrome de Sjögren: estudio piloto de casos y controles

Objective: Sjögren's syndrome (SS) is a chronic auto-immune inflammatory systemic disease, in which the infiltration of mo-nonuclear cells in the exocrine glands leads to physiological and morphological changes. This pilot case-control study aims to describe the profile, evaluate the oral condition, quality of life (QoL) and psychological condition, through complete clinical examination, OHIP-14 and DASS-21 questionnaires. Materials and Methods: The study was conducted with seven individuals with a final diagnosis of SS (case group [CG]), and seven individuals with symptoms of dry mouth (control group [GCO]), consulting at the institution from January to November 2021. participants were selected by free demand and those previously seen at the institution with a diagnosis of SS between 19 and 70 years of age. The questionnaire OHIP-14 was applied to assess the patient's quality of life, where seven dimensions are assessed, subdivided into 14 questions through the Lickert scale (0 to 4) assigned by the individual and which quantifies the impact of oral health on QoL. The questionnaire DASS-21 assessed the psychological condition of the patient, which presents seven questions for each emotional state (depression, anxiety, and stress), totaling 21 questions. The general clinical condition, evolution of SS, oral clinical condition, and the profile of this population were related to QoL factors and psychological conditions, using these assessment instruments. Results: There was no statistically significant difference between the groups regarding stimulated salivary flow. The only symptom with a statistically significant difference in the CG was difficulty in phonation (p< 0.001). The dimensions related to functional limitation and physical pain showed the most expressive results (p=0.004) (p=0.025), showing a strong negative impact on the QoL of the CG individuals, and the dimension related to disability was the least affected (p=0.684). The analysis of depression, anxiety, and stress did not show statistically significant results between the groups; however, in the CG, 5 (71.42%) individuals showed a severe degree of depression, anxiety, and stress. Conclusions: Individuals in the case group showed some changes, with a strong negative impact on QoL compared to the control group.

Objetivo: El síndrome de Sjögren (SS) es una enfermedad inflamatoria sistémica crónica autoinmune, en la que la infiltración de células mononucleares en las glándulas exocrinas provoca cambios fisiológicos y morfológicos. Este estudio piloto de casos y controles tiene como objetivo describir el perfil, evaluar la condición bucal, calidad de vida (CdV) y condición psicológica, mediante examen clínico completo, cuestionarios OHIP-14 y DASS-21. Materiales y Métodos: El estudio se realizó con 7 individuos con diagnóstico final de SS, grupo de casos (CG) y 7 individuos con síntomas de sequedad bucal, grupo control (GCO) atendidos en la institución de enero a noviembre de 2021. Los participantes fueron seleccionados por libre demanda y entre los atendidos previamente en la institución con diagnóstico de SS entre 19 y 70 años de edad. Para evaluar la calidad de vida del paciente se aplicó el cuestionario OHIP-14, donde se evalúan siete dimensiones, sub-divididas en 14 preguntas a través de la escala de Likert (0 a 4) asignada por el individuo y que cuantifica el impacto de la salud bucal en la calidad de vida. El cuestionario DASS-21 evaluó la condición psicológica del paciente, el cual presenta siete preguntas para cada estado emocional (depresión, ansiedad y estrés), totalizando 21 preguntas. El estado clínico general, la evolución del SS, el estado clínico bucal y el perfil de esta población se relacionaron con factores de calidad de vida y condiciones psicológicas, mediante estos instrumentos de evaluación. Resultados: En cuanto al flujo salival estimulado, no hubo diferencias estadísticamente significativas entre los grupos. El único síntoma que mostró diferencia estadísticamente significativa en el CG fue la dificultad en la fonación (p< 0,001). Las dimensiones relacionadas con limitación funcional y dolor físico mostraron los resultados más expresivos (p=0,004) (p=0,025), mostrando un fuerte impacto negativo en la CdV de los individuos del GC, y la dimensión relacionada con discapacidad fue la menos afectada (p=0,684). El análisis de depresión, ansiedad y estrés no mostró resultados estadísticamente significativos entre los grupos; sin embargo, en el GC, 5 (71,42%) individuos presentaron un grado severo de depresión, ansiedad y estrés. Conclusión: Se puede concluir que los individuos del grupo de casos mostraron algunos cambios, con un fuerte impacto negativo en la calidad de vida en comparación con el grupo de control.

Fatores de risco para óbito perinatal em gestantes de alto risco de um hospital terciário de Curitiba-PR, Brasil: estudo caso-controle / Risk factors for perinatal death in high-risk pregnant women at a tertiary hospital in Curitiba-PR, Brazil: a case-control study

Resumo Estudo caso-controle com o objetivo de estimar os fatores de risco da mortalidade perinatal em um hospital de referência para gestações de alto risco em Curitiba-PR. Os dados de características sociodemográficas, maternas, da gestação e do concepto foram obtidos dos prontuários hospitalares de 316 casos e 316 controles do período de 2013 a 2017. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final variáveis com p < 0,05. Os resultados mostram aumento do risco de óbito perinatal em mães com tipo sanguíneo B (OR = 2,82; IC95%: 1,07-7,43), que não realizaram pré-natal (OR = 30,78; IC95%: 4,23-224,29), conceptos com malformações congênitas (OR = 63,90; IC95%: 27,32-149,48), nascidos com menos de 28 (OR = 24,21; IC95%: 1,10-531,81) e entre 28-31 semanas de gestação (OR = 6,03; IC95%: 1,34-27,17) e peso ao nascer abaixo de 1.000g (OR = 51,94; IC95%: 4,31-626,46), entre 1.000-1.499g (OR = 11,17; IC95%: 2,29-54,41) e entre 1.500-2.499g (OR = 2,75; IC95%: 1,25-6,06). Conceptos de gestações com desfecho prematuro, baixo peso ao nascer e presença de malformações congênitas são os principais fatores de risco para o óbito perinatal. Em contrapartida, a assistência pré-natal adequada é importante fator de proteção.

