Mortality trends and sociodemographic factors associated with early death in sickle cell disease patients in the state of São Paulo.

OBJECTIVE: To estimate trends in mortality rate and average age of death, and identify sociodemographic factors associated with early death in patients with sickle cell disease (SCD). METHODS: An ecological and cross-sectional study was conducted using data from the Mortality Information System. All deaths of patients residing in the state of São Paulo from 1996 to 2015 with at least one International Disease Code for SCD in any field of the death certificate were included. Simple linear regression was used to estimate trends. The Log-rank test and multiple Cox regression were used to identify factors associated with early death. RESULTS: The age-standardized mortality rate per million inhabitants increased by 0.080 per year (R2=0.761; p<0.001). When the events were stratified by age at death, the increase was 0.108 per year for those occurring at age 20 years or older, (R2=0.789; p<0.001) and 0.023 per year for those occurring before age 20 years old (R2=0.188; p=0.056). The average age at death increased by 0.617 years (7.4 months) per year (R2=0.835; p<0.001). Sociodemographic factors associated with early death identified were male gender (hazard ratio - HR=1.30), white race (HR=1.16), death occurring in the hospital (HR=1.29), and living in the Greater São Paulo (HR=1.13). CONCLUSIONS: The mortality rate and the average age of death in patients with SCD have increased over the last two decades. Sociodemographic factors such as gender, race, place of occurrence, and residence were found to be associated with early death.

Mortality trends and sociodemographic factors associated with early death in sickle cell disease patients in the state of São Paulo / Tendência da mortalidade e fatores sociodemográficos associados à morte precoce em pacientes com doença falciforme no estado de São Paulo

ABSTRACT Objective: To estimate trends in mortality rate and average age of death, and identify sociodemographic factors associated with early death in patients with sickle cell disease (SCD). Methods: An ecological and cross-sectional study was conducted using data from the Mortality Information System. All deaths of patients residing in the state of São Paulo from 1996 to 2015 with at least one International Disease Code for SCD in any field of the death certificate were included. Simple linear regression was used to estimate trends. The Log-rank test and multiple Cox regression were used to identify factors associated with early death. Results: The age-standardized mortality rate per million inhabitants increased by 0.080 per year (R2=0.761; p<0.001). When the events were stratified by age at death, the increase was 0.108 per year for those occurring at age 20 years or older, (R2=0.789; p<0.001) and 0.023 per year for those occurring before age 20 years old (R2=0.188; p=0.056). The average age at death increased by 0.617 years (7.4 months) per year (R2=0.835; p<0.001). Sociodemographic factors associated with early death identified were male gender (hazard ratio — HR=1.30), white race (HR=1.16), death occurring in the hospital (HR=1.29), and living in the Greater São Paulo (HR=1.13). Conclusions: The mortality rate and the average age of death in patients with SCD have increased over the last two decades. Sociodemographic factors such as gender, race, place of occurrence, and residence were found to be associated with early death.

RESUMO Objetivo: Estimar as tendências da taxa de mortalidade e da idade média de morte e identificar os fatores sociodemográficos associados ao óbito precoce em pacientes com doença falciforme (DF). Métodos: Estudo ecológico e transversal realizado com dados do Sistema de Informações sobre Mortalidade. Foram incluídos todos os eventos de óbitos de pacientes residentes no estado de São Paulo de 1996 a 2015, que continham pelo menos um Código Internacional de Doenças para DF, em qualquer campo do atestado de óbito. As tendências foram estimadas por meio da regressão linear simples. Para a identificação dos fatores associados ao óbito precoce, foram realizadas análises de sobrevida, por meio da regressão de Cox simples e múltipla. Resultados: A taxa de mortalidade, padronizada pela idade, por milhão de habitantes, aumentou 0,080 ao ano (R²=0,761; p<0,001). Quando os eventos foram estratificados por idade do óbito, naqueles que ocorreram com 20 anos ou mais, o aumento foi de 0,108 ao ano (R²=0,789; p<0,001) e, nos que ocorreram antes de 20 anos, foi de 0,023 ao ano (R²=0,188; p=0,056). A idade média ao morrer aumentou 0,617 ano por ano (R²=0,835; p<0,001). Os fatores associados ao óbito precoce identificados no modelo múltiplo foram: sexo masculino (hazard ratio — HR=1,30), raça branca (HR=1,16), morte dentro do hospital (HR=1,29) e moradia na Grande São Paulo (HR=1,13). Conclusões: Houve aumento da taxa de mortalidade e da idade média de óbito com DF nas duas últimas décadas estudadas. Os fatores sociodemográficos sexo, raça, local de ocorrência e município de residência estiveram associados com a faixa etária do óbito.

The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting.

Introduction: Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births. Methods: This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs). Results: The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors. Discussion: The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.

Psychometric properties of the Brazilian version of the Big Five Inventory.

INTRODUCTION: There is growing interest in the fields of psychiatry and psychology in investigating the relationship between personality and psychopathology. The Big-5 is a model developed to investigate five personality dimensions: Extroversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. In the present study, we describe the process of translation into Brazilian Portuguese and adaptation of a free tool to evaluate the Big-5 model: The Big-5 Inventory (BFI). The instrument has 44 items with a Likert response scale ranging from 1 to 5. OBJECTIVES: To translate and adapt the BFI into Brazilian Portuguese. METHODS: The adaptation was conducted in the following steps: 1) Translation, 2) Evaluation Committee, 3) Back-translation, 4) Pilot study, 5) Evaluation Committee, and 6) Application. The sample comprised 490 participants from various regions of Brazil. The participants' ages ranged from 18 to 71 years, most of them had completed high school (62.9%), and the majority were women (75%). RESULTS: A model with the following fit indexes was found: χ2/df: 1.954; goodness fit index (GFI): 0.924; comparative fit index (CFI): 0.920; and root mean square error of approximation (RMSEA): 0.044. CONCLUSION: The results are suggestive that the Brazilian version of this instrument has good psychometric properties and represent a cost-free option for investigating associations with the Big-5 in psychiatry.

Psychometric properties of the Brazilian version of the Big Five Inventory

Abstract Introduction There is growing interest in the fields of psychiatry and psychology in investigating the relationship between personality and psychopathology. The Big-5 is a model developed to investigate five personality dimensions: Extroversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. In the present study, we describe the process of translation into Brazilian Portuguese and adaptation of a free tool to evaluate the Big-5 model: The Big-5 Inventory (BFI). The instrument has 44 items with a Likert response scale ranging from 1 to 5. Objectives To translate and adapt the BFI into Brazilian Portuguese. Methods The adaptation was conducted in the following steps: 1) Translation, 2) Evaluation Committee, 3) Back-translation, 4) Pilot study, 5) Evaluation Committee, and 6) Application. The sample comprised 490 participants from various regions of Brazil. The participants' ages ranged from 18 to 71 years, most of them had completed high school (62.9%), and the majority were women (75%). Results A model with the following fit indexes was found: χ2/df: 1.954; goodness fit index (GFI): 0.924; comparative fit index (CFI): 0.920; and root mean square error of approximation (RMSEA): 0.044. Conclusion The results are suggestive that the Brazilian version of this instrument has good psychometric properties and represent a cost-free option for investigating associations with the Big-5 in psychiatry.

Incidentes transfusionais imediatos notificados em crianças e adolescentes / Reacciones transfusionales inmediatas notificadas en niños y adolescentes / Immediate transfusion incidents reported in children and adolescents

Resumo Objetivo Analisar o perfil dos incidentes transfusionais imediatos notificados em crianças e adolescentes internados em hospital geral de alta complexidade. Métodos Estudo documental retrospectivo, com análise de 287 Fichas de Notificação, reportando reações transfusionais em crianças e adolescentes de zero a 18 anos de idade, ocorridas no período de janeiro de 2007 e maio de 2021, em um serviço de hemovigilância de um Hospital Universitário, de caráter filantrópico, de alta complexidade, localizado na cidade de São Paulo. Resultados Das 287 fichas avaliadas, 42,5% das reações foram observadas em adolescentes (entre 12 e 18 anos), 83,6% ocorreram na primeira transfusão. Manifestações clínicas mais comuns foram lesões de pele e hipertermia. Cerca de 50% das reações ocorreram em pacientes com leucemia ou anemias e o hemocomponente associado foi o concentrado de hemácias. Incidentes mais comuns foram: reação febril não hemolítica e reações alérgicas, em sua maioria leves e moderadas. Outras reações foram 9,8% moderadas/graves. Conclusão O estudo favoreceu maior conhecimento sobre os incidentes transfusionais ocorridos em crianças e adolescentes e traz contribuições para reforçar a segurança do paciente e dos serviços de hemoterapia pediátrica.

Resumen Objetivo Analizar el perfil de las reacciones transfusionales inmediatas notificadas en niños y adolescentes internados en un hospital de alta complejidad. Métodos Estudio documental retrospectivo, con análisis de 287 Fichas de Notificación, donde se reportaron reacciones transfusionales en niños y adolescentes de cero a 18 años, ocurridas en el período de enero de 2007 a mayo de 2021, en un servicio de hemovigilancia de un hospital universitario de carácter filantrópico, de alta complejidad, ubicado en la ciudad de São Paulo. Resultados De las 287 fichas analizadas, el 42,5 % de las reacciones fue observada en adolescentes (entre 12 y 18 años) y el 83,6 % sucedió en la primera transfusión. Las manifestaciones clínicas más comunes fueron lesiones en la piel e hipertermia. Cerca del 50 % de las reacciones ocurrió en pacientes con leucemia o anemia, y el componente sanguíneo asociado fue el concentrado de eritrocitos. Los incidentes más comunes fueron: reacción febril no hemolítica y reacciones alérgicas, en su mayoría leves y moderadas. Otras reacciones fueron 9,8 % moderadas/graves. Conclusión El estudio ayudó a tener mayores conocimientos sobre los incidentes transfusionales ocurridos en niños y adolescentes y contribuye para reforzar la seguridad del paciente y de los servicios de hemoterapia pediátrica.

Abstract Objective To analyze the profile of immediate transfusion incidents reported in children and adolescents hospitalized in a high complexity general hospital. Methods This is a documentary and retrospective study that analyzed 287 notification records, reporting transfusion reactions in children and adolescents from zero to 18 years of age, occurred from January 2007 to May 2021, in a hemovigilance service of a high-complexity philanthropic university hospital in the city of São Paulo. Results Of the 287 records assessed, 42.5% of reactions were observed in adolescents (between 12 and 18 years), and 83.6% occurred in the first transfusion. Most common clinical manifestations were skin lesions and hyperthermia. About 50% of reactions occurred in patients with leukemia or anemia and the associated blood component was red blood cell concentrate. Most common incidents were nonhemolytic febrile reaction and mostly mild and moderate allergic reactions. Other reactions were 9.8% moderate/severe. Conclusion The study favored greater knowledge about transfusion incidents in children and adolescents and brings contributions to enhance patient safety and pediatric hemotherapy services.

Temporal Trend and Risk Factors for Respiratory Distress Syndrome-Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country.

OBJECTIVE: This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths. STUDY DESIGN: This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI. RESULTS: A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: -6.50%; 95% CI: -9.11 to -3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09-1.29), zero to three prenatal care visits (1.25; 1.18-1.32), multiple pregnancy (1.24; 1.16-1.33), vaginal delivery (1.29; 1.22-1.36), GA 22 to 27 weeks (106.35; 98.36-114.98), GA 28 to 31 weeks (20.12; 18.62-21.73), male sex (1.16; 1.10-1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08-7.47) and 4 to 6 (3.97; 3.72-4.23). CONCLUSION: During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants. KEY POINTS: · RDS is associated with preterm live births.. · Impact of RDS-associated neonatal mortality in middle-income countries is scarce.. · Qualified perinatal care can reduce RDS-associated neonatal mortality..

Clusters of preterm live births and respiratory distress syndrome-associated neonatal deaths: spatial distribution and cooccurrence patterns.

BACKGROUND: Prematurity and respiratory distress syndrome (RDS) are strongly associated. RDS continues to be an important contributor to neonatal mortality in low- and middle-income countries. This study aimed to identify clusters of preterm live births and RDS-associated neonatal deaths, and their cooccurrence pattern in São Paulo State, Brazil, between 2004 and 2015.  METHODS: Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥ 400 g, without congenital anomalies from mothers living in São Paulo State, Brazil, during 2004-2015. RDS-associated neonatal mortality was defined as deaths < 28 days with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality and preterm live births rates per municipality were submitted to first- and second-order spatial analysis before and after smoothing using local Bayes estimates. Spearman test was applied to identify the correlation pattern between both rates. RESULTS: Six hundred forty-five thousand two hundred seventy-six preterm live births and 11,078 RDS-associated neonatal deaths in São Paulo State, Brazil, during the study period were analyzed. After smoothing, a non-random spatial distribution of preterm live births rate (I = 0.78; p = 0.001) and RDS-associated neonatal mortality rate (I = 0.73; p = 0.001) was identified. LISA maps confirmed clusters for both, with a negative correlation (r = -0.24; p = 0.0000). Clusters of high RDS-associated neonatal mortality rates overlapping with clusters of low preterm live births rates were detected. CONCLUSIONS: Asymmetric cluster distribution of preterm live births and RDS-associated neonatal deaths may be helpful to indicate areas for perinatal healthcare improvement.

Clusters of cause specific neonatal mortality and its association with per capita gross domestic product: A structured spatial analytical approach.

BACKGROUND: Infant mortality rate is a measure of population health and neonatal mortality account for great proportion of these deaths. Underdevelopment might be associated to higher neonatal mortality risk due to assistant related factors. Spatial and temporal distribution of mortality help identifying and developing strategies for interventions. OBJECTIVE: To investigate the cluster areas of asphyxia-associated neonatal mortality and to explore its association with per capita gross domestic product (GDP) in São Paulo State (SP), Brazil. METHODS: Ecological study including live births residents in SP from 2004-2013. Neonatal deaths (0-27 days) with perinatal asphyxia were defined as intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome written in any line of the Death Certificate. Geoprocessing analytical approach included detection of first order effects through quintiles and spatial moving average maps, followed by second order effects by global and local spatial autocorrelation (Moran and LISA, respectively) before and after smoothing with local Bayesian estimates. Finally, Spearman correlation was applied between asphyxia-associated neonatal mortality and mean per capita GDP rates for the municipalities with significant LISA. RESULTS: There were 6,713 asphyxia-associated neonatal deaths among 5,949,267 live births (rate: 1.13/1000) in SP. Spatial moving average maps showed a non-random distribution among municipalities, with presence of clusters (I = 0.048; p = 0.023). LISA map identified clusters of asphyxia-associated neonatal mortality in the south, southeast and northwest. After applying local Bayes estimates, clusters were more pronounced (I = 0.589; p = 0.001). There was a partial overlap of the areas of higher asphyxia-associated neonatal mortality and lower mean per capita GDP. CONCLUSIONS: Spatial analysis identified cluster areas of high asphyxia-associated neonatal mortality and low per capita GDP rates, with a significant negative correlation. This optimized, structured, and hierarchical approach to identify high-risk areas of cause-specific neonatal mortality may be helpful for guiding public health efforts to decrease neonatal mortality.

Personality Impairment in Children and Adolescents with ADHD / Comprometimento da Personalidade em Crianças e Adolescentes com TDAH / Deterioro de la Personalidad en Niños y Adolescentes con TDAH

Abstract Attention deficit hyperactivity disorder in children and adolescents manifests itself in a heterogeneous manner as regards personality aspects. This study aimed to evaluate, by using the Ego Impairment Index, the personality functioning characteristics of children and adolescents between 9 and 15 years old (to be completed), diagnosed with the disorder (clinical group) and compare them with a non-clinical group. The groups included 42 participants each. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version was used for diagnosis, and the Rorschach Performance Assessment System (R-PAS) was utilized for personality traits. When compared to their peers, the participants in the clinical group showed ability to discern adaptive behaviors through proper judgment, difficulty in keeping thinking and reasoning processes stable, a negative view of themselves and others, in addition to difficulty in establishing cooperative relationships.

Resumo O transtorno da falta de atenção com hiperatividade em crianças e adolescentes manifesta-se de forma heterogênea com relação aos aspectos de personalidade. O presente estudo teve por objetivo avaliar, por meio do Índice de Enfraquecimento do Ego, características do funcionamento da personalidade de crianças e adolescentes, entre 9 e 15 anos incompletos, com o diagnóstico do transtorno (grupo clínico) e compará-las com um grupo não-clínico. Os grupos contemplaram 42 participantes cada. Utilizou-se para o diagnóstico a entrevista Kiddie-Sads Referente ao Momento Presente e ao Longo da Vida, e o Sistema de Avaliação por Performance no Rorschach (R-PAS) para as características de personalidade. Os participantes do grupo clínico, quando comparados com seus pares, mostraram capacidade de discernir comportamentos adaptativos por meio de julgamento adequado, dificuldade em manter estáveis os processos de pensamento e raciocínio, visão negativa de si próprios e dos demais, dificuldade para estabelecer relacionamentos cooperativos.

Resumen El trastorno por déficit de atención con hiperactividad es uno de los más encontrados entre las patologías infantiles y se manifiesta de forma no homogénea con relación a los aspectos de personalidad. Este estudio comparó a través de lo Índice de Enflaquecimiento del Ego características de personalidad de niños y adolescentes entre 9 y 15 años incompletos con diagnóstico con un grupo de mismo sexo y edad sin diagnóstico. Cada grupo estaba compuesto por 42 participantes. Se utilizó la entrevista Kiddie-Sads sobre el momento presente y al largo de la vida para el diagnóstico y el Sistema de Evaluación por Performance en el Rorschach (R-PAS), para las características de personalidad. El grupo clínico mostró capacidad para discernir conductas adaptativas a través del juicio adecuado, dificultad para mantener estables los procesos de pensamiento y razonamiento, visión negativa de sí mismos y de los demás, dificultad para establecer relaciones de cooperación.

Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU / Fatores de risco e mortalidade dos pacientes com sepse, lesão renal aguda séptica e não séptica na UTI

Abstract Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. Aims: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. Methods: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. Results: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). Conclusions: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.

Resumo A Lesão Renal Aguda (LRA), cuja etiologia mais frequente é sepse, tem incidência de 5-6% na Unidade de Terapia Intensiva (UTI). Objetivo: Avaliar pacientes que permaneceram mais de 48 horas na UTI e desenvolveram LRA ou Doença Renal Crônica agudizada (DRCag) e/ou sepse; identificar fatores associados e causas que possam afetar a evolução desses pacientes. Método: Estudo prospectivo, observacional, coorte e quantitativo dos pacientes em UTI entre maio a dezembro de 2013 com sepse e LRA. Excluídos pacientes < 48 horas e/ou dialíticos prévios. Resultados: Dos 1156 pacientes admitidos, 302 foram incluídos e divididos em grupos: sem sepse e sem LRA (SSSLRA), apenas sepse (S), LRA séptica (LRAs), LRA não séptica (LRAns), DRCag séptica (DRCags), DRCag não séptica (DRCagns). Foi verificado que 94% apresentaram algum grau de lesão renal; Kidney Disease Improving Global Outcomes (KDIGO) 3 foi predominante nos grupos sépticos (p = 0.018); o nefrologista foi chamado apenas em 23% dos pacientes não sépticos vs. 54% dos sépticos (p < 0.001); houve necessidade de diálise em 8% dos não sépticos vs. 37% dos sépticos (p < 0.001); necessidade de Ventilação Mecânica (VM) em 61% da LRAns versus 90% na LRAs (p < 0.001). A mortalidade foi 38% e 39% na LRAs e DRCags vs. 16% e 0% na LRAns e DRCagns, respectivamente (p < 0.001). Conclusão: LRAs e DRCags têm pior prognóstico que a não séptica. O nefrologista ainda não é solicitado em grande parte dos casos com influência direta na mortalidade (p < 0.001), o débito urinário é consideravelmente prejudicado; o tempo de permanência na UTI, necessidade de VM e mortalidade são maiores quando há associação da sepse e LRA.

Sexual risky behavior, cocaine and alcohol use among substance users in an outpatient facility: a cross section study.

BACKGROUND: Substance dependence is considered an international health issue and studies that access the characteristic of this population are required to develop public health programs for harm reduction. To this aim, we purpose to to identify, in a population undergo addiction treatment, if the use of substances leads to sexual risky behavior and also check if another variables influences in this behavior. METHOD: Observational study of clinical sample collected of adult patients seeking treatment to dependence of alcohol and cocaine. The data collected were: socio-demographic, substance use, sexual behavior and childhood abuse. Risky sexual behaviors were considered: inconsistent use of condoms and presence of multiple sexual partners in the past six months. An exploratory analysis of the association between the variable "risky sexual behavior" and the other variables was performed using Pearson's chi-square, followed by a multivariate logistic regression analysis. RESULTS: After analyzing the variables with the presence or absence of risky sexual behavior, were included in the logistic regression the data that presented association with sexual risk behavior, and age appears as an independent factor for risky sexual behaviors. Other factors, such as schooling and unemployment, influence as much as the use of substances in risky sexual behaviors. CONCLUSION: Attributing just to the substance use this risky sexual behavior seems too simplistic. Other structural factors such as schooling, work, age and sexual abuse in childhood can influence decision making for safe sex.

Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU.

OBJECTIVE: Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. AIMS: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. METHODS: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. RESULTS: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). CONCLUSIONS: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.

[Primary Health Care-Sensitive Hospitalizations in children under one year of age, from 2008 to 2014, in the State of São Paulo, Brazil]. / Internações por Condições Sensíveis à Atenção Primária de Menores de um ano, de 2008 a 2014, no estado de São Paulo, Brasil.

