Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias / Morphological prognostic factors in nosocomial pneumonia: an autopsy study

OBJETIVO: Determinar a prevalência de pneumonia nosocomial nas autópsias em um hospital público universitário; identificar os fatores de risco relacionados à pneumonia nosocomial e os potenciais fatores prognósticos relacionados à ocorrência de pneumonia nosocomial fatal; e correlacionar os achados anatomopatológicos com a ocorrência de pneumonia nosocomial e/ou pneumonia aspirativa. MÉTODOS: Estudo retrospectivo de 199 pacientes autopsiados, maiores de 1 ano de idade, internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista entre 1999 e 2006, cuja causa de morte (causa básica ou associada) foi pneumonia nosocomial. Testou-se a associação dos dados demográficos, clínicos e anatomopatológicos com os desfechos pneumonia nosocomial fatal e pneumonia aspirativa fatal. As variáveis significativas entraram na análise multivariada. RESULTADOS: A idade média foi de 59 ± 19 anos. A prevalência de pneumonia nosocomial em autópsias foi 29 por cento, e essa foi a causa mortis de 22,6 por cento dos pacientes autopsiados. A pneumonia nosocomial fatal correlacionou-se com os achados anatomopatológicos de alterações estruturais tabágicas (OR = 3,23; IC95 por cento: 1,26-2,95; p = 0,02) e acometimento pulmonar bilateral (OR = 3,23; IC95 por cento: 1,26-8,30; p = 0,01). Não houve associações significativas entre as variáveis e pneumonia aspirativa fatal. CONCLUSÕES: Em nossa amostra, a pneumonia nosocomial teve prevalência elevada e foi responsável por quase 25 por cento das mortes. A mortalidade é favorecida por alterações estruturais tabágicas e pneumonia bilateral. Esses achados corroboram os resultados de diversos estudos clínicos sobre pneumonia nosocomial.

OBJECTIVE: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. METHODS: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. RESULTS: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29 percent, and the disease was the cause of death in 22.6 percent of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco-associated structural lesions (OR = 3.23; 95 percent CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95 percent CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. CONCLUSIONS: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25 percent of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.

Frequência de fatores de risco cardiovascular em voluntários participantes de evento de educação em saúde / Cardiovascular risk factors in a population attending a community event on health education

INTRODUÇÃO: As doenças cardiovasculares (DCV) constituem a principal causa de óbito no Brasil. OBJETIVO: Avaliar a frequência dos fatores de risco para DCV em indivíduos participantes de evento de educação em saúde na comunidade. MÉTODOS: Foram analisados retrospectivamente 428 formulários contendo informações clínicas e demográficas de voluntários participantes de evento em saúde, realizado em maio de 2006. Comparações entre proporções foram realizadas pelo teste do Qui quadrado e entre grupos pelo teste t de Student. As associações entre hipertensão arterial (HAS) e diabetes mellitus (DM) e variáveis clínicas foram avaliadas pelo modelo de regressão logística multivariado. O nível de significância adotado foi p<0,05. RESULTADOS: A idade média foi 57±14 anos, sendo 58 por cento mulheres. Os principais fatores de risco cardiovascular observados foram HAS (39,5 por cento), DM (15,4 por cento) e dislipidemia (25,8 por cento), sendo que 8,4 por cento, 17,5 por cento e 33,1 por cento, respectivamente, não sabiam informar sobre esses antecedentes. Antecedentes familiares de DCV ocorreram em 41 por cento dos indivíduos e somente 67 por cento referiram ter algum acesso a informações sobre DM ou dislipidemia. Entre os obesos (IMC>30 Kg/m², 27,3 por cento da casuística), a pressão arterial sistólica (133±16mmHg) e diastólica (84±11,5mmHg) e a glicemia casual (124±52,5mg/dl) foram maiores que nos não obesos (p<0,05). Houve associação entre obesidade e dislipidemia (p=0,04). Idade e IMC foram associados de forma independente com a presença de HAS e DM. CONCLUSÃO: A alta prevalência de fatores de risco modificáveis na população avaliada sugere a necessidade de medidas de saúde pública que promovam educação e prevenção primária dirigida, principalmente, para indivíduos idosos e com sobrepeso.

INTRODUCTION: Cardiovascular diseases (CVD) are the main cause of death in Brazil. OBJECTIVE: To evaluate the frequency of CVD risk factors in a population attending a health education community event. METHODS. Retrospective study that included 428 completed forms with clinical and demographic information of volunteers attending a public event, in May, 2006. Data were expressed by means and standard deviation or proportions and compared by Student´s t test or Chi-square test. Associations between Arterial Hypertension (AH), Diabetes Mellitus (DM) and clinical variables were analyzed by multinomial logistic regression. Significance level was p <0.05. RESULTS: Mean age was 57±14 years, and women represented 58 percent of the total population. The main cardiovascular risk factors were AH (39.5 percent), DM (15.4 percent) and dyslipidemia (25.8 percent). The frequency of unawareness about these risk factors was respectively 8.4 percent, 17.5 percent and 33.1 percent.. Family history of CVD was reported by 41 percent while only 67 percent reported having any information about DM or dyslipidemia. Among obese individuals (IMC>30 Kg/m2, 27.3 percent of the population), systolic blood pressure (133±16mmHg), diastolic blood pressure (84±11.5mmHg) and casual glycemia (124±52.5mg/dl) were higher when compared to non-obese (p<0.05). There was a significant association between obesity and dyslipidemia (p=0.04). Age and IMC were independently associated with AH and DM. CONCLUSION: The high frequency of modifiable cardiovascular risk factors in this population suggests the need for educational programs to promote primary prevention, mainly for the elderly and overweight.

Quality of life and its association with cardiovascular risk factors in a community health care program population

OBJECTIVE: To evaluate quality of life in a population that attended a specific community event on health care education, and to investigate the association of their quality of life with the presence of cardiovascular risk factors INTRODUCTION: Interest in health-related quality of life is growing worldwide as a consequence of increasing rates of chronic disease. However, little is known about the association between quality of life and cardiovascular risk factors. METHODS: This study included 332 individuals. Demographics, blood pressure, body mass index, and casual glycemia were evaluated. The brief version of the World Health Organization Quality of Life questionnaire on quality of life was given to them. The medians of the scores obtained for the physical, psychological, emotional, and environmental domains were used as cutoffs to define "higher" and "lower" scores. A multinomial logistic regression model was used to define the parameters associated with lower scores. RESULTS: Diabetes mellitus, dyslipidemia, and obesity were associated with lower scores in the physical domain. Dyslipidemia was also associeted with lower scores in the psychological domain. Male gender and regular physical activity had protective effects on quality of life. Aging was inversely associated with decreased quality of life in the environmental domain. CONCLUSION: The presence of cardiovascular risk factors is related to a decreased quality of life. Conversely, male gender and regular physical activity had protective effects on quality of life. These findings suggest that exercising should be further promoted by health-related public programs, with a special focus on women.