Abstract A case-control study was carried out to estimate risk factors for perinatal mortality in a referral hospital for high-risk pregnancies in Curitiba-PR. Sociodemographic, maternal, pregnancy and concept characteristics data were obtained from the hospital records of 316 cases and 316 controls from 2013 to 2017. A hierarchical multiple logistic regression analysis was performed, remaining in the final model variables with p < 0.05. The results show an increased risk of perinatal death in mothers with blood type B (OR = 2.82; 95%CI: 1.07-7.43), who did not undergo prenatal care (OR = 30.78; 95%CI: 4.23-224.29), fetuses with congenital malformations (OR = 63.90; 95%CI: 27.32-149.48), born under 28 (OR = 24.21; 95%CI: 1, 10-531.81) and between 28-31 weeks of gestation (OR = 6.03; 95%CI: 1.34-27.17) and birth weight below 1,000g (OR = 51.94; 95%CI: 4.31-626.46), between 1,000-1,499g (OR = 11.17; 95%CI: 2.29-54.41) and between 1,500-2,499g (OR = 2.75; 25-6.06). Concepts of pregnancies with premature outcome, low birth weight and the presence of congenital malformations are the main risk factors for perinatal death. On the other hand, adequate prenatal care is an important protective factor.

Factores de riesgo para infecciones asociadas al cuidado de la salud en recién nacidos sometidos a cirugía en una unidad de cuidados intensivos neonatales / Risk factors for healthcare-associated infections in newborns after surgery in a neonatal intensive care unit

Resumen Antecedentes: Las infecciones asociadas a la atención de la salud (IAAS) son causa frecuente de morbilidad y mortalidad. Objetivo: Identificar los factores de riesgo para el desarrollo de IAAS en recién nacidos (RN) sometidos a cirugía. Material y métodos: Estudio de casos y controles anidado en una cohorte. Los casos fueron RN sometidos a cirugía, con IAAS y los controles, RN sometidos a cirugía sin IAAS. Se registraron datos perinatales, uso de profilaxis antimicrobiana, de catéter venoso central (CVC), ventilación mecánica, nutrición parenteral y sondas; edad y peso al momento de la cirugía, tipo de cirugía, clasificación de la herida quirúrgica, duración de la cirugía, número de procedimientos quirúrgicos y tipo de infección. Se realizó análisis univariado y multivariado. Resultados: Se incluyeron 71 casos y 142 controles. Las IAAS más frecuentes fueron las infecciones sanguíneas (36.6 %); los principales microorganismos aislados en hemocultivos fueron cocos grampositivos. Los factores de riesgo asociados a IAAS en el análisis multivariado fueron duración del CVC > 8 días (RMa = 17.2), ≥ 2 intervenciones quirúrgicas (RMa = 16.5) y cirugía abdominal (RMa = 2.6). Conclusiones: Los RN sometidos a cirugía, principalmente aquellos con factores de riesgo, requieren vigilancia estrecha durante el posoperatorio. El CVC debe ser retirado tan pronto sea posible.

Abstract Background: Healthcare-associated infections (HAIs) are a common cause of morbidity and mortality. Objective: To identify the risk factors for the development of HAIs in newborns (NBs) undergoing surgery. Material and methods: Nested case-control study. Cases were NBs undergoing surgery with HAIs, while controls were NBs undergoing surgery with no HAIs. Perinatal data, use of antimicrobial prophylaxis, use of central venous catheter (CVC), mechanical ventilation, parenteral nutrition, and other medical devices were recorded, as well as age and weight at the time of surgery, type of surgery, surgical wound classification, duration of surgery, number of surgical procedures, and type of infection. Univariate and multivariate analyses were performed. Results: Seventy-one cases and 142 controls were included. The most frequent HAI was bloodstream infection (36.6%); the main microorganisms isolated in blood cultures were gram-positive cocci. The risk factors associated with HAIs in the multivariate analysis were CVC duration > 8 days (aOR = 17.2), ≥ 2 surgical interventions (aOR = 16.5) and abdominal surgery (aOR = 2.6). Conclusions: NBs undergoing surgery, mainly those with risk factors, require close monitoring during the postoperative period. CVC should be withdrawn as soon as possible.

Insomnia symptoms during the covid-19 pandemic: a case-control study / Sintomas de insônia durante a pandemia de covid-19: um estudo caso-controle

ABSTRACT OBJECTIVE To identify lifestyle-related, sociodemographic, and mental health characteristics of people with insomnia symptoms and people without insomnia during the pandemic. METHODS A case-control study was conducted with data collected by snowball sampling using an online questionnaire. From November 2020 to April 2021, 6,360 people with a mean age of 43.5 years (SD = 14.3) participated in the survey. For this study, we considered 158 cases of insomnia disorder and 476 controls (three controls per case) randomly selected from the participants without sleep problems. RESULTS The results of the comparative analysis between cases and controls showed that sleeping less than six hours daily (OR = 3.89; 95%CI 2.50-6.05), feeling sadness frequently (OR = 2.95; 95%CI 1.69-5.17), residing in metropolitan areas (OR = 1.71; 95%CI 1.04-2.84), being 40 years or older (OR = 1.93; 95%CI 1.22-3.06), and the interaction between occupation and poorer education (OR = 2.12; 95%CI 1.22-3.69) were predictors for symptoms of insomnia disorder during the pandemic. CONCLUSIONS In addition to confirming the hypothesis that mental health problems are associated with insomnia symptoms, the results point to insomnia as an important outcome for studies on the effects of unemployment, vulnerability and low education of the population, especially in large cities, highlighting that the effects of the crisis on health and the economy are extremely unequally distributed.

RESUMO OBJETIVO Identificar características relacionadas ao estilo de vida, sociodemográficas e saúde mental de pessoas com sintomas de insônia e pessoas sem insônia durante a pandemia. MÉTODOS A partir de dados coletados por amostragem em bola de neve, por meio de um questionário online foi realizado um estudo caso-controle. Durante o período de novembro de 2020 a abril de 2021, 6.360 pessoas com idade média de 43,5 anos (DP = 14,3) participaram da pesquisa. No presente estudo, foram considerados 158 casos de transtorno de insônia e 476 controles (três controles por caso) selecionados aleatoriamente dentre os participantes sem problemas de sono. RESULTADOS Os resultados da análise comparativa entre casos e controles mostraram que dormir menos de seis horas diárias (OR = 3,89; IC95% 2,50-6,05), sentir tristeza frequentemente (OR = 2,95; IC95% 1,69-5,17), residir em metrópoles (OR = 1,71; IC95% 1,04-2,84), estar com 40 anos ou mais (OR = 1,93; IC95% 1,22-3,06) e a interação entre ocupação e escolaridade mais precária (OR = 2,12; IC95% 1,22-3,69) foram fatores preditores para sintomas de transtorno de insônia durante a pandemia. CONCLUSÕES Além da confirmação da hipótese de que problemas de saúde mental estão associados a sintomas de insônia, os resultados apontam para a insônia como um desfecho importante para estudos sobre efeitos do desemprego, vulnerabilidade e baixa escolaridade da população, sobretudo nas grandes metrópoles, ressaltando que os efeitos da crise sobre a saúde e a economia são distribuídos de forma extremamente desiguais.

