Characteristics of pregnancies, deliveries and newborns in the Metropolitan Region of Aracaju, State of Sergipe, Brazil

OBJETIVOS: descrever as características das gestações, partos e nascimentos da região metropolitana de Aracaju. As principais características demográficas e socioeconômicas e de atenção à saúde da população foram avaliadas. MÉTODOS: estudo transversal dos nascimentos ocorridos entre março e julho de 2005, procedentes da região metropolitana de Aracaju, Sergipe, Brasil. Todas as mães que tiveram parto único nascido vivo foram entrevistadas através de um questionário estruturado, com informações sobre as condições demográficas, socioeconômicas, história sexual/reprodutiva. Registros do peso, comprimento e perímetro cefálico das crianças foram transferidos para o questionário. Foi feita comparação com outros estudos brasileiros de características semelhantes. RESULTADOS: foram analisados 4746 nascimentos de parto único de Aracaju, com 69% das mães referindo renda inferior a três salários mínimos. As mães adolescentes representaram 20,6% da amostra. Entre todos os nascimentos, 7,7% tiveram duração inferior a 37 semanas, percentual semelhante ao de baixo peso ao nascer (7,2%). Prevaleceu a assistência pré-natal oferecida pelo Sistema Único de Saúde (SUS) (76,0%), que custeou 85,2% dos partos. Destes, 31,6% foram cesáreas. CONCLUSÕES: o estudo mostrou menores percentuais de partos cesária, prematuridade e baixo peso ao nascer que os encontrados em Ribeirão Preto, São Luís e Pelotas. Estudos como este podem ser muito úteis ao planejamento de saúde perinatal. _________________________________________________________________________________________ ABSTRACT: OBJECTIVES: to describe the characteristics of pregnancies, deliveries and the status of newborns at birth in the Metropolitan Area of Aracaju. The main demographic and socioeconomic characteristics and details of the medical care given to the population under study are presented. METHODS: a cross-sectional study was carried out of all deliveries in the maternity hospitals of Aracaju, in the State of Sergipe, Brazil, from March-July 2005. All mothers who gave birth to a single live baby were interviewed regarding their background, reproductive history and sexual life. Hospital records, including the babies' weight, height and cephalic perimeter, were obtained and all information transferred to a standardised questionnaire. Data were compared to equivalent findings from other studies in Brazil. RESULTS: there were 4746 single live births during the study period in Aracaju. The majority of mothers (69%) were considered poor (income <3 minimum wages). Adolescent mothers comprised 20.6% of the population. The figures for low birth-weight (7.2%) and prematurity (7.7%) were similar. Almost all mothers (98.3%) received prenatal care, 76.0% from public services – the Sistema Único de Saúde (SUS) -which financed most deliveries. Caesarean sections accounted for 31.6% of all deliveries. CONCLUSIONS: deliveries in Aracaju's showed good performance with a lower rate for Caesarean sections, prematurity, and low birth-weight than Ribeirão Preto, São Luís and Pelotas. Perinatal health planning may benefit from this kind of study

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60&nbsp;years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death.&nbsp;The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19

Importance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, setting, and participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure: Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main outcomes and measures: Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results: Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and relevance: The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4&nbsp;% presented with RS, while 13.6&nbsp;% had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7&nbsp;% vs RS: 37.5&nbsp;%). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1&nbsp;% vs. RS 32.0&nbsp;%), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders