Instrumentos para avaliação do tabagismo: uma revisão sistemática Instruments used to evaluate smoking habits: a systematic review

O tabagismo é um dos principais responsáveis pela carga de doenças no mundo, causando uma a cada oito mortes. Conhecer os instrumentos que caracterizam o uso do tabaco é o primeiro passo para desenvolver pesquisas qualificadas e comparativas para enfrentar esse desafio. O objetivo foi identificar instrumentos e comparar domínios temáticos utilizados em pesquisas populacionais para avaliação do tabagismo nos últimos 5 anos. Foi realizada revisão sistemática em publicações de setembro de 2002 a setembro de 2007. Os termos utilizados foram: (Smok* or tobacco) AND (Questionnaire or scale or score or instrument or assessment or form) AND (*cultural* or translat* or valid* or reproduc* or psychomet*). Foram selecionados 186 artigos do total de 2236. Em apenas 91 havia citação dos instrumentos utilizados. Os principais temas foram perfil e prevalência (38%), dependência (24%) e motivação (10,8%). Questionários definidos foram empregados em 96% dos estudos de dependência. Já nas pesquisas de perfil e prevalência 79% utilizaram questionários próprios. A transparência e a padronização dos instrumentos e a preferência pelo uso de questionários validados são quesitos essenciais para a qualidade e reprodutibilidade das pesquisas sobre o tabagismo.<br>Smoking is one of the most important causes of illness in the world, responsible for one out of every eight deaths. To know the instruments that characterize the use of tobacco is the first step to develop reliable and comparable research to tackle this challenge. The objective was to identify and compare instruments and domains used in population-based studies over the past five years aiming to determine smoking patterns. A systematic review was conducted on articles published from September 2002 to September 2007. The terms used were: (*Smok or tobacco) AND (Questionnaire or scale or score or instrument or assessment or form) AND (*cultural* or translat* or valid* or reproduc* or psychomet*). Out of 2,236 references, 186 articles were selected, of which only 91 informed the instruments used. From the 91 manuscripts, 49 distinct instruments were identified. The main topics were profile and prevalence (38%), dependence (24%) and motivation (10.8%). The researchers used standard instruments in 96% of studies of addiction. The majority of articles about profile and prevalence (79%) used self-developed questionnaires. The transparency and standardization of instruments and the preference for the use of validated questionnaires are crucial areas for quality and reproducibility of research on smoking

Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians

ABSTRACT: Objectives: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population. Methods: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group. Results: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer. Conclusion: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation