Performance of severity indices for admission and mortality of trauma patients in the intensive care unit: a retrospective cohort study.

BACKGROUND: Little is known about the performance of severity indices for indicating intensive care and predicting mortality in the Intensive Care Unit (ICU) of trauma patients. This study aimed to compare the performance of severity indices to predict trauma patients' ICU admission and mortality. METHODS: A retrospective cohort study which analyzed the electronic medical records of trauma patients aged ≥ 18 years, treated at a hospital in Brazil, between 2014 and 2017. Physiological [Revised Trauma Score (RTS), New Trauma Score (NTS) and modified Rapid Emergency Medicine Score (mREMS)], anatomical [Injury Severity Score (ISS) and New Injury Severity Score (NISS)] and mixed indices [Trauma and Injury Severity Score (TRISS), New Trauma and Injury Severity Score (NTRISS), Base-deficit Injury Severity Score (BISS) and Base-deficit and New Injury Severity Score (BNISS)] were compared in analyzing the outcomes (ICU admission and mortality) using the Area Under the Receiver Operating Characteristics Curves (AUC-ROC). RESULTS: From the 747 trauma patients analyzed (52.5% female; mean age 51.5 years; 36.1% falls), 106 (14.2%) were admitted to the ICU and 6 (0.8%) died in the unit. The ISS (AUC 0.919) and NISS (AUC 0.916) had better predictive capacity for ICU admission of trauma patients. The NISS (AUC 0.949), TRISS (AUC 0.909), NTRISS (AUC 0.967), BISS (AUC 0.902) and BNISS (AUC 0.976) showed excellent performance in predicting ICU mortality. CONCLUSIONS: Anatomical indices showed excellent predictive ability for admission of trauma patients to the ICU. The NISS and the mixed indices had the best performances regarding mortality in the ICU.

Autoestima de trabalhadores terceirizados do setor de conservação de higiene e limpeza de hospitais privados / Self-esteem of outsourced workers in the hygiene conservation and cleaning of private hospitals / Autoestima de trabajadores subcontratados en el sector de higiene y limpieza de hospitales privados

Objetivo: analisar aspectos positivos e negativos relacionados à autoestima de trabalhadores terceirizados de serviços de higiene e limpeza hospitalar. Método: estudo exploratório, de abordagem qualitativa, realizado em duas instituições hospitalares privadas. Os participantes foram trabalhadores terceirizados dos serviços de higiene e limpeza. Para a coleta de dados, utilizou-se um questionáriosociodemográfico e um roteiro de entrevista semiestruturada. Realizada análise temática indutiva. Resultados: a amostra constitui-se de 15 trabalhadores, do sexo feminino, que expressaram aspectos positivos e negativos que afetam sua autoestima, que estão relacionados à organização e ambiente de trabalho, às relações interpessoais e benefícios trabalhistas. Conclusão: aspectos positivos e negativos estão presentes entre esses trabalhadores e os gestores hospitalares devem refletir sobre o serviço de higiene e limpeza, estabelecendo estratégias educativas e coletivas para os trabalhadores relacionadas às práticas de trabalho realizadas neste contexto(AU)

Objective: to analyze positive and negative aspects related to the self-esteem of outsourced workers in hospital hygiene and cleaning services. Method: exploratory study, with a qualitative approach, carried out in two private hospital institutions. Participants were outsourced workers from hygiene and cleaning services. For data collection, a sociodemographic questionnaire and a semi-structured interview script were used. Inductive thematic analysis was performed. Results: the sample consisted of 15 female workers, who expressed positive and negative aspects that affect their self-esteem, which are related to the organization and work environment, interpersonal relationships and work benefits. Conclusion: positive and negative aspects are present among these workers and hospital managers should reflect on the hygiene and cleaning service, establishing educational and collective strategies for workers related to work practices carried out in this context(AU)

Objetivo: analizar aspectos positivos y negativos relacionados con la autoestima de trabajadores subcontratados en los servicios de higiene y limpieza hospitalaria. Método: estudio exploratorio, con enfoque cualitativo, realizado en dos hospitales privadas. Los participantes eran trabajadores subcontratados de los servicios de higiene y limpieza. Para la recolección de datos, se utilizó un cuestionario sociodemográfico y un guion de entrevista semiestructurada. Se realizó un análisis temático inductivo. Resultados: la muestra estuvo conformada por 15 trabajadoras, quienes expresaron aspectos positivos y negativos que inciden en su autoestima, los cuales están relacionados con la organización y clima laboral, las relaciones interpersonales y las prestaciones laborales. Conclusión: los aspectos positivos y negativos están presentes entre estos trabajadores y los administradores de hospitales deben reflexionar sobre el servicio de higiene y limpieza, estableciendo estrategias educativas y colectivas para los trabajadores, relacionadas con las prácticas de trabajo realizadas en este contexto(AU)

Covid-19: processo de trabalho da equipe de enfermagem em Unidade de Terapia Intensiva / Covid-19: work process of the nursing team in an Intensive Care Unit