Influencia de la malnutrición fetal en el crecimiento y desarrollo craneofacial

Introducción: La malnutrición fetal incide de forma negativa en el crecimiento y la maduración, afectando las estructuras craneofaciales en el feto. Objetivo: Determinar los efectos de la malnutrición fetal por defecto en el crecimiento y desarrollo craneofacial en niños. Métodos: Se realizó un estudio analítico de casos y controles, en el área de salud José Martí del municipio Camagüey, desde enero de 2018 hasta diciembre de 2020. El universo estuvo constituido por niños de 6-11 años de edad, pertenecientes al área salud y la muestra quedó conformada por 40 niños, 20 en el grupo de estudio y 20 controles. El grupo de estudio se conformó por niños que presentaron bajo peso al nacer por defecto y tuvieron alteraciones en el crecimiento del complejo craneofacial y el grupo control por niños que no presentaron alteraciones en el crecimiento del complejo craneofacial y que al nacimiento se encontraban normopeso. A todos los niños se les efectuaron mediciones antropométricas craneofaciales. Resultados: La medida de la circunferencia cefálica al nacer en los controles masculinos superó en 0,78 cm al sexo femenino y entre los malnutridos por defecto, los masculinos lograron 1,57 cm más que los femeninos. En el diámetro bicigomático hubo una fuerte asociación estadística y el riesgo relativo indicó que la incidencia del bajo peso al nacer fue mayor que en los controles (p <0,05). Conclusiones: Los niños con bajo peso al nacer presentan menor crecimiento y desarrollo craneofacial según las variables antropométricas.

Introduction: Fetal malnutrition impacts in a negative way the growth and development, thus affecting the craniofacial structures of the fetus. Objective: To determine the effects of fetal malnutrition by defect on craniofacial growth and development in children. Methods: An analytical case and control study was carried out in Jose Martí health area of Camagüey, from January 2018 to December 2020. A sample of 40 was selected from the totality of the children between 6 and 11 years old who belong to the referred health area, to be divided into 20 cases and the same number in the control group. The study group was composed of those low birth weight who present craniofacial abnormalities while control group included the children without craniofacial abnormalities and normal weight at birth. Anthropometric craniofacial measurements were performed on all the sample. Results: The head circumference at birth in male children of control group was 0.78 cm higher than that on female sex. Among those low birth weight, male children exhibited 1.57 cm higher than females. Regarding the bizygomatic diameter there was a strong statistic association and the relative risk indicated a higher incidence on the study group compared to the control group (p <0.05). Conclusions: Low birth weight children show lower craniofacial growth and development, with higher impact on females according to anthropometric variables.

Atividades de Vida Diária, Atividade Física, Aptidão Física e Qualidade de Vida em Crianças com Cardiopatia Congênita: Um Estudo de Caso-Controle / Activities of Daily Living, Physical Activity, Physical Fitness and Quality of Life in Children with Congenital Heart Disease: A Case-Control Study

Resumo Fundamento Apesar dos relatos de redução da aptidão física em crianças com cardiopatia congênita (CC), não foram realizadas avaliações específicas de desempenho para atividades de vida diária. Objetivos O objetivo foi comparar as atividades de vida diária, qualidade de vida, postura, aptidão física e níveis de atividade física entre crianças com CC e controles saudáveis (CS). Métodos O estudo incluiu 30 crianças, de 6 a 14 anos, com diagnóstico de CC moderada ou grave e 30 consideradas CS pareadas por idade e sexo. Os dados sociodemográficos e clínicos dos participantes foram registrados. Todos os participantes realizaram diversos testes: teste de TGlittre-P para atividades de vida diária; teste de caminhada de 6 minutos (TC6M) para capacidade funcional; bateria de testes Fitnessgram para aptidão física; dinamômetro de mão para medir a força de preensão; pedômetro para medir a atividade física; além disso, a criança e os pais completaram o Pediatric Quality of Life Inventory (PedsQL) para avaliação da qualidade de vida, além de análises posturais. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados Indivíduos com CC apresentaram um tempo de conclusão do teste TGlittre-P mais longo e uma distância de TC6M mais curta em comparação com o CS (TGlittre-P: CC 3,45 [3,24-4,02] min vs. CS 3,10 [2,57-3,23] min, TC6M: CC 514,00 [412,50-566,00] m vs. CS 591,50 [533,00-631,00] m). Para o grupo CC, os resultados dos testes de sit-ups, flexões, elevação do tronco e sentar e alcançar, dentro da bateria do Fitnessgram, além de força de preensão, postura e qualidade de vida foram menores do que os do grupo CS. Os níveis de atividade física foram semelhantes entre os grupos. Conclusões O desempenho das atividades de vida diária, a capacidade funcional, a aptidão física, a postura e a qualidade de vida de crianças com CC moderada e grave foram afetados em comparação com seus pares saudáveis.

Abstract Background Despite reports of reduced physical fitness in children with congenital heart disease (CHD), no specific performance evaluations for activities of daily living have been conducted. Objectives The aim was to compare the activities of daily living, quality of life, posture, physical fitness and physical activity levels of children with CHD with healthy controls (HC). Methods The study included 30 children aged 6-14 diagnosed with moderate or severe CHD and 30 age-sex-matched HC. The sociodemographic and clinical data of the participants were recorded. All participants went through several tests, namely the TGlittre-P test for activities of daily living, the 6-minute walk test (6MWT) for functional capacity, the Fitnessgram test battery for physical fitness, the hand dynamometer for measuring grip strength, the pedometer for measuring physical activity, and both the child and parents reported the Pediatric Quality of Life Inventory (PedsQL) for evaluating the quality of life, in addition to posture analyses. Values of p < 0.05 were considered statistically significant. Results Individuals with CHD had a longer TGlittre-P test completion time and a shorter 6MWT distance than HC (TGlittre-P: CHD 3.45 [3.24-4.02]min vs. HC 3.10 [2.57-3.23]min, 6MWT: CHD 514.00 [412.50-566.00]m vs. HC 591.50 [533.00-631.00]m). For the CHD group, sit-ups, push-ups, trunk lift, and sit-and-reach test scores within the Fitnessgram battery, grip strength, posture, and quality of life scores were lower than those for the HC group. Physical activity levels were similar in the groups. Conclusions The performance of activities of daily living, functional capacity, physical fitness, posture, and quality of life of children with moderate and severe CHD were affected compared to healthy peers.

