Delirium in Hospitalized Elderly Patients and Post-Discharge Mortality

OBJECTIVE: To determine the impact of delirium on post-discharge mortality in hospitalized older patients. INTRODUCTION: Delirium is frequent in hospitalized older patients and correlates with high hospital mortality. There are only a few studies about its impact on post-discharge mortality. METHODS: This is a prospective study of patients over 60 years old who were hospitalized in the Geriatric Unit at Hospital das Clínicas of São Paulo between May 2006 and March 2007. Upon admission, demographics, comorbidities, number of drugs taken, and serum albumin concentration were evaluated for each patient. Delirium was diagnosed according to the DSM-IV criteria. Patients were divided into group A (with delirium) and group B (without delirium). One year after discharge, the patients or their caregivers were contacted to assess days of survival. RESULTS: The sample included 199 patients, 66 (33%) of whom developed delirium (Group A). After one year, 33 (50%) group A patients had died, and 45 (33.8%) group B patients had died (p = 0.03). There was a significant statistical difference in average age (p = 0.001) and immobility (p <0.001) between groups A and B. There were no statistically significant differences between groups A and B in number of drugs taken greater than four (p = 0.62), sex (p = 0.54) and number of diagnoses greater than four (p = 0.21). According to a multivariate analysis, delirium was not an independent predictor of post-discharge mortality. The predictors of post-discharge mortality were age > 80 years (p = 0.029), albumin concentration < 3.5 g/dl (p = 0.001) and immobility (p = 0.007). CONCLUSION: Delirium is associated with higher post-discharge mortality as a dependent predictor

Assistência de Enfermagem ao cuidador familiar de portadores de transtorno mental / Nursing care for family caregivers of patients with mental disorders

A aproximação familiar trazida pela reforma psiquiátrica foi uma conquista imprescindível, mas muitos familiares ainda encontram dificuldades em adequar-se a essa função, visto que se caracteriza uma experiência de fardo a carregar. Logo, há a necessidade de apoio aos familiares cuidadores, quanto à educação em saúde para o entendimento da doença e da situação vivida.  Buscou-se, portanto, identificar a sobrecarga sofrida pelo cuidador familiar de portador de transtorno mental e analisar a atuação do profissional de enfermagem na assistência ao cuidador familiar e sua relação com o ente PTM. A metodologia trata-se de uma revisão integrativa de literatura, com caráter teórico-reflexivo, que sintetiza os estudos disponíveis mais atuais sobre assistência de enfermagem ao cuidador familiar de portadores de transtornos mentais. Para a busca dos trabalhos foi utilizada a Biblioteca Virtual em Saúde onde foram pesquisados os descritores “saúde mental”, “cuidadores” e “enfermagem psiquiátrica. A presença de um portador de transtorno mental na família implica repercussões tanto nas interações emocionais como no andamento das atividades domésticas e na situação econômica. Identificou-se que as famílias não são preparadas durante a hospitalização de seus pacientes e, no momento da alta, percebiam o futuro do paciente com pessimismo, preocupação e incerteza. A falta de orientação foi apresentada como uma realidade cotidiana difícil de ser enfrentada, principalmente em relação aos cuidados. O papel dos enfermeiros é preponderante, enquanto profissionais de saúde habilitados a transmitir a informação necessária para a tomada de decisão para o cuidar. Apesar de a enfermagem ser presente na maioria dos serviços, foi de constatação absoluta um certo despreparo destes profissionais na potencialização do papel da família como parte integrante do cuidado. É importante avançar no conhecimento, na participação, no desenvolvimento de atividades e práticas que capacitem os profissionais de saúde para serviços mais qualificados. O enfermeiro, como profissional que mais atua diretamente com os pacientes e familiares, deve buscar progresso na metodologia de serviços de saúde com a inclusão do familiar aos seus cuidados e atenção, melhorando assim a qualidade de vida de todos os envolvidos

Dengue: 30 years of cases in an endemic area

The present study aimed to review literature on studies of dengue cases conducted over 30 years in the state of Ceara´. Between November 2015 and January 2016, articles published in Portuguese and English in 7 databases were searched using keywords and a Boolean operator. A total of 191 articles were identified in the databases; 133 were excluded according to the exclusion criteria, and 58 were included in the study. Of the 58 articles analyzed, 6 reported data from Brazil; including the Northeast region and the state of Ceara´; 41 reported data for only the city of Fortaleza; 7 reported data for the state of Ceara´; 4 reported data for cities in the interior of the state; and 3 included only children. The studies adopted different approaches and focused on different aspects of the disease. Study outcomes included the identification of serological, epidemiological, clinical, and laboratory characteristics; potential larvicides and biological predators of mosquitoes; potential antiviral agents; vector density characteristics; and educational dengue prevention and control strategies. Additionally, one vaccine trial was included. Although studies on dengue in the state of Ceara´ are scarce, they are encompassing, including several lines of research, and the number of studies and reports on dengue in the state of Ceara´ continues to increase

Profile Of Hypertensive Patients Registered In A Basic Health Unit

Objective: To identify the socio-demographic profile of hypertensive patients registered in HIPERDIA in a Basic Health Unit in the city of Parnamirim-RN and to analyze their perception about this system. Methodology: This is a cross-sectional, descriptive study with a quantitative approach, applying a questionnaire with objective questions to 100 volunteer patients who fit the established inclusion criteria. Data were collected in February and March 2016. Results: It was found a predominance of women, aged 40 to 49 years old, white and black, with incomplete high school, living with a partner and children. Most individuals reported excellent access to diagnosis of the disease, good understanding of the Hypertension and adherence to treatment. They considered the delivery of drugs by UBS as well as nursing care received as good. They reported rarely participating in health education activities and realized a great change in the quality of life with the completion of treatment. Conclusions: It is concluded that the HIPERDIA need some improvements by both managers as by health professionals so that it could better assist the demands of patients.   DOI: http://dx.doi.org/10.3823/233

Osteoporosis in Parkinson’s disease and the role of lean body mass: a cross-sectional study in a Brazilian tertiary center

BackgroundParkinson’s disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures.ObjectiveThis study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD.MethodsWe performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person’s 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations.ResultsWe evaluated 107 patients in total, of whom 45 (42%) were women. The group’s mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria.ConclusionOur findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD

Dynamics and determinants of SARS-CoV-2 RT-PCR testing on symptomatic individuals attending healthcare centers during 2020 in Bahia, Brazil

RT-PCR testing data provides opportunities to explore regional and individual determinants of test positivity and surveillance infrastructure. Using Generalized Additive Models, we explored 222,515 tests of a random sample of individuals with COVID-19 compatible symptoms in the Brazilian state of Bahia during 2020. We found that age and male gender were the most significant determinants of test positivity. There was evidence of an unequal impact among socio-demographic strata, with higher positivity among those living in areas with low education levels during the first epidemic wave, followed by those living in areas with higher education levels in the second wave. Our estimated probability of testing positive after symptom onset corroborates previous reports that the probability decreases with time, more than halving by about two weeks and converging to zero by three weeks. Test positivity rates generally followed state-level reported cases, and while a single laboratory performed ~90% of tests covering ~99% of the state's area, test turn-around time generally remained below four days. This testing effort is a testimony to the Bahian surveillance capacity during public health emergencies, as previously witnessed during the recent Zika and Yellow Fever outbreaks

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Associação entre a capacidade funcional, transtorno do sono e nível de atividade física em indivíduos com doença de Parkinson durante o período de pandemia de covid-19: um estudo transversal

Resumo Objetivo Avaliar o nível de atividade física, considerando as condições sociodemográficas, clínicas e funcionais, de pessoas idosas com Doença de Parkinson (DP). Método Foi realizado um estudo transversal a partir dos seguintes dados: nível de atividade física (International Physical Activity Questionnaire versão curta - IPAQ curto), transtornos do sono, queixa cognitiva, tempo de doença, grau de dependência para realizar atividades básicas do dia a dia pela escala Schwab & England (S & E) de indivíduos idosos com DP atendidos em um serviço de saúde terciário, durante a pandemia da covid-19. Regressão de Poisson, teste U de Mann-Whitney e teste t de Student foram utilizados para análise estatística. Resultados A cada 10 pontos de elevação na escala de S & E, a razão de prevalência de ser ativo foi maior em 1,04 (IC 95% 1,01 – 1,08) e quem não referiu transtorno de sono teve razão de prevalência de 1,17 (IC95% 1,02-1,34) vez maior de ser ativo. Indivíduos com DP inativos eram mais velhos e tinham maior tempo de doença. Conclusão Ênfase deve ser dada a capacidade funcional e ao sono de indivíduos com DP para o manejo adequado do nível de AF em períodos de restrição social