The scope of this article is to describe the trends of primary health care-sensitive (PHC) hospitalizations in children under one year of age between 2008 and 2014 in the State of São Paulo, Brazil. It is an ecological study with descriptive and analytical characteristics, based on secondary data from the national health information system. Hospitalizations were classified according to the Brazilian list of PHC hospitalizations considering the Early Neonatal, Late Neonatal and Post-Neonatal age groups. Linear regression models were adjusted for trend analysis of the 851,713 hospitalizations of children under one year of age analyzed, of which 22.6% were PHC-related. The main groups with decreases were: Bacterial pneumonia (-7.10%) and Nutritional disorders (-7.70%) in the Early neonatal phase. The main increases were: Disease related to prenatal/childbirth (+10.14%) and Immunosuppressive diseases and avoidable conditions in Post-neonatal (+14.13%) infants, among which pertussis and congenital syphilis were the main causes of hospitalization. The results showed a deficiency in the primary health care system for infants in the State of Sao Paulo. The estimated trends should be used for planning cost-effective strategies to prevent and control causes of hospitalization in children under one year of age.

Este estudo teve o objetivo de descrever as causas e as tendências de Internações por Condições Sensíveis à Atenção Primária (ICSAP) em menores de um ano, entre 2008 e 2014, no estado de São Paulo, Brasil. Trata-se de um delineamento ecológico, baseado em dados secundários do Sistema de Informações Hospitalares. Classificaram-se as internações segundo o diagnóstico principal e a Lista Brasileira de ICSAP, considerando as seguintes faixas etárias: Neonatais precoce, Neonatal tardia e Pós-neonatal. Para a análise de tendência das internações foram ajustados modelos de regressão linear. Ocorreram 851.713 internações de Menores de um ano, sendo 22,6% por ICSAP. As principais reduções das frequências de internação foram: Pneumonias bacterianas (-7,10%) e Desvios nutricionais (-7,70) em Neonatal precoce. As elevações foram: Doenças relacionadas ao pré-natal e parto (+10,14%) e Doenças imunizáveis e condições evitáveis em Pós-neonatal (+14,13%), com destaque para coqueluche e sífilis congênita. Os resultados mostram uma deficiência no cuidado à saúde infantil na atenção primária no estado de São Paulo, enquanto que as tendências de internações estimadas podem auxiliar no planejamento de estratégias para diminuir os agravos e os gastos no setor terciário de atenção em saúde.

Internações por Condições Sensíveis à Atenção Primária de Menores de um ano, de 2008 a 2014, no estado de São Paulo, Brasil / Primary Health Care-Sensitive Hospitalizations in children under one year of age, from 2008 to 2014, in the State of São Paulo, Brazil

Resumo Este estudo teve o objetivo de descrever as causas e as tendências de Internações por Condições Sensíveis à Atenção Primária (ICSAP) em menores de um ano, entre 2008 e 2014, no estado de São Paulo, Brasil. Trata-se de um delineamento ecológico, baseado em dados secundários do Sistema de Informações Hospitalares. Classificaram-se as internações segundo o diagnóstico principal e a Lista Brasileira de ICSAP, considerando as seguintes faixas etárias: Neonatais precoce, Neonatal tardia e Pós-neonatal. Para a análise de tendência das internações foram ajustados modelos de regressão linear. Ocorreram 851.713 internações de Menores de um ano, sendo 22,6% por ICSAP. As principais reduções das frequências de internação foram: Pneumonias bacterianas (-7,10%) e Desvios nutricionais (-7,70) em Neonatal precoce. As elevações foram: Doenças relacionadas ao pré-natal e parto (+10,14%) e Doenças imunizáveis e condições evitáveis em Pós-neonatal (+14,13%), com destaque para coqueluche e sífilis congênita. Os resultados mostram uma deficiência no cuidado à saúde infantil na atenção primária no estado de São Paulo, enquanto que as tendências de internações estimadas podem auxiliar no planejamento de estratégias para diminuir os agravos e os gastos no setor terciário de atenção em saúde.

Abstract The scope of this article is to describe the trends of primary health care-sensitive (PHC) hospitalizations in children under one year of age between 2008 and 2014 in the State of São Paulo, Brazil. It is an ecological study with descriptive and analytical characteristics, based on secondary data from the national health information system. Hospitalizations were classified according to the Brazilian list of PHC hospitalizations considering the Early Neonatal, Late Neonatal and Post-Neonatal age groups. Linear regression models were adjusted for trend analysis of the 851,713 hospitalizations of children under one year of age analyzed, of which 22.6% were PHC-related. The main groups with decreases were: Bacterial pneumonia (-7.10%) and Nutritional disorders (-7.70%) in the Early neonatal phase. The main increases were: Disease related to prenatal/childbirth (+10.14%) and Immunosuppressive diseases and avoidable conditions in Post-neonatal (+14.13%) infants, among which pertussis and congenital syphilis were the main causes of hospitalization. The results showed a deficiency in the primary health care system for infants in the State of Sao Paulo. The estimated trends should be used for planning cost-effective strategies to prevent and control causes of hospitalization in children under one year of age.

Evaluation of usability of a neonatal health information system according to the user's perception / Avaliação da usabilidade de um sistema de informação em saúde neonatal segundo a percepção do usuário

ABSTRACT Objective: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. Methods: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. Results: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.

RESUMO Objetivo: Mensurar o grau de satisfação de profissionais de saúde quanto à usabilidade de um sistema de informação em saúde neonatal e identificar os fatores que podem influenciar na satisfação do usuário frente à usabilidade. Métodos: Estudo transversal e exploratório realizado com 50 profissionais de saúde integrantes dos centros da Rede Brasileira de Pesquisas Neonatais. Para avaliação da usabilidade foi utilizado o instrumento System Usability Scale entre fevereiro e março de 2017. Realizou-se a análise estatística descritiva e inferencial das variáveis coletadas, com a finalidade de descrever a amostra, quantificar o grau de satisfação dos usuários e identificar as variáveis associadas ao grau de satisfação do usuário em relação à usabilidade. Resultados: Da população avaliada, 75% era do sexo feminino, com idade média 52,8 anos, 58% com pós-graduação (doutorado); tempo médio da última formação de 17 anos; área de atuação em medicina (neonatologia), grau intermediário de conhecimento em informática e tempo de utilização média do sistema de 52 meses. Quanto à usabilidade, 94% avaliaram o sistema como "bom", "excelente" ou "melhor impossível". A usabilidade do sistema não foi associada a idade, sexo, escolaridade, profissão, área de atuação, nível de conhecimento em informática e tempo de uso do sistema. Conclusões: O grau de satisfação do usuário do sistema informatizado de saúde foi considerado bom. Não foram identificados fatores demográficos que influenciassem sua avaliação.

EVALUATION OF USABILITY OF A NEONATAL HEALTH INFORMATION SYSTEM ACCORDING TO THE USER'S PERCEPTION.

OBJECTIVE: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. METHODS: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. RESULTS: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. CONCLUSION: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.

Hemovigilance: the experience of transfusion reaction reporting in a Teaching Hospital. / Hemovigilância: a experiência da notificação de reações transfusionais em Hospital Universitário.

OBJECTIVE: To describe the occurrence of immediate transfusion reactions received by the Risk Management Department of Hospital São Paulo. METHOD: Cross-sectional and retrospective study which analyzed the notification sheets of transfusion reactions that occurred between May 2002 and December 2016 and were included in the Hemovigilance National System. RESULTS: One thousand five hundred and forty-eight transfusion reaction notification sheets were analyzed, all of which concerned immediate reactions associated with packed red blood cells (72.5%). The most frequently reported reaction was febrile non-hemolytic transfusion reaction, and among severe and moderate cases, allergic reaction was the most common. The most frequently reported signs and symptoms were hyperthermia, sudoresis, chills, and skin lesions. No differences were observed regarding gender and age, and 90.7% of reactions occurred in patients with Rh+ factor. CONCLUSION: This study allowed for a better assessment and understanding of transfusion reactions, which will help to improve the quality of blood circulation and provide greater safety of patients undergoing transfusion therapy.

Factorial and construct validity of Portuguese version (Brazil) Bergen Facebook Addiction Scale / Validade fatorial e de construto da versão em português (Brasil) da Bergen Facebook Addiction Scale

ABSTRACT Objective To evaluate factorial and construct validity of the Brazilian Portuguese version of the Bergen Facebook Addiction Scale (BFAS-BR). Methods A sociodemographic questionnaire, the Brazilian Portuguese versions of Online Cognition Scale (OCS-BR) and of BFAS-BR were applied to a sample of Health Undergraduate (n = 356). Construct validity evidences were verified through the Confirmatory Factor Analysis. Discriminant validity was examined by correlational analysis between the version of the BFAS-BR and OCS-BR. Results Proposed factorial model of BFAS did not present a good quality adjustment. So, a model restructuring was necessary from behavioral addiction theoretical views and new model presented satisfactory adjustment quality and construct validity evidence. Correlation between both tested scales was strong (ρ = 0.707) and, therefore, they measure the same construct. Conclusion The BFAS-BR show adequate factorial and construct validity.

