ABSTRACT Objective To describe the clinical characteristics and treatment of children with sepsis, severe sepsis, and septic shock at a pediatric emergency department of a public hospital. Methods A retrospective, observational study. The medical records of patients included in the hospital Pediatric Sepsis Protocol and patients with discharge ICD-10 A41.9 (sepsis, unspecified), R57 (shock) and A39 (meningococcal meningitis) were evaluated. Results A total of 399 patients were included. The prevalence of sepsis, severe sepsis, and septic shock at the emergency room were 0.41%, 0.14% and 0.014%, respectively. The median age was 21.5 months for sepsis, 12 months for severe sepsis, and 20.5 months for septic shock. Sepsis, severe sepsis, and septic shock were more often associated with respiratory diseases. The Respiratory Syncytial Virus was the most common agent. The median time to antibiotic and fluid administration was 3 hours in patients with sepsis and severe sepsis. In patients with septic shock, the median times to administer antibiotics, fluid and vasoactive drugs were 2 hours, 2.5 hours and 6 hours, respectively. The median length of hospital stay for patients with sepsis, severe sepsis and septic shock were 3 days, 4 days and 1 day, respectively. The overall mortality was 2%. Conclusion Sepsis had a low prevalence. Early diagnosis and recognition are a challenge for the emergency care pediatrician, the first place of admission.

ABSTRACT Objective To develop and validate a high-risk predictive model that identifies, at least, one common adverse event in older population: early readmission (up to 30 days after discharge), long hospital stays (10 days or more) or in-hospital deaths. Methods This was a retrospective cohort study including patients aged 60 years or older (n=340) admitted at a 630-beds tertiary hospital, located in the city of São Paulo, Brazil. A predictive model of high-risk indication was developed by analyzing logistical regression models. This model prognostic capacity was assessed by measuring accuracy, sensitivity, specificity, and positive and negative predictive values. Areas under the receiver operating characteristic curve with 95% confidence intervals were also obtained to assess the discriminatory power of the model. Internal validation of the prognostic model was performed in a separate sample (n=168). Results Statistically significant predictors were identified, such as current Barthel Index, number of medications in use, presence of diabetes mellitus, difficulty chewing or swallowing, extensive surgery, and dementia. The study observed discrimination model acceptance in the construction sample 0.77 (95% confidence interval: 0.71-0.83) and good calibration. The characteristics of the validation samples were similar, and the receiver operating characteristic curve area was 0.687 (95% confidence interval: 0.598-0.776). We could assess an older patient’s adverse health events during hospitalization after admission. Conclusion A predictive model with acceptable discrimination was obtained, with satisfactory results for early readmission (30 days), long hospital stays (10 days), or in-hospital death.

ABSTRACT Objective To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. Methods A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). Results Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. “First contact access – use”, “longitudinality” and “coordination – information system” were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. Conclusion The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.

ABSTRACT Objective: To analyze the factors associated with the SARS-CoV-2 infection among oral health professionals. Material and Methods: This was a cross-sectional study in the city of São Paulo, São Paulo State, Brazil. Professionals from three different categories were included: dental surgeons (DS), dental assistants (DA), and dental hygienists (DH). A questionnaire was created on a digital platform and sent via institutional email to each subject. The questionnaire contained 32 questions about sociodemographic, work, and behavior factors. The data about SARS-CoV-2 infection was confirmed through RT-PCR exams. Descriptive (absolute and relative frequencies) and inferential analyses (chi-squared or Fisher’s exact test) (p<0.05) were performed. Results: There was a SARS-CoV-2 infection prevalence of 3.8% for DS, 30.0% for DH, and 33.3% for DA. SARS-CoV-2 was associated with a lower income (p=0.027), a lower education level (p=0.011), the category of technical professionals (DA and DH) (p=0.025), and using public transportation to commute to work (p=0.009). Conclusion: Sociodemographic factors like lower income and education levels and work factors like job category and public transportation were associated with COVID-19 among professionals on the oral health teams.