Investigação de surto de doença compatível com escorbuto em uma penitenciária masculina do Ceará, 2019-2020: um estudo de caso-controle / Investigation of an outbreak of disease compatible with scurvy in a male penitentiary in the state of Ceará, Brazil, 2019-2020: a case-control study / Investigación de un brote de enfermedad compatible con escorbuto en una penitenciaría masculina en el estado de Ceará, Brasil, 2019-2020: un estudio de casos y controlesInvestigação de surto

Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.

Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor< 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.

Estudio multicéntrico de incidencia y determinantes de COVID-19 en médicos de Argentina / Multicenter study of COVID-19 incidence and determinants in Argentinian physicians

Resumen Introducción: La información sobre COVID en médicos es limitada. Su conocimiento permitiría implementar acciones para reducir su impacto. El objetivo general fue determinar la incidencia de infección por SARS-CoV-2 en médicos de instituciones de salud de Argentina, sus características y factores aso ciados. Materiales y Métodos: Se realizó un estudio multicéntrico de cohorte prospectiva/retrospectiva con estudio de casos-controles anidado. Se incluyeron médicos activos al inicio de la pandemia no exceptuados por riesgo. Se estimó incidencia de casos confirmados. Se compararon factores asociados en casos y controles y se creó un modelo de regresión logística con las variables significativas del análisis bivariado. Resultados: Se incluyeron 343 médicos con COVID de 8 centros. La incidencia de la enfermedad fue de 12.1% y la de ausentismo global relacionado a COVID, de 34.1%. El 70% de los contactos estrechos fueron laborales. En el análisis multivariado de casos y controles, la residencia en la Ciudad Autónoma de Buenos Aires (OR 0.19, p = 0.01), el trabajo en áreas de alto riesgo (OR 0.22, p = 0.01) y vehículo individual (OR 0.34, p = 0.03) redujeron el riesgo de COVID. El odds de enfermar aumentó 4.6 veces (p = 0.02) por cada aislamiento por contacto estrecho. Discusión: El riesgo de enfermar aumentó considerablemente con cada aislamiento por contacto estrecho. La residencia en Ciudad Autónoma, el traslado en vehículo individual y el trabajo en áreas de alto riesgo lo redujeron. Dada la alta frecuencia de contactos estrechos en el ámbito laboral recomendamos reforzar las medidas de prevención en áreas de descanso y no COVID.

Abstract Background: Information about COVID infection in physicians is limited. This knowledge would allow the implementation of actions to reduce its impact. The objective was determining the incidence of SARS-CoV-2 infection in physicians from health institutions in Argentina, its characteristics, and associated factors. Methods: We conducted a multicenter prospective / retrospective cohort study with nested case-control study. Physicians active at the beginning of the pandemic were included, those on leave due to risk factors were excluded. The incidence of confirmed cases was estimated. We conducted bivariate analyses with various factors and used those significant in a logistic regression. Results: Three hundred and forty three physicians with COVID-infection from 8 centers were included. The incidence of disease was 12.1% and that of global absenteeism related to COVID, 34.1%. Almost 70% of close contacts were work-related. In the multivariate analysis living in Autonomous City of Buenos Aires (CABA) (OR 0.19, p = 0.01), working in high-risk areas (OR 0.22, p = 0.01) and individual transportation (OR 0, 34, p = 0.03) reduced the risk of COVID. The odds of infection increased 5.6 times (p = 0.02) for each close contact isolation. Discussion: The number of close contact isolation increased considerably the risk of infection. Living in Buenos Aires City, individual transpor tation and working in high-risk areas reduced it. Given the high frequency of close contact in the workplace, we strongly recommend the reinforcement of prevention measures in rest areas and non-COVID-wards.

Factores asociados a bronquiolitis en pacientes menores de 2 años atendidos en un hospital de referencia del Perú

RESUMEN Introducción: La bronquiolitis se considera una patología respiratoria de etiología viral, frecuente a nivel de infantes. Existen diversos determinantes que contribuyen a su desarrollo dentro de esta población. El conocer dichos factores permitirá ejecutar medidas preventivas, así como disminuir el número de casos. Objetivo: Determinar los factores asociados a bronquiolitis en pacientes menores de 2 años atendidos en un hospital de referencia del Perú. Materiales y Métodos: se realizó un diseño de tipo casos y controles no emparejado, con una muestra representativa, con un tamaño muestral de 174 casos y 174 controles por muestreo probabilístico aleatorio simple, se realizó un modelo de regresión logística para los factores asociados al lactante y la madre para el cálculo del Odds Ratio e intervalo de confianza al 95% respecto a la variable dependiente bronquiolitis aguda Resultados: se reportó una asociación para la bronquiolitis aguda con las variables prematuridad 3.02 (IC95% 1.54 - 5.92), bajo peso al nacer 1.85 (IC95% 1.07 - 3.20), género femenino 2.89 (IC95% 1.72 - 4.86), madre adolescente 3.82 (IC95% 2.13 - 6.86) y madre sin grado de instrucción 3.02 (IC95% 1.83 - 11.87). Conclusión: los factores de prematuridad, bajo peso al nacer y género femenino del lactante y el grado de instrucción y condición adolescente de la madre se asocian al bronquiolitis aguda en pacientes menores de 2 años.

