Nursing consultation protocol for patients after myocardial revascularization: influence on anxiety and depression Protocolo de consultas de enfermería al paciente después de la revascularización del miocardio: influencia en la ansiedad y depresión Protocolo de consultas de enfermagem ao paciente após a revascularização do miocárdio: influência na ansiedade e depressão

The objective was to evaluate the influence of the Nursing Consultation Protocol in aspects of anxiety and depression in patients after myocardial revascularization using the Hospital Anxiety and Depression scale (HAD). A randomized clinical trial developed in the outpatient clinic of a public hospital in Fortaleza-Ceará. One hundred and forty six patients, who underwent myocardial revascularization, composed the population, providing the sample of 39 patients in the control group (CG) and 39 in the intervention group (IG). The results were presented in tables. Anxiety had a mean of 5.41 in the CG and a median of 5 and a mean in the IG of 5.21 and a median of 4. Depression predominated in the CG, with a mean 4.82 and a median of 4, while the IG had a mean of 3.79 and a median of 3. It was found that people monitored in accordance with the Nursing Consultation Protocol had a lower percentage of anxiety and depression after six months.<br>El objetivo fue verificar la influencia del protocolo de consultas de enfermería sobre aspectos relacionados a ansiedad y depresión en pacientes después de la revascularización del miocardio, utilizando la escala de HAD (Hospital Ansiety and Depresion). Se trata de un ensayo clínico, aleatorio, desarrollado en el ambulatorio de un hospital público en Fortaleza, estado de Ceará. La población fue compuesta 146 pacientes en los cuales fue realizada la revascularización del miocardio, constituyendo la muestra 39 pacientes del grupo de control (GC) y 39 del grupo de intervención (GI). Los resultados fueron presentados en tablas. La ansiedad tuvo promedio en el GC de 5,41 y mediana de 5 y, en el GI, tuvo promedio de 5,21 y mediana de 4. La depresión predominó en el GC, con promedio 4,82 y mediana de 4; en cuanto el GI tuvo promedio de 3,79 y mediana de 3. Se constató que las personas acompañadas de acuerdo con el protocolo de consultas de enfermería tuvieron un porcentaje menor de ansiedad y depresión, después de seis meses de acompañamiento.<br>O objetivo foi verificar a influência do protocolo de consultas de enfermagem nos aspectos relacionados à ansiedade e à depressão em pacientes após revascularização miocárdica, utilizando a escala de HAD (Hospital Ansiety and Depression). Ensaio clínico, randomizado, desenvolvido no ambulatório de um hospital público, Fortaleza, CE. Compôs a população 146 pacientes nos quais foi realizada revascularização miocárdica, constituindo a amostra 39 pacientes do grupo controle (GC) e 39 do grupo de intervenção (GI). Os resultados foram apresentados em tabelas. A ansiedade teve média no GC de 5,41 e mediana de 5 e, no GI, teve média de 5,21 e mediana de 4. A depressão predominou no GC, com média 4,82 e mediana de 4, enquanto o GI teve média de 3,79 e mediana de 3. Constatou-se que as pessoas acompanhadas de acordo com o protocolo de consultas de enfermagem tiveram menor percentual de ansiedade e depressão, após seis meses de acompanhamento

The association between Zika virus infection and microcephaly in Brazil 2015–2017: An observational analysis of over 4 million births

BACKGROUND: In 2015, high rates of microcephaly were reported in Northeast Brazil following the first South American Zika virus (ZIKV) outbreak. Reported microcephaly rates in other Zika-affected areas were significantly lower, suggesting alternate causes or the involvement of arboviral cofactors in exacerbating microcephaly rates. METHODS AND FINDINGS: We merged data from multiple national reporting databases in Brazil to estimate exposure to 9 known or hypothesized causes of microcephaly for every pregnancy nationwide since the beginning of the ZIKV outbreak; this generated between 3.6 and 5.4 million cases (depending on analysis) over the time period 1 January 2015-23 May 2017. The association between ZIKV and microcephaly was statistically tested against models with alternative causes or with effect modifiers. We found no evidence for alternative non-ZIKV causes of the 2015-2017 microcephaly outbreak, nor that concurrent exposure to arbovirus infection or vaccination modified risk. We estimate an absolute risk of microcephaly of 40.8 (95% CI 34.2-49.3) per 10,000 births and a relative risk of 16.8 (95% CI 3.2-369.1) given ZIKV infection in the first or second trimester of pregnancy; however, because ZIKV infection rates were highly variable, most pregnant women in Brazil during the ZIKV outbreak will have been subject to lower risk levels. Statistically significant associations of ZIKV with other birth defects were also detected, but at lower relative risks than that of microcephaly (relative risk &lt; 1.5). Our analysis was limited by missing data prior to the establishment of nationwide ZIKV surveillance, and its findings may be affected by unmeasured confounding causes of microcephaly not available in routinely collected surveillance data. CONCLUSIONS: This study strengthens the evidence that congenital ZIKV infection, particularly in the first 2 trimesters of pregnancy, is associated with microcephaly and less frequently with other birth defects. The finding of no alternative causes for geographic differences in microcephaly rate leads us to hypothesize that the Northeast region was disproportionately affected by this Zika outbreak, with 94% of an estimated 8.5 million total cases occurring in this region, suggesting a need for seroprevalence surveys to determine the underlying reason.</p

The association between Zika virus infection and microcephaly in Brazil 2015–2017: An observational analysis of over 4 million births

BACKGROUND: In 2015, high rates of microcephaly were reported in Northeast Brazil following the first South American Zika virus (ZIKV) outbreak. Reported microcephaly rates in other Zika-affected areas were significantly lower, suggesting alternate causes or the involvement of arboviral cofactors in exacerbating microcephaly rates. METHODS AND FINDINGS: We merged data from multiple national reporting databases in Brazil to estimate exposure to 9 known or hypothesized causes of microcephaly for every pregnancy nationwide since the beginning of the ZIKV outbreak; this generated between 3.6 and 5.4 million cases (depending on analysis) over the time period 1 January 2015-23 May 2017. The association between ZIKV and microcephaly was statistically tested against models with alternative causes or with effect modifiers. We found no evidence for alternative non-ZIKV causes of the 2015-2017 microcephaly outbreak, nor that concurrent exposure to arbovirus infection or vaccination modified risk. We estimate an absolute risk of microcephaly of 40.8 (95% CI 34.2-49.3) per 10,000 births and a relative risk of 16.8 (95% CI 3.2-369.1) given ZIKV infection in the first or second trimester of pregnancy; however, because ZIKV infection rates were highly variable, most pregnant women in Brazil during the ZIKV outbreak will have been subject to lower risk levels. Statistically significant associations of ZIKV with other birth defects were also detected, but at lower relative risks than that of microcephaly (relative risk andlt; 1.5). Our analysis was limited by missing data prior to the establishment of nationwide ZIKV surveillance, and its findings may be affected by unmeasured confounding causes of microcephaly not available in routinely collected surveillance data. CONCLUSIONS: This study strengthens the evidence that congenital ZIKV infection, particularly in the first 2 trimesters of pregnancy, is associated with microcephaly and less frequently with other birth defects. The finding of no alternative causes for geographic differences in microcephaly rate leads us to hypothesize that the Northeast region was disproportionately affected by this Zika outbreak, with 94% of an estimated 8.5 million total cases occurring in this region, suggesting a need for seroprevalence surveys to determine the underlying reason.</p