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The Brazilian Amazon, a vital tropical region, faces escalating threats from human activities, agriculture, and climate change. This study aims to assess the relationship between forest fire occurrences, meteorological factors, and hospitalizations due to respiratory diseases in the Legal Amazon region from 2009 to 2019. Employing simultaneous equation models with official data, we examined the association between deforestation-induced fires and respiratory health issues. Over the studied period, the Legal Amazon region recorded a staggering 1,438,322 wildfires, with 1,218,606 (85%) occurring during August-December, known as the forest fire season. During the forest fire season, a substantial portion (566,707) of the total 1,532,228 hospital admissions for respiratory diseases were recorded in individuals aged 0-14 years and 60 years and above. A model consisting of two sets of simultaneous equations was constructed. This model illustrates the seasonal fluctuations in meteorological conditions driving human activities associated with increased forest fires. It also represents how air quality variations impact the occurrence of respiratory diseases during forest fires. This modeling approach unveiled that drier conditions, elevated temperatures, and reduced precipitation exacerbate fire incidents, impacting hospital admissions for respiratory diseases at a rate as high as 22 hospital admissions per 1000 forest fire events during the forest fire season in the Legal Amazon, 2009-2019. This research highlights the urgent need for environmental and health policies to mitigate the effects of Amazon rainforest wildfires, stressing the interplay of deforestation, climate change, and human-induced fires on respiratory health.

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BACKGROUND: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce. OBJECTIVE: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. METHODS: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. RESULTS: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). CONCLUSIONS: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues.

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BACKGROUND: In early 2023, when Omicron was the variant of concern, we showed that vaccinating pregnant women decreased the risk for severe COVID-19-related complications and maternal morbidity and mortality. OBJECTIVE: This study aimed to analyze the impact of COVID-19 during pregnancy on newborns and the effects of maternal COVID-19 vaccination on neonatal outcomes when Omicron was the variant of concern. STUDY DESIGN: INTERCOVID-2022 was a large, prospective, observational study, conducted in 40 hospitals across 18 countries, from November 27, 2021 (the day after the World Health Organization declared Omicron the variant of concern) to June 30, 2022, to assess the effect of COVID-19 in pregnancy on maternal and neonatal outcomes and to assess vaccine effectiveness. Women diagnosed with laboratory-confirmed COVID-19 during pregnancy were compared with 2 nondiagnosed, unmatched women recruited concomitantly and consecutively during pregnancy or at delivery. Mother-newborn dyads were followed until hospital discharge. The primary outcomes were a neonatal positive test for COVID-19, severe neonatal morbidity index, severe perinatal morbidity and mortality index, preterm birth, neonatal death, referral to neonatal intensive care unit, and diseases during the neonatal period. Vaccine effectiveness was estimated with adjustment for maternal risk profile. RESULTS: We enrolled 4707 neonates born to 1577 (33.5%) mothers diagnosed with COVID-19 and 3130 (66.5%) nondiagnosed mothers. Among the diagnosed mothers, 642 (40.7%) were not vaccinated, 147 (9.3%) were partially vaccinated, 551 (34.9%) were completely vaccinated, and 237 (15.0%) also had a booster vaccine. Neonates of booster-vaccinated mothers had less than half (relative risk, 0.46; 95% confidence interval, 0.23-0.91) the risk of being diagnosed with COVID-19 when compared with those of unvaccinated mothers; they also had the lowest rates of preterm birth, medically indicated preterm birth, respiratory distress syndrome, and number of days in the neonatal intensive care unit. Newborns of unvaccinated mothers had double the risk for neonatal death (relative risk, 2.06; 95% confidence interval, 1.06-4.00) when compared with those of nondiagnosed mothers. Vaccination was not associated with any congenital malformations. Although all vaccines provided protection against neonatal test positivity, newborns of booster-vaccinated mothers had the highest vaccine effectiveness (64%; 95% confidence interval, 10%-86%). Vaccine effectiveness was not as high for messenger RNA vaccines only. Vaccine effectiveness against moderate or severe neonatal outcomes was much lower, namely 13% in the booster-vaccinated group (all vaccines) and 25% and 28% in the completely and booster-vaccinated groups, respectively (messenger RNA vaccines only). Vaccines were fairly effective in protecting neonates when given to pregnant women ≤100 days (14 weeks) before birth; thereafter, the risk increased and was much higher after 200 days (29 weeks). Finally, none of the neonatal practices studied, including skin-to-skin contact and direct breastfeeding, increased the risk for infecting newborns. CONCLUSION: When Omicron was the variant of concern, newborns of unvaccinated mothers had an increased risk for neonatal death. Neonates of vaccinated mothers had a decreased risk for preterm birth and adverse neonatal outcomes. Because the protective effect of COVID-19 vaccination decreases with time, to ensure that newborns are maximally protected against COVID-19, mothers should receive a vaccine or booster dose no more than 14 weeks before the expected date of delivery.