ABSTRACT Introduction: Bronchiolitis is considered a respiratory pathology of viral etiology that is frequent in infants. There are several determinants that contribute to its development within this population. Knowledge of these factors will allow preventive measures to be in place, as well as reduce the number of cases. Objective: To determine the factors associated with bronchiolitis in patients under 2 years of age treated at a reference hospital in Peru. Materials and Methods: an unpaired case-control type design was carried out, with a representative sample, with a sample size of 174 cases and 174 controls by simple random probabilistic sampling, a logistic regression model was carried out for the factors associated with the infant. and the mother for the calculation of the Odds Ratio and 95% confidence interval regarding the dependent variable acute bronchiolitis. Results: an association was reported for acute bronchiolitis with the following variables: prematurity 3.02 (95% CI 1.54 - 5.92), low birth weight 1.85 (95% CI 1.07 - 3.20), female gender 2.89 (95% CI 1.72 - 4.86), teenage mother 3.82 (95% CI 2.13 - 6.86) and mother with low educational level 3.02 (95% CI 1.83 - 11.87). Conclusion: prematurity, low birth weight, female gender, birth to an adolescent mother and maternal low educational levels are associated with acute bronchiolitis in patients under 2 years of age.

Factores de adherencia al tratamiento de hipertensión arterial en servicios de primer nivel de atención / Adherence factors to hypertension treatment in primary care services

Introducción: La enfermedad arterial hipertensiva no controlada (EAHNC), se asoció en 2008 con alta mortalidad por enfermedad cardiovascular que genera 9,4 millones de fallecimientos y 7% de la carga de enfermedad expresada en Años de Vida Ajustados por Discapacidad (AVAD). Un 50% de los pacientes no se adhieren al tratamiento EAH y se desconoce sobre las causas en el nivel básico de atención en Colombia. Objetivo: Identificar factores asociados con la adherencia al tratamiento de EAH en una Empresa Social del Estado (E.S.E), pública de un municipio colombiano. Materiales y métodos: Estudio de casos y controles, 75 casos y 75 controles seleccionados aleatoriamente a partir de una base de pacientes del programa de control de hipertensión arterial. Resultados: La edad mayor a 50 años fue el único factor asociado con falta de adherencia al tratamiento, sujetos entre 50-59 años con un OR=3,18 (Intervalo al 95% de confianza) IC95% 1,01-10,00; y entre 60-69 años OR=3,70 IC95% 1,17-11,60 tienen mayor probabilidad de no adherirse al tratamiento. Conclusiones: Los mayores de 50 a 69 años de edad presentaron la más alta probabilidad de no adherencia al tratamiento de la EAH. Se requieren reforzar medidas de seguimiento para mejorar su adherencia al tratamiento.

Introduction: In 2008, uncontrolled hypertensive arterial disease (UHAD) was associated with a high cardiovascular mortality that caused 9.4 million deaths and 7% of the disease burden expressed as Disability-Adjusted Life Years (DALYs). The reasons why 50% of the patients treated in primary care facilities in Colombia do not adhere to UHAD treatment are unknown. Objective: To identify factors associated with UHAD treatment adherence in a Public Health Care institution from a Colombian city. Materials and methods: A case-control study with 75 cases and 75 controls randomly selected from a patient database of the arterial hypertension control program. Results: Being older than 50 years was the only factor associated with lack of adherence to treatment. Participants who were 50-59 (OR=3.18; IC95% 1.01-10.00) and 60-69 (OR=3.70; IC95% 1.17-11.60) are less likely to adhere to treatment. Conclusions: Patients who are 50-69 years old had the highest probability of non-adherence to UHAD treatment. Follow-up measures are necessary to improve this figure.

Factores de riesgo relacionados con enfermedad renal crónica. Policlínico Luis A. Turcios Lima, Pinar del Río, 2019

RESUMEN Fundamento La enfermedad renal crónica presenta una prevalencia elevada en Pinar del Río, Cuba, y constituye una de las principales causas de muerte; por ello se requiere obtener información de interés y que contribuya a su conocimiento. Objetivo determinar los factores de riesgo relacionados con la enfermedad renal crónica. Métodos se realizó un estudio de casos y controles, con pacientes pertenecientes a 16 consultorios del Policlínico Luis A. Turcios Lima, de Pinar del Río, en el periodo enero-diciembre de 2019. La selección de los participantes se realizó de forma aleatoria 1:2 (30 casos y 60 controles). El análisis estadístico se basó en una estrategia multivariada, la determinación del Odds Ratio, con intervalos de confianza al 95 %, y la prueba de Chi Cuadrado con un nivel de significación estadística de P<0,05. Se analizaron variables sociodemográficas, hábitos tóxicos, antecedentes familiares de enfermedad renal crónica y antecedentes patológicos personales, entre otras. Resultados los factores de riesgo identificados como de mayor incidencia fueron la edad por encima de 60 años, la obesidad, la hipercolesterolemia, los antecedentes patológicos personales de hipertensión arterial y la diabetes mellitus, así como la cardiopatía isquémica, las uropatías obstructivas y tener familiares con enfermedad renal crónica. Conclusión Los principales factores de riesgo fueron la presencia de antecedentes de la enfermedad en la familia, así como padecer hipertensión arterial y diabetes mellitus. Otras de las variables analizadas también se mostraron como tal, pero en menor medida.

ABSTRACT Background Chronic kidney disease has a high prevalence in Pinar del Río, Cuba, and is one of the main causes of death; so, it is necessary to obtain information of interest that contributes to its knowledge. Objective to determine the risk factors related to chronic kidney disease. Methods a case-control study was carried out, with patients belonging to the Luis A. Turcios Lima Polyclinic 16 doctor's office, in Pinar del Río, from January-December 2019. The selection of participants was carried out randomly 1:2 (30 cases and 60 controls). The statistical analysis was based on a multivariate strategy, the determination of the Odds Ratio, with 95% confidence intervals, and the Chi Square test with a level of statistical significance of P <0.05. Sociodemographic variables, toxic habits, family history of chronic kidney disease and personal pathological history, among others, were analyzed. Results the risk factors identified as having the highest incidence were age over 60 years old, obesity, hypercholesterolemia, personal pathological history of arterial hypertension and diabetes mellitus, as well as ischemic heart disease, obstructive uropathies and having relatives with chronic kidney disease. Conclusion The main risk factors were the presence of the disease family history, as well as suffering from high blood pressure and diabetes mellitus. Other variables analyzed were also shown as such, but to a lesser extent.

