Fatores sociodemográficos e clínicos associados ao tempo de decisão para a procura de atendimento no infarto agudo do miocárdio

OBJETIVO: analizar la interacción del género en la asociación entre el tiempo de decisión para la búsqueda de servicio de salud y las variables sociodemográficas y clínicas. MÉTODO: estudio exploratorio, transversal, con 100 individuos entrevistados en hospitales de Salvador-BA. En el análisis se empleó el test Chi-cuadrado o Exacto de Fisher y el modelo de regresión linear robusto. La significancia estadística adoptada fue de 5%. RESULTADOS: hombres y mujeres presentaron tiempos de decisión elevados. Hubo menor tiempo de decisión para tabaquistas, con dolor constante y de fuerte intensidad. Hubo interacción entre género y tabaquismo y entre género y dolor irradiado para el cuello o mandíbula para el desenlace del tiempo de decisión. CONCLUSIÓN: los tiempos de decisión fueron elevados y sufrieron influencia de variables clínicas y de género. El estudio ofrece subsidios para prácticas de cuidar en enfermería enfocadas en la especificidad de esos factores y de los géneros objetivando obtener éxito en la reducción del tiempo de decisión.OBJETIVO: analisar a interação do sexo na associação entre o tempo de decisão para a procura de serviço de saúde e as variáveis sociodemográficas e clínicas. MÉTODO: estudo exploratório, transversal, com 100 indivíduos entrevistados em hospitais de Salvador, BA. Na análise, empregou-se o teste qui-quadrado ou exato de Fisher e o modelo de regressão linear robusto. A significância estatística adotada foi de 5%. RESULTADOS: Resultados: homens e mulheres apresentaram tempos de decisão elevados. Houve menor tempo de decisão para tabagistas, com dor constante e de forte intensidade. Houve interação entre sexo e tabagismo e entre sexo e dor irradiada para o pescoço ou a mandíbula para o desfecho tempo de decisão. CONCLUSÃO: os tempos de decisão foram elevados e sofreram influência de variáveis clínicas e do sexo. O estudo oferece subsídios para práticas de cuidar em enfermagem, focalizadas na especificidade desses fatores e dos gêneros, visando-se obter êxito na redução do tempo de decisão.OBJECTIVE: this study aimed to analyze the interaction of gender in the association between decision time for seeking healthcare services and the sociodemographic and clinical variables. METHOD: this exploratory, cross-sectional study was performed with 100 individuals interviewed in hospitals in Salvador, Bahia. The chi-square test or Fisher's exact test and the robust linear regression model were used in the analysis. A statistical significance of 5% was adopted. RESULTS: men and women presented long decision times. The decision time was less for smokers and those with constant and/or severe pain. There was an interaction between gender and smoking and between gender and pain radiating to the neck or jaw for the decision time outcome. CONCLUSION: decision times were long and were influenced by clinical and gender variables. The study provides support for nursing care practices focused on the specificity of these factors and of the genders aiming to reduce the decision time

Factors associated with the decision to seek health care in myocardial infarction: gender differences

Analizar, entre géneros, la influencia de variables cognitivas y emocionales en Tiempo de Decisión (TD) para búsqueda de atención ante infarto de miocardio. Cien adultos fueron entrevistados en dos hospitales de Salvador-BA. Para análisis, se emplearon promedios porcentuales, test Chi-cuadrado y modelo de regresión lineal robusto. Predominaron hombres, edad promedio 58,78 años y baja condición socioeconómica. La media geométrica de la muestra fue 1,1h, para hombres 0,9h, para mujeres 1,4h. Se constató menor TD para quien consideró graves los síntomas y mayor para quien esperó evolución y tomó algo para mejorar, tales asociaciones estadísticamente significativas. Existió interacción entre género y variables: esperar la mejoría sintomática (p=0,014), ocultarlo (p=0,016) y pedir ayuda (p=0,050), cuando se verificó la asociación de variables de interés y TD. Los tiempos de decisión fueron elevados, e influidos por variables cognitivas, emocionales y de género. Los cuidados de enfermería pueden promover la atención precoz.Analyze cognitive and emotional variables between genders in terms of the decision time (DT) to seek care when experiencing symptoms of myocardial infarction. One hundred adults were interviewed at two hospitals in Salvador-BA. The analysis used percentage means, the chi-square test, and a robust linear regression model. Most participants were male, with a mean age of 58.78 years and a low socioeconomic status. The geometrical mean of the sample was 1.1h (0.9h for men, and 1.4h for women). A shorter decision time was found for those who considered their symptoms to be severe, and a longer decision time for those who expected symptoms to improve and took something to feel better, with statistically significant associations. An interaction was observed between gender and the following variables: waiting for symptoms to improve (p=0.014), concealing symptoms (p=0.016) and asking for help (p=0.050), thus an association was observed between the variables of interest and DT. The decision times were long and were affected by cognitive, emotional and gender variables. Nursing care may promote early assistance.O objetivo deste estudo foi analisar, entre gêneros, a influência de variáveis cognitivas e emocionais no tempo de decisão (TD) para procura de atendimento face ao infarto do miocárdio. Cem adultos foram entrevistados em dois hospitais de Salvador-BA. Na análise empregaram-se médias percentuais, teste Q-quadrado e modelo de regressão linear robusto. Houve a predominância de homens, com idade média de 58,78 anos e baixa condição socioeconômica. A média geométrica da amostra foi 1,1h - 0,9h para homens; 1,4h para mulheres. Constatou-se menor tempo de decisão para quem considerou grave os sintomas, e maior para quem esperou melhora e tomou algo para recuperar-se, tais associações são estatisticamente significantes. Houve interação entre gênero e variáveis: esperar a melhora dos sintomas (p=0,014), ocultá-los (p=0,016) e pedir ajuda (p=0,050), quando verificou-se a associação das variáveis de interesse e TD. Os tempos de decisão foram elevados e sofreram influência de variáveis cognitivas, emocionais e de gênero. Cuidados de enfermagem podem promover o atendimento precoce

