Clinical characteristics and variables associated with COVID-19 morbidity and mortality in Luanda, Angola, in the first year of the pandemic

Background: The impact of SARS-CoV-2 infection in Africa is still unclear. In comparison to Europe and North America, morbidity and death rates are lower. Several factors have been proposed, including geographical variation in virus impact, environmental factors, differences in age distribution, and the impact of infectious diseases such as malaria, HIV infection and tuberculosis. Objectives: We investigated the clinical characteristics and putative determinants linked with COVID-19 in Angolan patients. Methods: Cross-sectional study undertaken at Military Hospital, Luanda, from March 2020 to March 2021. The survey collected sociodemographic and clinical information. Results: The sample included 1,683 patients aged ≥18 years, 64% men, with mean age of 46.3 years. SARS-CoV-2 was positive in 39% of the cases with RT-PCR. Patients ≥46 years with a level of education of ≥12 years had a considerably higher likelihood of testing positive. About 58% of positive patients had at least one comorbidity, of which hypertension and Diabetes were associated with SARS-CoV-2 infection. HIV and pulmonary TB were putative protective factors. About 14% of positive patients died. Most deaths occurred in patients ≥46 years, with less education and unemployed. Working as a healthcare practitioner was linked to a protective effect. Malignant diseases were the most common comorbidities associated with death. Conclusions: We identified putative factors related to SARS-CoV-2 infection and mortality. HIV and TB were protective and not associated with mortality. Further study with a broader scope should be conducted to explain the main features related to COVID-19 mortality in Angola

The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.

Natureza e magnitude do estresse na residência médica / Stress nature and magnitude during medical residency training

A natureza estressante do treinamento na Residência Médica tem sido amplamente discutida na literatura. O objetivo deste artigo é apresentar dados sobre os principais fatores estressantes do treinamento e os efietos desse estresse nos residentes e na qualidade da assistência prestada aos pacientes. A magnitude do estresse, durante o treinamento na Residência Médica, resulta da interaçäo de três tipos de estresse: profissional, situacional e pessoal. Säo descritos os principais distúrbios comportamentais e disfunçöes profissionais que afetam os residentes, salientando-se a importância do conhecimento desses dados para o planejamento, organizaçäo e avaliaçäo de programas de Residência Médica.

Psiquiatria e hospital geral. / Psychiatry and general hospital

Os autores relatam a experiencia vivenciada pelo Departamento de Psiquiatria da Escola Paulista de Medicina no hospital geral de ensino daquela instituicao, o Hospital Sao Paulo. Descrevem a importancia da existencia da unidade psiquiatrica, do servico de interconsultas e da presenca de psiquiatra fazendo parte da equipe de plantao do pronto-socorro geral. Discutem como a existencia de tais servicos contribuiu para uma mudanca de atitude do medico geral em relacao a situacao emocional dos pacientes e do atendimento de urgencia e encaminhamento de pacientes com problematica psiquiatrica

A percepcao pelo alcoolatra do que o leva ao alcoolismo e a internacao. / The perception by the alcoholic of what conducts to alcoholism and hospitalization

Os autores estudam, em uma amostra de sessenta e dois pacientes alcoolatras, a maneira peculiar de como eles percebem sua situacao.Discutem as possiveis causas que envolvem o insucesso do tratamento hospitalar, comentando a personalidade de que apenas as complicacoes clinicas e os estados psicoticos associados ao alcoolismo sao ali tratados, nao a dependencia em si