O objetivo deste estudo foi compreender o processo de trabalho da equipe de enfermagem atuante em Unidade de Terapia Intensiva para atendimento de pacientes com covid-19. Tratou-se de uma pesquisa descritiva, de abordagem qualitativa. A coleta de dados ocorreu por meio de entrevista semiestruturada e audiogravada, e a interpretação foi realizada a partir da análise temática indutiva. Participaram 28 profissionais de enfermagem, sendo oito enfermeiros gerentes, sete enfermeiros assistenciais e 13 técnicos de enfermagem, todos atuantes na Unidade de Terapia Intensiva de um hospital público no interior de Minas Gerais. O processo de trabalho esteve relacionado à sobrecarga, pressões, sofrimento e impacto dos óbitos. Foram relatadas, positivamente, oportunidades de aprendizado técnico-científico e de inserção no mercado de trabalho. A vacinação proporcionou maior segurança, e os profissionais também refletiram sobre a vida e o seu real valor. Logo, conceder o reconhecimento a esses profissionais diante do trabalho vivenciado e desempenhado denota compromisso social e valorização para com aqueles que fizeram a diferença em uma das maiores pandemias da história

The objective of this study was to understand the work process of the nursing team working in Intensive Care Unit for the care of patients with COVID-19. It was a descriptive research, with a qualitative approach. Data collection took place with semi-structured and audio-recorded interviews, and interpretation was performed based on inductive thematic analysis. A total of 28 nursing professionals participated, with eight manager nurses, seven assistant nurses, and 13 nursing technicians, all working in the Intensive Care Unit sector of a public hospital in the interior of Minas Gerais. The work process was related to overload, pressure, suffering, and the impact of deaths. Opportunities for technical-scientific learning and insertion in the job market were positively reported. Vaccination provided more safely, and professionals also reflect on life and its real value. Therefore, granting recognition to these professionals in view of the work experienced and performed denotes social commitment and appreciation for those who made a difference in one of the greatest pandemics in history

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones, and Beyond.

INTRODUCTION: Body packing consists of the concealment of substances (drugs and non-narcotics) or products inside the human body with the purpose of smuggling and may represent an emergency due to the fatal risk of narcotic toxicity, intestinal obstruction, and visceral perforation. However, non-narcotic body packing, especially in developing countries, is under-evaluated. Thus, the objective of this study was to evaluate cases of body packers in Brazil as regards narcotic and non-narcotic contents. METHODS: This retrospective study analyzes the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil. RESULTS: Ten cases of body packing were observed. We found that five patients carried drugs, while seven carried non-narcotic substances such as cell phones and accessories. All the patients were male, prisoners, and young adults. In six patients, there was gastrointestinal obstruction, and in three, there was acute narcotic intoxication. Abdominal radiography diagnosed eight of the cases. In nine of the cases, emergency laparotomy was required, but all patients successfully recovered. CONCLUSION: There was a higher prevalence of body packing of non-narcotic content; however, diagnostic and surgical approaches were similar to those of narcotic content. Clinicians must be aware of both non-narcotic and narcotic body packing.

Knowledge About COVID-19 in Brazil: Cross-Sectional Web-Based Study.

BACKGROUND: COVID-19 is a highly transmissible illness caused by SARS-CoV-2. The disease has affected more than 200 countries, and the measures that have been implemented to combat its spread, as there is still no vaccine or definitive medication, have been based on supportive interventions and drug repositioning. Brazil, the largest country in South America, has had more than 140,000 recorded deaths and is one of the most affected countries. Despite the extensive quantity of scientifically recognized information, there are still conflicting discussions on how best to face the disease and the virus, especially with regard to social distancing, preventive methods, and the use of medications. OBJECTIVE: The main purpose of this study is to evaluate the Brazilian population's basic knowledge about COVID-19 to demonstrate how Brazilians are managing to identify scientifically proven information. METHODS: A cross-sectional study design was used. An original online questionnaire survey was administered from June 16 to August 21, 2020, across all five different geopolitical regions of the country (ie, the North, Northeast, Center-West, Southeast, and South). The questionnaire was comprised of questions about basic aspects of COVID-19, such as the related symptoms, conduct that should be followed when suspected of infection, risk groups, prevention, transmission, and social distancing. The wrong questionnaire response alternatives were taken from the fake news combat website of the Brazilian Ministry of Health. Participants (aged ≥18 years) were recruited through social networking platforms, including Facebook, WhatsApp, and Twitter. The mean distributions, frequencies, and similarities or dissimilarities between the responses for the different variables of the study were evaluated. The significance level for all statistical tests was less than .05. RESULTS: A total of 4180 valid responses representative of all the states and regions of Brazil were recorded. Most respondents had good knowledge about COVID-19, getting an average of 86.59% of the total score with regard to the basic aspects of the disease. The region, education level, age, sex, and social condition had a significant association (P<.001) with knowledge about the disease, which meant that women, the young, those with higher education levels, nonrecipients of social assistance, and more economically and socially developed regions had more correct answers. CONCLUSIONS: Overall, Brazilians with social media access have a good level of basic knowledge about COVID-19 but with differences depending on the analyzed subgroup. Due to the limitation of the platform used in carrying out the study, care should be taken when generalizing the study findings to populations with less education or who are not used to accessing social networking platforms.