RESUMO Objetivo Avaliar a validade fatorial e de construto da versão em português brasileiro da Bergen Facebook Addiction Scale (BFAS-BR). Métodos Um questionário sociodemográfico e as versões em português brasileiro da Online Cognition Scale (OCS-BR) e da BFAS-BR foram aplicados em uma amostra de universitários de cursos de Saúde (n = 356). As evidências da validade de construto foram verificadas por meio da Análise Fatorial Confirmatória. A validade discriminante foi examinada pela análise correlacional das BFAS-BR e OCS-BR. Resultados O modelo fatorial proposto da BFAS não apresentou bom ajuste. Então, um modelo reestruturado foi necessário a partir das concepções teóricas das adições de comportamento. O novo modelo apresentou qualidade de ajustamento satisfatório e evidências de validade de construto. A correlação entre as versões em português de ambas as escalas testadas foi forte (ρ = 0,707). Conclusões A versão em português da Bergen Facebook Addiction Scale apresentou adequada validade de construto.

Hemovigilância: a experiência da notificação de reações transfusionais em Hospital Universitário / Hemovigilancia: la experiencia de la notificación de reacciones transfusionales en Hospital Universitario / Hemovigilance: the experience of transfusion reaction reporting in a Teaching Hospital

RESUMO Objetivo Descrever a ocorrência das reações transfusionais imediatas recebidas na Gerência de Risco do Hospital São Paulo. Método Estudo transversal retrospectivo, com análises das fichas de notificação de reações transfusionais, no período de maio de 2002 a dezembro de 2016, que foram inseridas no Sistema Nacional de Hemovigilância. Resultados Foram analisadas 1.548 fichas de Reação Transfusional, em sua totalidade reações imediatas, associadas ao Concentrado de Hemácias (72,5%). A mais comum foi a Reação Febril Não Hemolítica Leve, e, entre as graves e moderadas, a Reação Alérgica. Os sinais e sintomas mais notificados foram a hipertermia, a sudorese, os calafrios e as lesões em derme. Não foram observadas diferenças entre sexo e idade, 90,7% das reações ocorreram em pacientes com Fator Rh+. Conclusão O estudo permitiu uma melhor avaliação e compreensão das reações transfusionais, o que viabilizará a qualidade no ciclo do sangue e uma maior segurança dos pacientes submetidos à terapia transfusional.

RESUMEN Objetivo Describir la ocurrencia de las reacciones transfusionales inmediatas recibidas en la Gestión de Riesgo del Hospital São Paulo. Método Estudio transversal retrospectivo, con análisis de las fichas de notificación de reacciones transfusionales, en el período de mayo de 2002 a diciembre de 2016, que fueron introducidas en el Sistema Nacional de Hemovigilancia. Resultados Fueron analizadas 1.548 fichas de Reacción Transfusional, en su totalidad reacciones inmediatas, asociadas con el Concentrado de Hematíes (72,5%). La más común fue la Reacción Febril No Hemolítica Ligera y, entre las severas y moderadas, la Reacción Alérgica. Las señales y los síntomas más notificados fueron la hipertermia, la transpiración, los escalofríos y las lesiones en la dermis. No se observaron diferencias entre sexo y edad, el 90,7% de las reacciones ocurrieron en pacientes con Factor RH+. Conclusión El estudio permitió una mejor evaluación y comprensión de las reacciones transfusionales, lo que hará factible la calidad en el ciclo de la sangre y una mayor seguridad de los pacientes sometidos a la terapia transfusional.

ABSTRACT Objective To describe the occurrence of immediate transfusion reactions received by the Risk Management Department of Hospital São Paulo. Method Cross-sectional and retrospective study which analyzed the notification sheets of transfusion reactions that occurred between May 2002 and December 2016 and were included in the Hemovigilance National System. Results One thousand five hundred and forty-eight transfusion reaction notification sheets were analyzed, all of which concerned immediate reactions associated with packed red blood cells (72.5%). The most frequently reported reaction was febrile non-hemolytic transfusion reaction, and among severe and moderate cases, allergic reaction was the most common. The most frequently reported signs and symptoms were hyperthermia, sudoresis, chills, and skin lesions. No differences were observed regarding gender and age, and 90.7% of reactions occurred in patients with Rh+ factor. Conclusion This study allowed for a better assessment and understanding of transfusion reactions, which will help to improve the quality of blood circulation and provide greater safety of patients undergoing transfusion therapy.