Síntomas otorrinolaringológicos asociados con infección positiva de SARS-CoV-2 confirmada con RT-PCR: un estudio de casos y controles en Colombia / Otolaryngological symptoms associated with positive RT-PCR SARS-CoV-2 infection: a case-control study in Colombia

Introducción: las alteraciones otorrinolaringológicas en pacientes con COVID-19 tienen particular importancia a nivel mundial. Sin embargo, todavía no hay consenso en la literatura acerca de la epidemiología, la gravedad y el tiempo de recuperación de estos trastornos. Objetivo: este estudio tiene como objetivo evaluar la asociación entre los síntomas otorrinolaringológicos y la positividad del SARS-CoV-2 confirmada mediante la reacción en cadena de la polimerasa de transcripción inversa (RT-PCR), así como la gravedad, duración y recuperación de estos síntomas en pacientes de la Fundación Santa Fe de Bogotá, un hospital de referencia de COVID-19 en Bogotá, Colombia. Métodos: estudio observacional, prospectivo, tipo casos y controles, realizado entre el 9 de octubre de 2020 y el 14 de enero de 2021. Los casos incluyeron adultos que obtuvieron una prueba positiva para el SARS-CoV-2 mediante RT-PCR. Los casos se emparejaron en una proporción de 2:1 con adultos sintomáticos seleccionados al azar con una prueba negativa, o con pacientes prequirúrgicos. Resultados: se incluyeron 130 casos y 253 controles entre los 10.004 pacientes sometidos a la prueba del SARS-CoV-2. La edad media era de 41,8 años (desviación estándar [DE]: 16,3). Los síntomas otorrinolaringológicos asociados a la positividad al SARS-CoV-2 fueron anosmia/hiposmia (adjusted odds ratio [aOR]: 5,82; intervalo de confianza [IC] del 95 %: 1,92-17,68), disgeusia/hipogeusia (aOR: 9,09; IC del 95 %: 2,86-28,92) y tos seca (aOR: 3,18; IC del 95 %: 1,56-6,48). La duración media de la anosmia/hiposmia y de la disgeusia/hipogeusia en los pacientes con SARS-CoV-2 positivos fue de 14,5 días y 15 días (rango intercuartílico [IQR]: 8-27), respectivamente. Hasta el 70,3 % y el 67,5 % de la población informó de una recuperación completa de la anosmia/hiposmia y la disgeusia/hipogeusia. En cuanto a la gravedad de los síntomas de anosmia/hiposmia y disgeusia/hipogeusia, el 62,1 % y el 65,4 % de la población positiva para SARS-CoV-2 los clasificó como graves. Sin embargo, solo el 6,1 % de ellos recibió tratamiento para estos síntomas. Conclusiones: los síntomas otorrinolaringológicos asociados con la positividad para SARS-CoV-2 son útiles para orientar el diagnóstico, pero establecer sus características clínicas también es esencial para un tratamiento adecuado.

Introduction: Otolaryngological disorders in COVID-19 patients have drawn attention worldwide. However, there is still no consensus regarding the prevalence, severity or recovery of these disorders. This study aimed to assess the association between otolaryngological symptoms and SARS-CoV-2 positivity confirmed by RT-PCR, as well as the severity, duration, and recovery of these symptoms in patients receiving care at Fundación Santa Fe de Bogotá, a COVID-19 referral hospital in Bogotá, Colombia. Methods: Observational, analytic, prospective, case-control study conducted between October 9, 2020, and January 14, 2021. Cases included adults who tested positive for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR). Cases were matched in a 2:1 ratio with randomly selected symptomatic adults with a negative test, or patients awaiting surgery. Results: Of 10004 patients tested for SARS-CoV-2, 130 cases and 253 controls were included. The mean age was 41.8 years (standard deviation [SD]: 16.3). The otolaryngological symptoms associated with SARS-CoV-2 positivity were anosmia/hyposmia (adjusted odds ratio [aOR]: 5.82; 95% confidence interval [CI]: 1.92-17.68), dysgeusia/ hypogeusia (aOR: 9.09; 95% CI: 2.86-28.92), and dry cough (aOR: 3.18; 95% CI: 1.56-6.48). The median duration of anosmia/hyposmia and dysgeusia/hypogeusia in SARS-CoV-2 positive patients was 14.5 days and 15 days (interquartile range [IQR]: 8-27), respectively. Up to 70.3% and 67.5% of the population reported a complete recovery of anosmia/hyposmia and dysgeusia/hypogeusia. Regarding the severity of anosmia/hyposmia and dysgeusia/hypogeusia symptoms, 62.1% and 65.4% of the SARS-CoV-2 positive population classified them as severe. However, only 6.1% of them received treatment for these symptoms. Conclusions: Otolaryngological symptoms associated with SARS-CoV-2 positivity are a useful guide to diagnosis, although adequate treatment also requires determination of their clinical characteristics.

Determinants of late neonatal nosocomial infection: a case-control study in Ceará / Determinantes de infecção nosocomial tardia neonatal: estudo de caso-controle no Ceará

ABSTRACT OBJECTIVES To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care. METHODS This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant. RESULTS Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56-0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30-0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84-35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12-5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26-9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54-7.69); central venous catheters (OR = 10.00; 95%CI: 6.66-16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02-5.12); surgery (OR = 4.00; 95%CI: 2.27-7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83-17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26-2.68); central venous catheters (OR = 2.48; 95%CI: 1.40-4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections. CONCLUSION Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.