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Background: Pediatric COVID-19 patients have lower rates of hospitalization and fatal outcomes compared to adults with COVID-19; however, children represent a challenge in the detection, diagnosis, and treatment of COVID-19. Our aim was to determine the risk factors for hospital admission, invasive mechanical ventilation, and mortality in pediatric COVID-19 patients in Mexico during the COVID-19 pandemic. Material and methods: A retrospective cohort of pediatric patients with COVID-19 from February 2020 to April 2021 was reported on the National Epidemiological Surveillance System for Viral Respiratory Disease (SISVER) platform. Results: Among the 104,133 patients included in our study, 6214 were hospitalized, and 621 patients underwent invasive mechanical ventilation. A total of 0.65 % died during hospitalization. Children aged <12 months (odds ratio [OR]: 17.1; 95 % confidence interval [CI]: 15.9-19.4, p < 0.001), 1-4 years (OR: 3.69; 95 % CI: 3.2-4.1, p < 0.001), 5-9 years (OR: 1.86; 95 % CI: 1.66-2.08, p < 0.001), and 10-14 years (OR: 1.23; 95 % CI: 1.11-1.37, p < 0.001), and those diagnosed with diabetes (OR: 2.32; 95 % CI 1.68-3.20, p < 0.001) and obesity (OR: 1.24; 95 % CI 1.04-1.48, p = 0.015) were associated with hospital admission. Renal disease (OR: 3.85; 95 % CI: 2.25-6.59, p < 0.001) was associated with invasive mechanical ventilation. Pneumonia (OR: 15.9; 95 % CI: 12.6-20.1, p < 0.001) and renal disease (OR: 3.85; 95 % CI: 2.25-6.59, p value < 0.001) were associated with death. Conclusion: Pneumonia increases the risk of death. The youngest age group has a higher risk of hospital admission. Comorbidities such as renal disease or immunosuppression increase the risk of death in all age groups.

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Maternal, placental, and neonatal factors were compared between infants born at ≤29 weeks of gestational age with admission hyperthermia (>37.5○C) and euthermia (36.5-37.5○C). Admission hyperthermia was associated with longer duration of face-mask positive-pressure ventilation and infant's temperature ≥37.5○C in the delivery room. Infants born preterm with admission hyperthermia had greater odds of developing necrotizing enterocolitis and neurodevelopmental impairment.

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ABSTRACT Objective: To assess differences in the sputum microbiota of community-acquired pneumonia (CAP) patients with either COPD or asthma, specifically focusing on a patient population in Turkey. Methods: This retrospective study included hospitalized patients > 18 years of age with a diagnosis of pneumonia between January of 2021 and January of 2023. Participants were recruited from two hospitals, and three patient groups were considered: CAP patients with asthma, CAP patients with COPD, and CAP patients without COPD or asthma. Results: A total of 246 patients with CAP were included in the study, 184 (74.8%) and 62 (25.2%) being males and females, with a mean age of 66 ± 14 years. Among the participants, 52.9% had COPD, 14.2% had asthma, and 32.9% had CAP but no COPD or asthma. Upon analysis of sputum cultures, positive sputum culture growth was observed in 52.9% of patients. The most commonly isolated microorganisms were Pseudomonas aeruginosa (n = 40), Acinetobacter baumannii (n = 20), Klebsiella pneumoniae (n = 16), and Moraxella catarrhalis (n = 8). CAP patients with COPD were more likely to have a positive sputum culture (p = 0.038), a history of antibiotic use within the past three months (p = 0.03), utilization of long-term home oxygen therapy (p < 0.001), and use of noninvasive ventilation (p = 0.001) when compared with the other patient groups. Additionally, CAP patients with COPD had a higher CURB-65 score when compared with CAP patients with asthma (p = 0.004). Conclusions: This study demonstrates that CAP patients with COPD tend to have more severe presentations, while CAP patients with asthma show varied microbial profiles, underscoring the need for patient-specific management strategies in CAP.

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SUMMARY OBJECTIVE: The aim of the study was to compare the epidemiology and clinical profiles of hospital admissions in a single Brazilian Hepatology Unit from the period 2014-2017 to 2019-2022. METHODS: A retrospective analysis of hospital database from the abovementioned periods was done. The study included patients over the age of 18 years who were hospitalized due to complications of diseases such as viral hepatitis, alcoholic disease, nonalcoholic fatty liver disease, and autoimmune liver and drug-induced hepatitis. RESULTS: In both study periods, middle-aged males were predominant and were younger than females. In the first period (2014-2017), hepatitis C (33.5%) was the most prevalent cause of admission, followed by alcoholic liver disease (31.7%). In the second period (2019-2022), nonalcoholic fatty liver disease (38%) and alcoholic liver disease (27.6%) were the most frequent causes of admission. No changes were observed in the proportion of alcoholic liver disease or drug-induced hepatitis in both study periods. The prevalence of viral hepatitis decreased in both genders, with hepatitis C decreasing from 32.4 to 9.7% for males and 35.4 to 10.8% for females, and OR=0.2; 95%CI 0.1-0.3 for both males and females. Similarly, the prevalence of hepatitis B decreased from 19.1 to 8.1% and OR=0.3; 95%CI 0.2-0.5 for males and 8.2 to 3.7% and OR=0.4; 95%CI 0.1-0.9 for females. The prevalence of autoimmune liver diseases increased only in males, from 2.1 to 5.9% and OR=2.9; 95%CI 1.2-6.6. CONCLUSION: Over the past 4 years, there has been a shift in hospital admission profile at a Brazilian Hepatology Unit, with a decrease in viral hepatitis and an increase in autoimmune diseases and nonalcoholic fatty liver disease. Males were more affected at younger ages than females. Furthermore, ascites was the most prevalent cause of complications in both periods analyzed.

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ABSTRACT This study aimed to identify factors associated with colonization by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in adult patients admitted to a Brazilian hospital. This is a cross-sectional study, in which patients underwent a nasal swab and were asked about hygiene behavior, habits, and clinical history. Among the 702 patients, 180 (25.6%) had S. aureus and 21 (2.9%) MRSA. The factors associated with MRSA colonization were attending a gym (OR 4.71; 95% CI; 1.42 - 15.06), smoking habit in the last year (OR 2.37; 95% CI; 0.88 - 6.38), previous hospitalization (OR 2.18; CI 95%; 0.89 - 5.25), and shared personal hygiene items (OR 1.99; 95% CI; 0.71 - 5.55). At the time of admission, colonization by CA-MRSA isolates was higher than that found in the general population. This can be an important public health problem, already endemic in hospitals, whose factors such as those associated with habits (smoking cigarettes) and behaviors (team sports practice and activities in gyms) have been strongly highlighted. These findings may help developing infection control policies, allowing targeting patients on higher-risk populations for MRSA colonization.

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ABSTRACT Objective: to identify sociodemographic factors, clinical conditions and sarcopenia parameters that predict hospital admission and death in older adults with cognitive impairment. Method: this is a longitudinal observational study carried out with 170 older adults with cognitive impairment assessed between 2019 and 2021. Predictor variables were sociodemographic characteristics, clinical conditions and sarcopenia parameters. Sarcopenia was operationalized through handgrip muscle strength (dynamometry), muscle mass (calf circumference) and the Timed Up and Go test. Occurrence of hospital admission and death within one year after assessment of older adults were the predicted variables. Analyzes were carried out using descriptive statistics, independent Student' t-test, Mann-Whitney U test, chi-square test and univariate logistic regression. Results: most participants were female (±77.57 years old), with low education, sedentary, 15.9% with sarcopenia and 13% with a history of hospital admission. It was identified that education level had an effect on occurrence of hospital admission (U=1,423.5, p=0.027) and death (U=647.0, p=0.025) within one-year follow-up. Furthermore, there is an association between history of hospital admission in the last 6 months and occurrence of hospital admission [χ2(1)=4.729; p=0.030] and death [χ2(1)=3.919; p=0.048] within one year follow-up. It was identified that history of hospital admission in the last 6 months was associated with occurrence of hospital admission within one-year follow-up (OR=2.963; 95%CI 1.076-8.165, p=0.036). Conclusion: history of hospital admission in the last six months is associated with occurrence of hospital admission over a year in older adults with cognitive impairment.

RESUMEN Objetivo: identificar factores sociodemográficos, condiciones clínicas y parámetros de sarcopenia que predicen la hospitalización y la muerte en personas mayores con deterioro cognitivo. Método: estudio observacional longitudinal realizado con 170 personas mayores con deterioro cognitivo evaluados entre 2019 y 2021. Las variables predictoras fueron las características sociodemográficas, las condiciones clínicas y los parámetros de sarcopenia. La sarcopenia se puso en práctica mediante la fuerza de los músculos de prensión manual (dinamometría), la masa muscular (circunferencia de la pantorrilla) y la prueba Timed Up and Go. La ocurrencia de hospitalización y muerte dentro del año posterior a la evaluación del anciano configuró las variables predichas. Los análisis se realizaron mediante estadística descriptiva las pruebas t de Student independiente, U de Mann-Whitney, chi-cuadrado y regresión logística univariada. Resultados: la mayoría de los participantes fueron del sexo femenino (±77,57 años), con bajo nivel educativo, sedentarios, el 15,9% con sarcopenia y el 13% con antecedentes de hospitalización. Se identificó que el nivel de escolaridad tuvo efecto en la ocurrencia de hospitalización (U=1.423,5, p=0,027) y muerte (U=647,0, p=0,025) al año de seguimiento. Además, existe asociación entre el antecedente de hospitalización en los últimos 6 meses y la ocurrencia de hospitalización [χ2(1)=4,729; p=0,030] y muerte [χ2(1)=3,919; p=0,048] al año de seguimiento. Se identificó que el antecedente de hospitalización en los últimos 6 meses se asoció con la ocurrencia de hospitalización en un año de seguimiento (OR=2,963; IC95% 1,076-8,165, p=0,036). Conclusión: un antecedente de hospitalización en los últimos seis meses se asocia con la ocurrencia de hospitalización mayor a un año en personas mayores con deterioro cognitivo.

RESUMO Objetivo: identificar fatores sociodemográficos, condições clínicas e parâmetros de sarcopenia preditores de hospitalização e óbito em idosos com comprometimento cognitivo. Método: estudo observacional longitudinal realizado com 170 idosos com comprometimento cognitivo avaliados entre 2019 e 2021. As variáveis preditoras foram características sociodemográficas, condições clínicas e parâmetros de sarcopenia. A sarcopenia foi operacionalizada por meio da força muscular de preensão palmar (dinamometria), da massa muscular (circunferência da panturrilha) e do teste Timed Up and Go. A ocorrência de hospitalização e óbito até um ano após a avaliação do idoso configuraram as variáveis preditas. Procedeu-se análises por estatística descritiva, testes t-student independente, U Mann Whitney, Qui-Quadrado e de regressão logística univariada. Resultados: a maioria dos participantes era do sexo feminino (±77,57 anos), de baixa escolaridade, sedentários, 15,9% com sarcopenia e 13% com histórico de internação. Foi identificado que o nível de escolaridade teve efeito sobre a ocorrência de hospitalização (U=1423,5, p=0,027) e de óbito (U=647,0, p=0,025) no seguimento de um ano. Além disso, há associação do histórico de internação nos últimos 6 meses com a ocorrência de hospitalização [χ2(1)=4,729; p=0,030] e de óbito [χ2(1)=3,919; p=0,048] no seguimento de um ano. Identificou-se que o histórico de internação nos últimos 6 meses associou-se com a ocorrência de hospitalização em um ano de seguimento (OR=2,963; IC95% 1,076-8,165, p=0,036). Conclusão: o histórico de internação nos últimos seis meses está associado à ocorrência de hospitalização ao longo de um ano em idosos com comprometimento cognitivo.

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Introduction: Assistive technology is aimed at improving the quality of nursing care for patients admitted to oncology intensive care units (ICUs). Objective: To develop a nursing admission form for patients admitted to an oncology intensive care unit. Materials and methods: This is a methodological study conducted in three stages: 1) an integrative literature review to compose the content of the research form, 2) content validation, which included the participation and approval of 15 specialists (nurses) using Pasquali's concordance validation method, and 3) presentation of the final version of the form. Results: A total of 20 articles were included in the review; the first version of the form was structured based on the thematic synthesis; 15 specialists participated in content validation and, after completion of the instrument, it was found that all the items had a content validation index ≥ 0.85; based on the suggestions, the admission form was organized into blocks of items: identification, brief history, admission conditions, and physical examination, with a total of four items. Conclusions: The nursing survey form for patients admitted to oncology ICUs is suitable for use by the nursing team at the time of patient admission, enabling data recording to support the planning and systematization of care in the oncology ICU setting.

Introducción: la tecnología asistencial pretende mejorar la calidad de los cuidados de enfermería a los pacientes ingresados en unidades de cuidados intensivos oncológicos. Objetivo: desarrollar un formulario de admisión de enfermería para pacientes ingresados en una unidad de cuidados intensivos oncológicos. Materiales y método: estudio metodológico realizado en tres etapas: 1a) revisión bibliográfica integradora para componer el contenido del formulario de investigación; 2a) validación del contenido, que contó con la participación y el juicio de 15 especialistas (enfermeros) mediante el método de validación por acuerdo de Pasquali; 3a) presentación de la versión final del formulario. Resultados: se incluyeron 20 artículos en la revisión; a partir de la síntesis temática, se estructuró la primera versión del formulario; 15 especialistas participaron en la validación de contenido y, tras completar el instrumento, se constató que todos los ítems tenían un índice de validación de contenido ≥ 0,85; con base en las sugerencias, el formulario de admisión se organizó en bloques de ítems: identificación, historia breve, condiciones de admisión y examen físico, con un total de cuatro ítems. Conclusiones: el formulario de investigación de enfermería para pacientes ingresados en unidades de cuidados intensivos oncológicos es adecuado para ser utilizado por el equipo de enfermería en el momento del ingreso de los pacientes, permitiendo registrar datos que apoyen la planificación y sistematización de los cuidados en el contexto de la unidad de cuidados intensivos oncológicos.

Introdução: a tecnologia assistencial visa melhorar a qualidade da assistencia de enfermagem aos pacientes admitidos em unidades de terapia intensivas oncológicas. Objetivo: desenvolver uma ficha de admissao de enfermagem para pacientes de unidade de terapia intensiva oncológica. Materiais e método: estudo metodológico realizado em tres etapas: 1a) revisao integrativa da literatura para compor o conteúdo da ficha de investigaçao; 2a) validaçao de conteúdo, que contou com a participaçao e o julgamento de 15 especialistas (enfermeiros) por meio do método de validaçao de concordância de Pasquali; 3a) apresentaçao da versao final da ficha. Resultados: na revisao, 20 artigos foram incluídos; a partir da síntese temática, foi estruturada a primeira versao da ficha; da validaçao de conteúdo, participaram 15 especialistas e, após o preenchimento do instrumento, verificou-se que todos os itens obtiveram índice de validaçao de conteúdo ≥ 0,85; com base nas sugestoes, a ficha de admissao foi organizada a partir dos blocos de itens: identificaçao, breve histórico, condiçoes de admissao e exame físico, com um total de quatro itens. Conclusões: a ficha de investigaçao de enfermagem para pacientes admitidos em unidades de terapias intensivas oncológicas está adequada para ser aplicada pela equipe de enfermagem no momento da admissao do paciente, o que possibilita o registro de dados para subsidiar o planejamento e a sistematizaçao da assistencia no contexto da unidade de terapia intensiva oncológica.

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Purpose: The role of marks in the University Admission Test (UAT) plus the marks from pre-university academic records in predicting academic achievement at the end of the Medicine undergraduate degree program is not completely known. This study was undertaken to compare the performance of marks in the UAT alone with those of the UAT plus marks from the National High School Exam (ENEM in Brazil) regarding students' outcomes at the end of the Medicine undergraduate degree program. Methods: Fifty-one (51) students from the last semester (12th) of our Medicine undergraduate degree program were included in the study. They were divided into a group of those who used the marks obtained in the UAT plus the marks obtained in the ENEM (ENEM group, n=9), and those who only used the marks in the UAT (non-ENEM group, n=42). We compared the academic achievement of the non-ENEM group with that of the ENEM group regarding the mean marks obtained in the clerkship, in the Progress Test (PT), and in the Objective Structured Clinical Examination (OSCE). Results: The mean scores obtained in the disciplines of the clerkship were higher in the non-ENEM group compared to the ENEM group (7.32 ± 0.41 vs 6.98 ± 0.31, p= 0.01). Both groups obtained similar mean marks in the OSCE and in the PT. A moderate correlation was observed between the marks in the clerkship with those of the UAT from the non-ENEM group (p=0.00006; r=0.45). Conclusion: Marks of the UAT alone appear to be associated with a higher academic achievement in the clerkship than marks of the UAT plus scores obtained from the ENEM at the end of the Medicine undergraduate degree program.

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RESUMEN Objetivo. Determinar la prevalencia y los factores asociados al ingreso a la unidad de cuidados intensivos en niños y adolescentes con neumonía adquirida en la comunidad. Materiales y métodos. Estudio observacional transversal analítico en el Instituto Nacional de Salud del Niño San Borja en el 2019, la muestra estuvo conformada por niños de mayores de un mes y menores de 18 años que ingresaron a emergencia con diagnóstico de neumonía adquirida en la comunidad. Se utilizó la regresión de Poisson para evaluar asociación. Resultados. Se evaluaron 166 pacientes con diagnóstico de neumonía, 94 (56,6%) fueron varones y la mediana de la edad fue 24 meses (RIC: 11‒48). La mayoría de los pacientes presentó un puntaje PIRO modificado leve de 136 (81,9%), 31 (18,7%) pacientes tuvieron neumonía complicada y 24 (14,5%) ingresaron a cuidados intensivos. A mayor edad se halló menor prevalencia de ingreso a UCI (RP=0,99, IC95%: 0,98‒0,99); la gravedad evaluada con el score PIRO modificado (RP=3,40, IC95%: 1,46‒7,93) y la presencia de neumonía complicada (RP: 5,88, IC95%: 2,46‒14,06) estuvieron asociados al ingreso a cuidados intensivos. Conclusiones. En niños con neumonía adquirida en la comunidad la prevalencia de ingreso a cuidados intensivos fue de 14,5%. Los pacientes con neumonía de menor edad, con mayor gravedad evaluada con el puntaje PIRO modificado y con neumonía complicada tienen mayor prevalencia de ingreso a cuidados intensivos.

ABSTRACT Objective. To determine the prevalence and factors associated with intensive care unit admission in children and adolescents with community-acquired pneumonia. Materials and methods. Analytical cross-sectional observational study at the Instituto Nacional de Salud del Niño San Borja in 2019. The sample consisted of children older than one month and younger than 18 years who were admitted to emergency diagnosed with community-acquired pneumonia. We used Poisson regression to assess association. Results. We evaluated 166 patients diagnosed with pneumonia, 94 (56.6%) were male and the median age was 24 months (IQR: 11 - 48). Most patients had a mild modified PIRO score of 136 (81.9%); 31 (18.7%) patients had complicated pneumonia and 24 (14.5%) were admitted to intensive care. The higher the age, the lower the prevalence of admission to ICU (PR=0.99, 95%CI: 0.98-0.99). The severity assessed with the modified PIRO score (PR=3.40, 95%CI: 1.46-7.93) and the presence of complicated pneumonia (PR: 5.88, 95%CI: 2.46-14.06) were associated with admission to intensive care. Conclusions. The prevalence of admission to intensive care in children with community-acquired pneumonia was 14.5%. Younger patients with pneumonia, with greater severity assessed with the modified PIRO score and with complicated pneumonia have a higher prevalence of admission to intensive care.

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Background: There is evidence that early admission to the palliative care (PC) program in adult cancer patients improves symptoms management, reduces unplanned hospital admissions, minimizes aggressive cancer treatments, and enables patients to make decisions about their end-of-life (EOL) care. Objectives: This retrospective cohort study aimed to determine whether late admission to a PC program is associated with aggressive treatment at the EOL in adult patients with oncological diseases from their admission until death. Design/Methods: The study evaluated the aggressiveness in EOL management in patients with advanced stage oncological diseases who died between 2017 and 2019. The study population was divided into two groups based on the time of admission to the PC program. Aggressiveness at the EOL was measured using five criteria: treatment, hospital admission and duration, emergency department care, and/or intensive care unit utilization. Results: The study found a significant difference in the rate of aggressive EOL treatments between late admission to PC care and early admission [adjusted EOL 79.6% versus 70.4%; relative risk (RR): 1.98, 90% CI: 1.08-3.59, p: 0.061]; In the analysis of secondary variables, a significant association was observed between early admission to PC and the suspension of active treatments at the EOL, leading to a decrease in aggressiveness (77% versus 55.8%; RR: 1.38, 95% CI: 1.14-1.67, p: 0.004). Conclusion: Our findings suggest that early referral to PC services is associated with less aggressive treatment at the EOL, including suspension of active treatments.

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The objective of this research was to determine some of the sociodemographic and academic characteristics of the students who entered the Dentistry career in the period 2007 to 2014. Data was collected from 673 student files. The variables considered were sex, admission age, marital status, children, nationality, place of origin, high school of origin, and admission exam score. The data was obtained from the database of the Student Applications System, the physical files, and the Supreme Electoral Tribunal of Costa Rica. Descriptive statistics were performed, establishing the absolute and relative frequency of the variables. The Mann-Whitney test was used to determine if there were statistically significant differences between the admission exam and the established sociodemographic variables (p<0,05, IC 95%). 68,4% of the students are female. The average age was 18.4 years (SD=2,41). 99,0% of the students are from Costa Rica. 99,3% were single and only 0,9% had children. The largest number of students entered through an admission exam (78.9%) and 50.7% studied at a public high school. Regarding the address, 77.9% of the subjects resided in the Greater Metropolitan Area. The average grade of the admission exam was 613,8 (SD=49,95). There was a statistically significant difference between the entrance exam grade and the different types of high schools of origin. The group of students who entered to train as Dentists at the University of Costa Rica from 2007 to 2014 was a population with an average age of entry of 18,4 years, Costa Rican, predominantly female, single, without children, from geographic areas within the Greater Metropolitan Area (GMA), graduated from public schools with an average admission exam grade of 612,2.

El objetivo de esta investigación fue determinar algunas de las características sociodemográficas y académicas de los estudiantes que ingresaron a la carrera de Odontología en el período 2007 al 2014. Se recopilaron los datos de 673 expedientes de los estudiantes. Las variables consideradas fueron: sexo, edad de ingreso, estado civil, hijos, nacionalidad, lugar de procedencia, colegio de procedencia y nota de examen de admisión. Los datos se obtuvieron de la base de datos del Sistema de Aplicaciones Estudiantiles (SAE), los expedientes físicos y del Tribunal Supremo de Elecciones de Costa Rica. Se realizó estadística descriptiva estableciendo la frecuencia absoluta y relativa de las variables. Se empleó el test de Mann Whitney para determinar si existían diferencias estadísticamente significativas entre el examen de admisión y las variables sociodemográficas establecidas (p<0,05, IC 95%). El 68,4% de los estudiantes pertenecen al sexo femenino. La edad promedio fue de 18,4 años (DS=2,41). El 99,0% de los discentes son de nacionalidad costarricense. El 99,3% eran solteros y sólo el 0,9% tenían hijos. La mayor cantidad de estudiantes ingresaron por examen de admisión (78,9%) y el 50,7% cursó sus estudios en un colegio público. Respecto al domicilio, el 77,9% de los sujetos residían en el Gran Área Metropolitana. El promedio de nota del examen de admisión fue de 613,8 (DS=49,95). Hubo una diferencia estadísticamente significativa entre la nota del examen de admisión y los diferentes tipos de colegios de procedencia. El grupo de estudiantes que ingresaron a formarse como Odontólogos en la Universidad de Costa Rica en el periodo de 2007 al 2014 fue una población con un promedio una edad de ingreso de 18,4 años predominantemente femenina, costarricense, soltera, sin hijos, proveniente de áreas geográficas dentro del Gran Área Metropolitana (GAM), egresadas de colegios públicos con un promedio de nota de examen de admisión de 612,2.

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AIM: This study evaluated the association between risk of malnutrition and performance status, and mortality in hospitalized breast cancer patients. METHODS: Prospective cohort study with hospitalized breast cancer patients evaluated at a referral Cancer Center. The Risk of malnutrition was assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) and performance status was determined using the Eastern Cooperative Oncology Group Performance Status Scale (ECOG PS). Logistic regression was used to analyze the factors associated with death, using the odds ratio (OR) with a 95% confidence interval (CI) as an effect measure. RESULTS: A total of 195 woman were included, with a mean age of 56.3 (±12.6) years. Patients with an overall PG-SGA score ≥18 (OR: 2.11; 95% CI: 1.03-4.62) and ECOG PS ≥ 3 (OR: 3.34; 95% CI: 1.48-7.52) had a higher occurrence of death during hospitalization, regardless of age or disease stage. The concomitant presence of these two factors improved the accuracy of the association (OR: 5.32; 95% CI: 3.11-9.76) and showed good predictive accuracy (C-statistics: 0.77). CONCLUSION: Nutritional risk and poor performance status were associated with a higher occurrence of death in women with breast cancer. The use of these two indicators improves their predictive accuracy for mortality.

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OBJECTIVES: To evaluate in a preplanned secondary analysis of our parent randomized controlled trial predictors of intensive care unit (ICU) admission in infants with bronchiolitis and analyze if these predictors are equally robust for children receiving high-flow or standard-oxygen. STUDY DESIGN: A secondary analysis of a multicenter, randomized trial of infants aged <12 months with bronchiolitis and an oxygen requirement was performed using admission and outcome data of all 1472 enrolled infants. The primary outcome was ICU admission. The predictors evaluated were baseline characteristics including physiological data and medical history. RESULTS: Of the 1472 enrolled infants, 146 were admitted to intensive care. Multivariate predictors of ICU admission were age (weeks) (OR: 0.98 [95% CI: 0.96-0.99]), pre-enrolment heart rate >160/min (OR: 1.80 [95% CI: 1.23-2.63]), pre-enrolment SpO2 (transcutaneous oxygen saturation) (%) (OR: 0.91 [95% CI: 0.86-0.95]), previous ICU admission (OR: 2.16 [95% CI: 1.07-4.40]), and time of onset of illness to hospital presentation (OR: 0.78 [95% CI: 0.65-0.94]). The predictors were equally robust for infants on high-flow nasal cannula therapy or standard-oxygen therapy. CONCLUSION: Age <2 months, pre-enrolment heart rate >160/min, pre-enrolment SpO2 of <87%, previous ICU admission and time of onset of ≤2 days to presentation are predictive of an ICU admission during the current hospital admission of infants with bronchiolitis independent of oxygenation method used. TRIAL REGISTRATION: ACTRN12613000388718.

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Background: Intubation rates up to 33% have been found in patients diagnosed with COVID-19. Some cohorts have reported the presence of dyspnea in 84.1% of intubated patients, being this the only symptom associated with intubation. Oxygen saturation < 90% and increased respiratory rate have also been described as predictors of intubation. Objective: To analyze the risk factors associated with intubation in patients hospitalized for COVID-19 at their admission. Material and methods: An observational, retrospective, analytical, cross-sectional study was carried out. The universe of study consisted of patients over 18 years of age hospitalized due to a diagnosis of SARS-CoV-2 virus infection from April 1, 2020 to April 31, 2021 in the Hospital de Especialidades (Specialties Hospital) "Dr. Bernardo Sepúlveda Gutiérrez" at the National Medical Center. Results: The mean age of intubated patients was 59.17 years (95% confidence interval [95% CI] -9.994 to -3.299, p < 0.001). Overall, 76.7% (230) of patients had a history of one or more preexisting comorbidities, including hypertension in 42.3% (127), obesity in 36.7% (110), and diabetes mellitus in 34.3% (103). Conclusions: The main clinical characteristics of patients hospitalized for COVID-19 in our center who required intubation are very similar to those observed in different centers, including male sex, age over 50 years and obesity, which were the most common.

Introducción: se han encontrado tasas de intubación de hasta 33% en pacientes con diagnóstico de COVID-19. Algunas cohortes han informado la presencia de disnea en el 84.1% de los pacientes intubados y este ha sido el único síntoma asociado con la intubación. La saturación de oxígeno < 90% y el aumento de la frecuencia respiratoria también han sido descritos como predictores de intubación. Objetivo: analizar los factores de riesgo asociados a intubación en pacientes con COVID-19 al momento de su admisión hospitalaria. Material y métodos: se realizó un estudio observacional, transversal, analítico y retrospectivo. El universo de estudio consistió en pacientes mayores de 18 años, hospitalizados por diagnóstico de infección por virus SARS-CoV-2 del 1 abril de 2020 al 31 abril de 2021 en el Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez" del Centro Médico Nacional. Resultados: se analizaron un total de 300 pacientes. La media de edad de los pacientes intubados fue de 59.17 años (p < 0.001, intervalo de confianza del 95% [IC 95%] −9.994 a −3.299). En general, el 76.7% (230) de los pacientes tenía antecedentes de una o más comorbilidades preexistentes, incluida la hipertensión en 42.3% (127), la obesidad en 36.7% (110) y la diabetes mellitus en 34.3% (103). Conclusiones: las principales características clínicas de los pacientes hospitalizados por COVID-19 en nuestro centro que requirieron de intubación son muy similares a las observadas en distintos centros, entre ellas el sexo masculino, la edad mayor de 50 años y la obesidad, que fueron las más prevalentes.

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Introdução: A tuberculose é causada pelo bacilo de Koch que atinge principalmente os pulmões. Contudo, uma pequena parcela, cerca de 15%, se desenvolve em outras estruturas corporais, como na laringe, gânglios, pleura, pele, intestinos, ossos e meninge, sendo denominada, tuberculose extrapulmonar. Sua transmissão ocorre por meio de aerossóis provenientes do sistema respiratório que após eliminadas, ficam suspensas no ar e/ou permanecem viáveis por um período no ambiente. No Brasil, no ano de 2020 estima-se que o número de óbitos foi de 4.543 pessoas, o coeficiente de mortalidade manteve-se de 2,3 por 100.000 habitantes e ao todo 36.000 foram infectadas. Objetivo: Evidenciar os principais desafios do enfermeiro no tratamento aos pacientes com tuberculose pulmonar nos espaços de assistência à saúde. Material e métodos: O estudo constitui-se de uma revisão de literatura, do tipo narrativa e de natureza descritiva, tendo como base teórica artigos científico acadêmicos. Para conduzir a revisão foram selecionadas as bases de dados Scielo e Biblioteca Virtual em Saúde: LILACS. Nisso, foram pautados artigos completos para levantamento de pesquisa em um período de até 5 anos. Resultados/Discussão: O modelo final desta revisão foi composto por nove artigos publicados entre os anos de 2019 e 2022. O presente estudo torna notório o importante papel da enfermagem no diagnóstico precoce na assistência primária, assim como na atuação de atividades para educação dos civis sobre promoção de saúde e prevenção de doenças. Entretanto, a falta de profissionais capacitados e a necessidade de maior participação da equipe multiprofissional representam as maiores problemáticas que cercam este estudo. A partir da leitura dos artigos tornou-se relevante segregar quatro tópicos que nortearam a discussão desta análise, são eles: Acessibilidade, incompletude de prontuários, renda familiar/estigma social e fortalecimento das estratégias de atendimento. Em relação a incompletude dos prontuários, notou-se que os enfermeiros que participaram da pesquisa delimitavam-se aos sinais e sintomas físicos dos pacientes e negligenciaram outros fatores, sendo uma influência do histórico do modelo biomédico, o que prejudica a integralidade da assistência à saúde. Esses indícios devem ser corrigidos, visto que outros métodos devem ser incluídos como fonte de informação para a assistência integral ao paciente. Identificou-se a necessidade de otimizar os registros no prontuário e reiterar a importância dessa prática para evitar que a real situação a respeito da TB seja disfarçada e haja tomada de decisões não condizentes e errôneas. Ademais, o fortalecimento das estratégias de enfrentamento da atenção primária é de tamanha importância, já que sua falta compromete a detecção precoce da doença, o tratamento adequado e a prevenção da disseminação da doença. Por fim, o enfermeiro tem o papel de orientar a população sobre meios de contaminação, buscar casos de TB e educar sobre os benefícios e malefícios do tratamento e da não adesão dele. Considerações finais: Conclui-se ser necessário uma padronização da conduta do enfermeiro, que deve incluir acesso integral aos doentes, acompanhamento do uso da medicação, teste rápidos, além de incentivar uma abordagem individualizada para os pacientes com tuberculose.

Introduction: Tuberculosis is caused by Koch's bacillus that mainly affects the lungs. However, a small portion, about 15%, develops in other body structures, such as the larynx, ganglia, pleura, skin, intestines, bones, and meninges, and is termed extrapulmonary tuberculosis. Its transmission occurs by means of aerosols coming from the respiratory system that, after being eliminated, remain suspended in the air and/or remain viable for a period in the environment. In Brazil, in the year 2020 it is estimated that the number of deaths was 4,543 people, the mortality coefficient remained 2.3 per 100,000 inhabitants and in all 36,000 were infected. Objective: To highlight the main challenges of the nurse in the treatment of patients with pulmonary tuberculosis in the health care spaces. Material and methods: The study consists of a review of literature, narrative type and descriptive nature, based on theoretical academic scientific articles. To conduct the review, the Scielo and Virtual Health Library databases were selected: LILACS. In this respect, full papers for the survey of research in a period of up to 5 years were drawn up. Results/Discussion: The final model of this review was composed of nine articles published between 2019 and 2022. The present study makes well known the important role of nursing in early diagnosis in primary care, as well as in the performance of activities for educating civilians about health promotion and disease prevention. However, the lack of skilled professionals and the need for greater participation of the multiprofessional team represent the biggest problems surrounding this study. From the reading of the articles, it became relevant to segregate four topics that guided the discussion of this analysis, are: Accessibility, incompleteness of medical records, family income/social stigma and strengthening of care strategies. Regarding the incompleteness of the medical records, it was noted that the nurses who participated in the research were limited to the physical signs and symptoms of the patients and neglected other factors, being an influence of the history of the biomedical model, which impairs the completeness of the health care. These indications should be corrected, as other methods should be included as a source of information for comprehensive patient care. The need to optimize the records in the medical record was identified and the importance of this practice was reiterated, to avoid the real situation with regard to TB being disguised and inconsistent and erroneous decisions being taken. Furthermore, the strengthening of strategies for coping with primary care is of such importance, since its lack compromises the early detection of the disease, the adequate treatment and the prevention of the dissemination of the disease. Finally, the nurse has the role of giving guidance to the population about means of contamination, of looking for cases of TB, and of educating about the benefits and harms of the treatment and of not adhering to it. Conclusion: It is concluded that a standardization of the nurse's conduct is necessary, which should include full access to patients, follow-up of the use of medication, rapid tests, besides encouraging an individualized approach for patients with tuberculosis.