The impact of vaccination on influenza-related hospitalizations of the elderly in Brazil

Objetivo: descrever a tendência temporal das hospitalizações por causas relacionadas à influenza e avaliar o impacto da vacinação na população idosa brasileira (≥60 anos de idade), no período de 1992 a 2006. Métodos: estudo ecológico com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS); foi realizada a análise da tendência dos coeficientes de morbidade hospitalar (CMH) por meio de modelos de regressão polinomial. Resultados: constatou-se que no Brasil, o CMH por essas causas diminuiu em média 0,75/1000 idosos/ano (p60 years between 1992 and 2006. Methods: ecological and observational study using data from the Brazilian National Hospitalization Information System (SIH/SUS). Trend analysis of hospital morbidity rates was performed using polynomial regression models. Resultados: in Brazil hospital morbidity rates from these causes in the population aged >60 decreased on average by 0.75/1,000 elderly/year (p<0,0001). Hospital morbidity rates were seen to reduce between May and August following the introduction of influenza vaccination campaigns in most regions of Brazil. However, in the northern region the study showed no reduction in hospital morbidity rates. Conclusion: there is evidence that influenza vaccination has contributed to the prevention of hospitalizations for influenza-related causes in Brazil, except in the northern region

CRITERIA FOR RADIOGRAPHIC DIAGNOSIS OF PERIODONTITIS IN EPIDEMIOLOGICAL STUDIES

Objective: This study aimed to compare four radiographic methods for interpreting the periodontitis in epidemiological studies on associations with systemic conditions.Methods: A database from a case-control study evaluating the association between osteoporosis and periodontitis was used to compare four different radiographic criteria (RC) with the clinical criteria (CC) for interpreting the presence of periodontal disease (PD): RC-1, one tooth; RC-2, at least two teeth; RC-3, at least three teeth; RC-4, at least four teeth, with one or more sites on the mesial or distal face presenting bone loss ≥ 3 mm, in relation to the cement-enamel junction. PD frequency and diagnostic values were calculated, along with the main association measurements (odds ratios), for the two criteria presenting highest specificity.Results: PD frequency varied according to the RC used, from 76.6% to 95.6%. RC-4 and RC-3 presented the highest specificity (30.5% and 21.0%, respectively). The sensitivity was 100% for all criteria tested. The unadjusted and adjusted odds ratios for RC-3 and RC-4 ranged from 1.13 to 1.52, without statistical significance.Conclusions: The findings showed that PD frequency may be influenced by different RCs, as well as indicating variation in the strength of the association between osteoporosis and periodontitis.

Association between dietary patterns and renal function in a cross-sectional study using baseline data from the ELSA-Brasil cohort

Previous analyses of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) identified four main dietary patterns (DP). The aim of this study was to explore the association between the previously defined DP and renal function (RF). A crosssectional study using the ELSA-Brasil baseline data was carried out. DP (‘‘traditional’’, ‘‘fruits and vegetables’’, ‘‘bakery’’, and ‘‘low sugar/low fat), metabolic syndrome (MS) using the Joint Interim Statement criteria, microalbuminuria (MA), and glomerular filtration rate (eGFR) through the CKD-EPI equation were evaluated. Abnormal RF was defined as eGFRo60 mL min–1 (1.73 m2 ) –1 and MAX3.0 mg/dL. Factors associated with RF were determined and mediation analysis was performed to investigate the association between DP, MS, and RF. A total of 15,105 participants were recruited, with a mean age of 52±9 years; 8,134 participants (54%) were females. The mediation analysis identified indirect associations between ‘‘bakery’’ and ‘‘fruits and vegetables’’, and both were associated with decreased eGFR and albuminuria in both genders, compared with ‘‘traditional’’ and ‘‘low sugar/low fat’’ patterns in the general population. There was a direct association of the ‘‘bakery’’ pattern with MA in men (OR: 1.17, 95%CI: 1.92–1.48). The ‘‘fruits and vegetables’’ pattern also showed a direct association with reduced eGFR in women (OR: 1.65, 95%CI: 1.28–2.12), although there was no significance after adjustment. The ‘‘fruits and vegetables’’ and ‘‘bakery’’ DPs were associated with renal dysfunction. The only independent, direct association was between ‘‘bakery’’ DP and MA in men, raising concerns about DP and renal damage in men

Previous BCG vaccination is associated with less severe clinical progression of COVID-19

Background: BCG vaccination, originally used to prevent tuberculosis, is known to “train” the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19./ Methods: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of “severe” above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis./ Results: BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74–93%) in subjects aged 60 or less and 35% (95% CI − 44–71%) in older subjects./ Conclusions: This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research.

DOENÇA PERIODONTAL MATERNA E PREMATURIDADE/BAIXO PESO AO NASCER: UMA METANÁLISE

OBJETIVO: Avaliar a associação entre doença periodontal (DP) e prematuridade/baixo peso ao nascer (PMBP).MATERIAL E MÉTODOS: Foi realizado um estudo de metanálise no qual foram empregadas as bases de dados PUBMED/Medline, Lilacs e SciELO  para selecionar estudos de caso-controle com ano de publicação no intervalo de tempo de  2001 a 2013.RESULTADOS: Dos 33 estudos de caso-controle elegíveis, 23 tiveram seus achados sumarizados na metanálise. O odds ratio da metanálise foi da ordem de 1,7 (95% IC [1,19 – 2,43],) apontando que gestantes com DP podem ter a chance elevada para terem filhos com PMBP ao serem comparadas àquelas sem DP.CONCLUSÃO: Os achados dessa metanálise sugerem que existe associação entre DP e PMBP

Previous BCG vaccination is associated with less severe clinical progression of COVID-19

BACKGROUND: BCG vaccination, originally used to prevent tuberculosis, is known to "train" the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19 METHODS: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of "severe" above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis. RESULTS: BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74-93%) in subjects aged 60 or less and 35% (95% CI - 44-71%) in older subjects. CONCLUSIONS: This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research

Seroprevalence of Chikungunya virus and living conditions in Feira de Santana, Bahia-Brazil.

BACKGROUND: Chikungunya is an arbovirus, transmitted by Aedes mosquitoes, which emerged in the Americas in 2013 and spread rapidly to almost every country on this continent. In Brazil, where the first cases were detected in 2014, it currently has reached all regions of this country and more than 900,000 cases were reported. The clinical spectrum of chikungunya ranges from an acute self-limiting form to disabling chronic forms. The purpose of this study was to estimate the seroprevalence of chikungunya infection in a large Brazilian city and investigate the association between viral circulation and living condition. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a population-based ecological study in selected Sentinel Areas (SA) through household interviews and a serologic survey in 2016/2017. The sample was of 1,981 individuals randomly selected. The CHIKV seroprevalence was 22.1% (17.1 IgG, 2.3 IgM, and 1.4 IgG and IgM) and varied between SA from 2.0% to 70.5%. The seroprevalence was significantly lower in SA with high living conditions compared to SA with low living condition. There was a positive association between CHIKV seroprevalence and population density (r = 0.2389; p = 0.02033). CONCLUSIONS/SIGNIFICANCE: The seroprevalence in this city was 2.6 times lower than the 57% observed in a study conducted in the epicentre of the CHIKV epidemic of this same urban centre. So, the herd immunity in this general population, after four years of circulation of this agent is relatively low. It indicates that CHIKV transmission may persist in that city, either in endemic form or in the form of a new epidemic, because the vector infestation is persistent. Besides, the significantly lower seroprevalences in SA of higher Living Condition suggest that beyond the surveillance of the disease, vector control and specific actions of basic sanitation, the reduction of the incidence of this infection also depends on the improvement of the general living conditions of the population