Fatores associados ao tempo da morte de vítimas de trauma: estudo de coorte retrospectivo / Factores asociados al momento de la muerte de víctimas de traumatismos: estudio de cohorte retrospectivo / Factors associated to the time of death of trauma victims: A retrospective cohort study

Objetivo: identificar os fatores associados ao tempo da morte de vítimas de trauma. Método: coorte retrospectiva que analisou laudos de autópsia de vítimas de trauma admitidas em 2015 no Instituto Médico Legal Central de São Paulo, Brasil. O tempo da morte foi identificado a partir do momento da ocorrência do trauma até a confirmação do óbito. O modelo linear generalizado foi aplicado para análise dos dados. Resultados: entre as 1.500 vítimas fatais (75,7% homens; idade média 49,7 anos), prevaleceram as quedas (33,5%), seguidas das agressões (27,8%). Os fatores associados ao tempo da morte foram número de regiões corporais afetadas (p<0,001), tipo de trauma (p<0,001), sexo (p=0,009), gravidade do trauma segundo New Injury Severity Score (p<0,001), agressões (p<0,001) e lesões autoprovocadas intencionalmente (p<0,001). Conclusão: mulheres, vítimas de traumas que envolveram intencionalidade de provocar a morte e com elevada gravidade apresentaram tempo de sobrevida reduzido após a(s) lesão(ões).

Objective: to identify factors associated to the time of death of trauma victims. Method: a retrospective cohort that analyzed autopsy reports of trauma victims admitted in 2015 at the Central Institute of Forensic Medicine of São Paulo, Brazil. The time of death was identified from the trauma moment to the confirmation of death. The generalized linear model was applied to analyze the data. Results: among the 1,500 fatal victims (75.7% were men; mean age of 49.7 years old), falls prevailed (33.5%), followed by aggressions (27.8%). The factors associated with the time of death were the number of body areas affected (p<0.001), type of trauma (p<0.001), gender (p=0.009), trauma severity according to the New Injury Severity Score (p<0.001), assaults (p>0.001), and intentionally self-harm injuries (p<0.001). Conclusion: women, victims of traumas with the intention of causing death and with high severity presented a reduced survival time after the injury(ies).

Objetivo: identificar los factores asociados al momento de la muerte de víctimas de traumatismos. Método: estudio de cohorte retrospectivo que analizó informes de autopsias de víctimas de traumatismos admitidas en 2015 en el Instituto Médico Legal Central de San Pablo, Brasil. El momento de la muerte se identificó a partir del momento en que sucedió el traumatismo hasta la confirmación de la muerte. Se aplicó el modelo lineal generalizado para el análisis de los datos. Resultados: entre las 1.500 víctimas fatales (75,7% de ellas hombres; media de edad de 49,7 años), prevalecieron las caídas (33,5%), seguidas por las agresiones (27,8%). Los factores asociados al momento de la muerte fueron la cantidad de áreas del cuerpo afectadas (p<0,001), el tipo de traumatismo (p<0,001), el sexo (p=0,009), la gravedad del traumatismo conforme al New Injury Severity Score (p<0,001), agresiones (p<0,001) y lesiones autoprovocadas intencionalmente (p<0,001). Conclusión: las mujeres, víctimas de traumatismos con intención de provocar la muerte y de alta gravedad presentaron un tiempo de sobrevida reducido después de la o las lesiones.

Public perception of COVID-19 in the Triângulo Mineiro region, Minas Gerais state, Brazil: a cross-sectional survey

This was a cross-sectional, anonymous, online survey aimed at assessing the perceptions and basic knowledge of COVID-19, a highly transmissible disease caused by SARS-CoV-2, in a sample population in the Triângulo Mineiro region, Minas Gerais, Brazil. A questionnaire devised by the researchers and distributed through social media was applied between June 16, 2020 and August 21, 2020. The survey consisted of questions about the basic aspects of COVID-19, which included symptoms, risk groups, suspicion of infection, prevention, transmission, and perception regarding social isolation. The average distribution, frequencies, similarities and differences between the responses for the different variables were evaluated. Five hundred twenty valid responses were obtained from participants aged ≥18 years. Most of the respondents showed satisfactory basic knowledge of COVID-19. Moreover, the data showed that the participants scored an average of 87.6%. Sex, age, and socioeconomic vulnerability presented a statistically significant link with knowledge of the disease; women, young participants, and the least socioeconomically vulnerable had the highest scores. This study indicated that the population in the Triângulo Mineiro region able to access social networking platforms were basically well informed regarding COVID-19, although differences were observed depending on the group analyzed.