Introducción: La tuberculosis es causada por el bacilo de Koch que afecta principalmente a los pulmones. Sin embargo, una pequeña porción, cercana al 15%, se desarrolla en otras estructuras corporales, como la laringe, ganglia, pleura, piel, intestinos, huesos y meninges, siendo llamada tuberculosis extrapulmonar. Su transmisión se realiza por medio de aerosoles procedentes del sistema respiratorio que, después de ser eliminados, se suspenden en el aire y/o permanecen viables durante un período en el medio ambiente. En el Brasil, en el año 2020, se estima que el número de fallecimientos fue de 4.543 personas, que el coeficiente de mortalidad se mantuvo en 2,3 por 100.000 habitantes y que en total 36.000 resultaron infectados. Objetivo: poner de relieve los principales retos del tratamiento de enfermería para pacientes con tuberculosis pulmonar en las áreas de atención de la salud. Material y métodos: El estudio es una revisión de la literatura, del tipo narrativo y de naturaleza descriptiva, basada en artículos teóricos académicos científicos. Para llevar a cabo el examen, se seleccionaron las bases de datos de Scielo y Virtual Library on Health: LILACS. A este respecto, se elaboraron artículos completos para un estudio de investigación en un período de hasta cinco años. Resultados/Debate: El modelo final de esta revisión se compone de nueve artículos publicados entre 2019 y 2022. En este estudio se destaca el importante papel de la enfermería en el diagnóstico precoz en la atención primaria, así como en las actividades de educación de los civiles sobre la promoción de la salud y la prevención de enfermedades. Sin embargo, la falta de profesionales cualificados y la necesidad de una mayor participación del equipo multiprofesional son los mayores problemas que rodean este estudio. A partir de la lectura de los artículos, se hizo relevante separar cuatro temas que guiaron el debate de este análisis, a saber: accesibilidad, registros incompletos, ingresos familiares/estigma social y el fortalecimiento de las estrategias de asistencia. En relación con la inexhaustividad de los registros médicos, se observó que las enfermeras que participaron en la investigación se limitaban a los signos y síntomas físicos de los pacientes y descuidaban otros factores, siendo una influencia de la historia del modelo biomédico, lo que daña la integridad de la atención sanitaria. Estas indicaciones deben corregirse, ya que se deben incluir otros métodos como fuente de información para la atención completa del paciente. Se ha identificado la necesidad de optimizar los registros médicos digitales y de reiterar la importancia de esta práctica para evitar que la situación real de la tuberculosis sea disfrazada, indigna y errónea. Además, el fortalecimiento de las estrategias de atención primaria es de tal importancia, ya que su ausencia pone en peligro la detección precoz de la enfermedad, el tratamiento adecuado y la prevención de la diseminación de la enfermedad. Finalmente, la enfermera tiene el papel de guiar a la población sobre los medios de contaminación, buscando casos de tuberculosis y educándolos sobre los beneficios y daños del tratamiento y de su falta de cumplimiento. Consideraciones finales: Se concluye que es necesaria la estandarización de la conducta de la enfermera, que debe incluir el pleno acceso a los pacientes, el seguimiento del uso de medicamentos, las pruebas rápidas y el fomento de un enfoque individualizado para los pacientes de tuberculosis.

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Introduction: Bipolar disorder (BD) is a chronically progressive mental condition, associated with a reduced quality of life and greater disability. Patient admissions are preventable events with a considerable impact on global functioning and social adjustment. While machine learning (ML) approaches have proven prediction ability in other diseases, little is known about their utility to predict patient admissions in this pathology. Aim: To develop prediction models for hospital admission/readmission within 5 years of diagnosis in patients with BD using ML techniques. Methods: The study utilized data from patients diagnosed with BD in a major healthcare organization in Colombia. Candidate predictors were selected from Electronic Health Records (EHRs) and included sociodemographic and clinical variables. ML algorithms, including Decision Trees, Random Forests, Logistic Regressions, and Support Vector Machines, were used to predict patient admission or readmission. Survival models, including a penalized Cox Model and Random Survival Forest, were used to predict time to admission and first readmission. Model performance was evaluated using accuracy, precision, recall, F1 score, area under the receiver operating characteristic curve (AUC) and concordance index. Results: The admission dataset included 2,726 BD patients, with 354 admissions, while the readmission dataset included 352 patients, with almost half being readmitted. The best-performing model for predicting admission was the Random Forest, with an accuracy score of 0.951 and an AUC of 0.98. The variables with the greatest predictive power in the Recursive Feature Elimination (RFE) importance analysis were the number of psychiatric emergency visits, the number of outpatient follow-up appointments and age. Survival models showed similar results, with the Random Survival Forest performing best, achieving an AUC of 0.95. However, the prediction models for patient readmission had poorer performance, with the Random Forest model being again the best performer but with an AUC below 0.70. Conclusion: ML models, particularly the Random Forest model, outperformed traditional statistical techniques for admission prediction. However, readmission prediction models had poorer performance. This study demonstrates the potential of ML techniques in improving prediction accuracy for BD patient admissions.