Objective to evaluate the effect of an educational program on blood pressure recording for nursing professionals in relation to theoretical knowledge and the quality of these records. Method quasi-experimental study conducted in a hospital service located in the city of São Paulo. The theoretical knowledge of 101 professionals was measured using a validated questionnaire before and after the educational intervention; the quality of blood pressure records was evaluated using a validated form which was applied to 354 records in the pre-intervention period and 288 in the post-intervention period. The educational program was based on active teaching-learning methodologies and consisted of two strategies: expository/dialogue class and a board game. The Wilcoxon, Mann-Whitney, Fisher and Chi-Square tests were used for comparisons, adopting a level of significance of α=0.05. Results the median of the professionals’ scores increased from 19 to 22 points in the post-intervention period (p<0.001). There was an improvement in the quality of the blood pressure recordings regarding the variables: cuff size (p<0.001), arm used in the procedure (p<0.001) and patient position (p<0.001). Conclusion the educational program showed positive results in the promotion of knowledge among nursing professionals and in the improvement of the quality of blood pressure recording.

Objetivo evaluar el efecto de un programa educativo sobre el registro de la presión arterial para profesionales de enfermería en relación al conocimiento teórico y a la calidad de esos registros. Método estudio cuasi-experimental conducido en un servicio hospitalario ubicado en la ciudad de São Paulo. El conocimiento teórico de 101 profesionales fue medido a través de un cuestionario validado antes y después de la intervención educativa; la calidad de los registros de la presión arterial fue evaluada utilizando formulario validado y aplicado a 354 prontuarios en el período pre-intervención y 288 en el período post-intervención. El programa educativo fue fundamentado en metodologías activas de enseñanza-aprendizaje y constituido por dos estrategias: clase expositiva-dialogada y un juego de tablero. Las pruebas de Wilcoxon, Mann-Whitney, Fisher y Qui-cuadrado se utilizaron para comparaciones, adoptando un nivel de significancia de α=0,05. Resultados la mediana de aciertos de los profesionales pasó de 19 a 22 puntos en el período post-intervención (p<0,001). Se observó una mejoría en la calidad de los registros de presión arterial en cuanto a las variables: tamaño del manguito (p<0,001), miembro utilizado en el procedimiento (p<0,001) y posición del paciente (p<0,001). Conclusión el programa educativo mostró resultados positivos en la promoción del conocimiento de los profesionales de enfermería y en la mejora de la calidad de los registros de la presión arterial.

Objetivo avaliar o efeito de um programa educativo sobre o registro da pressão arterial para profissionais de enfermagem em relação ao conhecimento teórico e à qualidade desses registros. Método estudo quase-experimental conduzido em um serviço hospitalar localizado no município de São Paulo. O conhecimento teórico de 101 profissionais foi mensurado por meio de questionário validado antes e após a intervenção educativa. A qualidade dos registros da pressão arterial foi avaliada utilizando-se formulário validado e aplicado a 354 prontuários no período pré-intervenção e 288 no período pós-intervenção. O programa educativo foi fundamentado em metodologias ativas de ensino-aprendizagem e constituído por duas estratégias: aula expositiva-dialogada e um jogo de tabuleiro. Os testes de Wilcoxon, Mann-Whitney, Fisher e Qui-Quadrado foram utilizados para comparações, adotando-se um nível de significância de α=0,05. Resultados a mediana de acertos dos profissionais passou de 19 para 22 pontos no período pós-intervenção (p<0,001). Houve melhora na qualidade dos registros de pressão arterial quanto às variáveis tamanho do manguito (p<0,001), membro utilizado no procedimento (p<0,001) e posição do paciente (p<0,001). Conclusão o programa educativo mostrou resultados positivos na promoção do conhecimento dos profissionais de enfermagem e na melhora da qualidade dos registros da pressão arterial.