RESUMO OBJETIVO Identificar os fatores determinantes para infecções relacionadas à assistência à saúde (IRAS) tardias em terapia intensiva neonatal e multirresistência bacteriana. MÉTODOS Estudo caso-controle em unidade de terapia intensiva neonatal do Estado do Ceará, entre janeiro de 2013 e dezembro de 2017. Considerado caso o recém-nascido notificado como IRAS tardia e, controle, aquele sem infecção. Variáveis com valor de p ≤ 0,05 em análise regressiva bivariada inicial foram incluídas em modelo logístico hierarquizado não condicional para análise multivariada. Valores de p menores que 0,01 foram considerados significativos. RESULTADOS Dos 1.132 participantes, 427 (37,7%) tiveram infecções tardias relacionadas a assistência à saúde, com 54 (12,6%) hemoculturas positivas e 14,9% dessas foram bactérias multirresistentes. Na análise bivariada observou-se efeito protetor do sexo feminino (OR = 0,71; IC95% 0,56-0,90) e recém-nascido ≥ 34 semanas (OR = 0,48; IC95% 0,30-0,75). Nos mais prematuros, as infecções tardias tiveram chance dezoito vezes maior em menores do que 30 semanas (OR = 18,61; IC95% 9,84-35,22); e nos menores de 1.500g, quatro vezes maior (OR = 4,18; IC95% 3,12-5,61). O uso de ventilação mecânica aumentou em mais de sete vezes a chance (OR = 7,14; IC95% 5,26-9,09); o mesmo aconteceu com o recurso da nutrição parenteral (OR = 5,88; IC95% 4,54-7,69), com o cateter venoso central (OR = 10,00; IC95% 6,66-16,66); o número de cateteres utilizado (OR = 3,93; IC95% 3,02-5,12); a realização de cirurgia (OR = 4,00; IC95% 2,27-7,14) e o tempo de internamento (OR = 1,06; IC95% 1,05-1,07). Permaneceram significativos após ajuste: prematuro menor do que 30 semanas (OR = 5,62; IC95% 1,83-17,28); uso de ventilação (OR = 1,84; IC95% 1,26-2,68); uso de cateter venoso central (OR = 2,48; IC95% 1,40-4,37) e tempo de internamento (OR = 1,06; IC95% 1,05-1,07). Dentre os óbitos, 41 (55,4%) foram associados às infecções tardias. CONCLUSÃO Melhores práticas devem ser adotadas no cuidado da prematuridade e o uso racional de procedimentos, para evitar infecções tardias relacionadas a assistência à saúde, óbitos preveníveis e riscos de multirresistência bacteriana e contaminação ambiental.

Trabalho rural associado a cânceres linfohematopoiéticos em hospital público de referência: estudo caso-controle, Ceará, Brasil, 2019-2021 / Rural labor associated with lymphohematopoietic cancers in a public reference hospital: a case-control study, Ceará, Brazil, 2019-2021 / Trabajo rural asociado a cánceres linfohematopoyéticos en un hospital público de referencia: estudio de caso control, Ceará, Brasil, 2019-2021

Trata-se de um estudo do tipo caso-controle pareado com o objetivo de verificar a associação entre ocupações e cânceres linfohematopoiéticos em um hospital público de referência no Estado do Ceará, Brasil, durante 2019-2021. O grupo caso foi constituído por pacientes hematológicos que apresentavam mieloma múltiplo, leucemias ou linfomas não Hodgkin, acompanhados pelo serviço social de uma unidade hospitalar de transplante de medula óssea (n = 114), enquanto indivíduos comparáveis de unidade hospitalar distinta constituíram o grupo controle (n = 114), formando pares 1:1. O diagnóstico foi efetuado por equipe médica e as variáveis foram aferidas por acesso aos registros hospitalares. Comparamos os grupos em regressão logística condicional bivariada e ajustada por região de residência. Entre os resultados, destacamos que o câncer de maior prevalência no grupo caso foi o mieloma múltiplo (43,9%), seguido pelas leucemias (43%) e por linfomas não Hodgkin (13,2%). Proporções de ocupações, zona de residência, abastecimento de água e Superintendência Regional de Saúde de residência apresentaram diferença estatisticamente significante entre os grupos caso e controle. Verificamos que trabalhadores rurais possuíam maiores chances de apresentar os cânceres estudados (ORbruto = 5,00, IC95%: 1,91; 13,06 e ORajustado = 3,38, IC95%: 1,20; 9,54), enquanto trabalhadores do comércio apresentaram menores chances (ORbruto = 0,26, IC95%: 0,10; 0,70 e ORajustado = 0,30, IC95%: 0,10; 0,88). Os achados deste estudo possibilitam reflexões sobre o processo de adoecimento dos trabalhadores rurais e refletem o potencial dos serviços de saúde em contribuir com investigações sobre exposições ocupacionais.

This is a paired case-control study that sought to verify the association between professions and lymphohematopoietic cancers in a public reference hospital in the State of Ceará, Brazil, during 2019-2021. Case group consisted of hematological patients with multiple myeloma, leukemias or non-Hodgkin lymphomas, monitored by the social service of a bone marrow transplant hospital unit (n = 114), whereas comparable individuals from a different hospital unit made up the control group (n = 114), forming 1:1 pairs. Diagnosis was performed by a medical team and the variables were measured by accessing hospital records. Group comparison was conducted using bivariate conditional logistic regression and adjusted by region of residence. Results show that multiple myeloma (43.9%), leukemias (43%) and non-Hodgkin lymphomas (13.2%) were the cancer with the highest prevalence in the case group. Proportions of jobs, area of residence, water supply and Regional Superintendence of Health showed statistically significant difference between the case and control groups. Rural workers were more likely to present the cancers studied (ORraw = 5.00, 95%CI: 1.91; 13.06 and ORadjusted = 3.38, 95%CI: 1.20; 9.54), whereas trade workers had lower odds (ORraw = 0.26, 95%CI: 0.10; 0.70 and ORadjusted = 0.30, 95%CI: 0.10; 0.88). The findings allow us to reflect on the process of illness among rural workers and illustrate the potential of health services to contribute to investigations on occupational exposures.

Se trata de un estudio del tipo caso control apareado con el objetivo de verificar la asociación entre ocupaciones y cánceres linfohematopoyéticos en un hospital público de referencia en el estado de Ceará, Brasil, durante el período 2019-2021. El grupo caso estaba formado por pacientes hematológicos que presentaban mieloma múltiple, leucemias o linfomas no Hodgkin, bajo seguimiento por parte del servicio social de una unidad hospitalaria de trasplante de médula ósea (n = 114), mientras que individuos comparables de otra unidad hospitalaria constituyeron el grupo control (n = 114), formando pares 1:1. El diagnóstico fue realizado por un equipo médico, y las variables se midieron accediendo a los registros hospitalarios. Comparamos los grupos en regresión logística condicional bivariada y ajustada por región de residencia. Entre los resultados, destacamos que el cáncer de mayor prevalencia en el grupo caso fue el mieloma múltiple (43,9%), seguido de las leucemias (43%) y los linfomas no Hodgkin (13,2%). Las proporciones de ocupaciones, zona de residencia, abastecimiento de agua y Superintendencia Regional de Salud de residencia presentaron diferencia estadísticamente significativa entre los grupos caso y control. Constatamos que los trabajadores rurales tenían más probabilidades de padecer los cánceres estudiados (ORcrudo = 5,00, IC95%: 1,91; 13,06 y ORajustado = 3,38, IC95%: 1,20; 9,54), mientras que los trabajadores del comercio presentaron menos posibilidades (ORcrudo = 0,26, IC95%: 0,10; 0,70 y ORajustado = 0,30, IC95%: 0,10; 0,88). Los hallazgos de este estudio permiten reflexiones sobre el proceso de enfermedad de los trabajadores rurales y reflejan el potencial de los servicios de salud para contribuir a las investigaciones sobre exposiciones ocupacionales.

Lung cancer and occupational exposure: hospital-based case-control study / Cáncer de pulmón y exposición profesional: estudio caso-control hospitalario / Câncer de pulmão e exposição ocupacional: estudo caso-controle de base hospitalar

ABSTRACT Objective To analyze the relationship between occupation and lung cancer in patients at a national referral hospital for cancer care in southern Brazil. Method Hospital-based case-control study conducted between February and October 2019. Occupational histories were coded according to international classifications and translated into occupations associated with lung cancer (List A and B). The odds ratios were adjusted for smoking, with a 95% confidence interval, calculated by conditional logistic regression. Results 99 cases and 227 controls were included. Among men, the occupation of painters (list A) was associated with lung cancer (OR = 14.3; 95% CI: 1.8-116.5), there were no occupations in list B associated with lung cancer. In women, no increased risks were found. Conclusions It has been shown that exposure to occupational carcinogens among repair and construction painters increases the risk of lung cancer.

RESUMEN Objetivo Analizar la relación entre la ocupación y el cáncer de pulmón en pacientes ambulatorios de un hospital nacional de referencia para la atención oncológica en el sur de Brasil. Método Estudio caso-control hospitalario realizado entre febrero y octubre de 2019. Se codificaron los antecedentes laborales según clasificaciones internacionales y se tradujeron a ocupaciones asociadas con el cáncer de pulmón (Lista A y B). Las odds ratios se ajustaron para el tabaquismo, con un intervalo de confianza del 95%, calculada por regresión logística condicional. Resultados se incluyeron 99 casos y 227 controles. Entre los hombres, la ocupación de pintores (lista A) se asoció con el cáncer de pulmón (OR = 14,3; IC del 95%: 1,8-116,5), no hubo ocupación de la lista B asociada con el cáncer de pulmón. En las mujeres, no se encontraron mayores riesgos. Conclusiones Se ha demostrado que la exposición a carcinógenos ocupacionales entre los pintores de la reparación y la construcción aumenta el riesgo de cáncer de pulmón.

RESUMO Objetivo Analisar a relação entre ocupação e câncer de pulmão em pacientes de um hospital de referência nacional para atendimento oncológico no Sul do Brasil. Método Estudo caso-controle de base hospitalar realizado entre fevereiro e outubro de 2019. Os históricos ocupacionais foram codificados de acordo com classificações internacionais e traduzidos em ocupações associadas ao câncer de pulmão (Lista A e B). As odds ratios foram ajustadas para tabagismo, com intervalo de confiança de 95%, calculadas por regressão logística condicional. Resultados Foram incluídos 99 casos e 227 controles. Entre os homens a ocupação de pintores (lista A) estava associada ao câncer de pulmão (OR= 14,3; IC 95%: 1,8-116,5), não houve ocupações da lista B associadas ao câncer de pulmão. Nas mulheres não foram encontrados riscos aumentados. Conclusões Evidenciou-se que a exposição aos carcinógenos ocupacionais entre pintores de reparo e da construção civil aumentam o risco de câncer de pulmão.

Covid-19 entre indígenas na Amazônia brasileira: fatores associados ao óbito / Covid-19 among the Brazilian Amazon indigenous people: factors associated with death

Resumo Este estudo objetiva analisar fatores associados ao óbito de indígenas pela covid-19 no estado do Amapá, Brasil. Trata-se de um estudo caso-controle emparelhado por sexo e idade, que utilizou um banco de dados secundários público, produzido pela Secretaria de Estado da Saúde do Amapá. Os casos (n=29) foram óbitos de indígenas pela covid-19 e os controles foram curas da doença (n=87), registrados entre abril de 2020 e janeiro de 2021. Dados de indivíduos com doença ativa foram excluídos da análise. Foram realizadas análises univariadas seguidas por regressão logística múltipla para estudo das variáveis independentes associadas ao desfecho de óbito. A maioria dos casos de óbito era do sexo feminino (51,7%), sem comorbidades (62,1%), residentes em municípios da Região Metropolitana de Macapá (RMM) (65,5%) e em área urbana (89,7%). A mediana das idades do grupo de óbitos foi de 72 anos (intervalo interquartil= 21,5). O modelo múltiplo final demonstrou que indígenas com comorbidade cardiovascular apresentaram chance 4,01 vezes (intervalo de confiança de 95% - IC 95%= 1,05-15,36) maior de óbito pela covid-19 quando comparados a indígenas sem comorbidades. E que indígenas residentes na RMM apresentaram chance 2,90 vezes (IC 95%= 1,10-7,67) maior de óbito quando comparados aos indígenas residentes no interior do estado Amapá.

Abstract This case-control study paired by gender and age analyzes factors associated with the death of indigenous people from COVID-19 in the state of Amapá, Brazil. Data were collected from a public secondary database produced by the Amapá State Department of Health. Cases (n=29) were deaths of indigenous people from COVID-19 and controls were cures of the disease (n=87), recorded between April 2020 and January 2021. Data from individuals with active disease were excluded. Univariate analysis followed by multiple logistic regression were performed to study the independent variables associated with death. Most cases of death were women (51.7%), without comorbidities (62.1%), residing in cities of the Metropolitan Region of Macapá (RMM) (65.5%) and in urban areas (89.7%). Median age of the death group was 72 years (interquartile range=21.5). The final multiple model showed that indigenous individuals with cardiovascular comorbidity had a 4.01 times greater chance (95% confidence interval - 95% CI=1.05-15.36) of death by COVID-19 when compared with indigenous people without comorbidities. And that indigenous people residing in the RMM had a 2.90 times greater chance (95%CI = 1.10-7.67) of death when compared with indigenous residing in the countryside.