RESUMO: Introdução: A glicemia de jejum é um teste usado para o monitoramento do diabetes mellitus, bem como para seu rastreamento e diagnóstico. O objetivo do estudo foi analisar resultados de glicemia de jejum de pacientes da rede pública e sua correlação com hemoglobina glicada e lipídios. Métodos: Estudo transversal, com 77.581 pacientes, atendidos em 2014. Resultados: A maioria é do sexo feminino (65%), com idade entre 18 e 115 anos (53 ± 15,5 anos). A concordância entre glicemia de jejum e hemoglobina glicada foi moderada (Kappa = 0,416), entretanto foi substancial para níveis compatíveis com diabetes (Kappa = 0,689) e pobre para pré-diabetes (Kappa = 0,188). Glicemia de jejum ≥ 100 mg/dL foi encontrada em 41,1% dos pacientes e hemoglobina glicada ≥ 5,7% em 61,5%. As alterações lipídicas são mais frequentes nos indivíduos com alterações na glicemia. Dos 14.241 indivíduos com glicemia de jejum ≥ 126 mg/dL, a microalbuminúria foi pesquisada em apenas 883 (6,2%) indivíduos, com resultado alterado em 201 (22,8%). Conclusões: Nos indivíduos que realizaram mais de uma dosagem de glicemia de jejum, a maioria permaneceu com exames alterados, principalmente os que apresentavam valores compatíveis com o diagnóstico de diabetes, sugerindo que não conseguem um controle adequado. A baixa frequência de pesquisa de microalbuminúria em indivíduos com glicemia de jejum sugestiva de diabetes reflete a pequena preocupação com o rastreio de suas complicações crônicas. A elevada frequência de dislipidemia nesses indivíduos evidencia ser uma população de elevado risco cardiovascular.

ABSTRACT: Introduction: Fasting glucose is a test used for monitoring diabetes mellitus, as well as its screening and diagnosis. The objective of this study was to evaluate fasting glucose results and their correlation with glycated hemoglobin and lipids. Methods: Cross-sectional study, involving 77,581 patients, attended in 2014. Results: The majority of the patients are women (65%). The age of the patients ranged from 18 to 115 years (mean of 53 ± 15.5). The agreement between fasting glucose and glycated hemoglobin was moderate (kappa = 0.416); however, it was substantial for the levels used for the diagnosis of diabetes (kappa = 0.689) and poor for pre-diabetes (kappa = 0.188). Fasting glucose ≥ 100 mg/dL was observed in 41.1% of the patients and 61.5% present glycated hemoglobin ≥ 5.7%. Lipid abnormalities are likeliest in patients with elevated fasting glucose. From those 14,241 individuals that had fasting glucose ≥ 126 mg/dL, the microalbuminuria test was performed in only 883 (6.2%) patients, with abnormal results in 201 (22.8%). Conclusions: The high frequency of fasting glucose with abnormal results may reflect the high proportion of exams performed by individuals with diagnosis of diabetes, to evaluate their glycemic control. The low frequency of requests for microalbuminuria tests in those with probable diagnosis of diabetes reflects the little attention paid for the screening of chronic complications of diabetes. It calls attention the high frequency of dyslipidemia in those individuals, highlighting the fact that this is a population with high cardiovascular risk.

RESUMO: Introdução: A glicemia de jejum é um teste usado para o monitoramento do diabetes mellitus, bem como para seu rastreamento e diagnóstico. O objetivo do estudo foi analisar resultados de glicemia de jejum de pacientes da rede pública e sua correlação com hemoglobina glicada e lipídios. Métodos: Estudo transversal, com 77.581 pacientes, atendidos em 2014. Resultados: A maioria é do sexo feminino (65%), com idade entre 18 e 115 anos (53 ± 15,5 anos). A concordância entre glicemia de jejum e hemoglobina glicada foi moderada (Kappa = 0,416), entretanto foi substancial para níveis compatíveis com diabetes (Kappa = 0,689) e pobre para pré-diabetes (Kappa = 0,188). Glicemia de jejum ≥ 100 mg/dL foi encontrada em 41,1% dos pacientes e hemoglobina glicada ≥ 5,7% em 61,5%. As alterações lipídicas são mais frequentes nos indivíduos com alterações na glicemia. Dos 14.241 indivíduos com glicemia de jejum ≥ 126 mg/dL, a microalbuminúria foi pesquisada em apenas 883 (6,2%) indivíduos, com resultado alterado em 201 (22,8%). Conclusões: Nos indivíduos que realizaram mais de uma dosagem de glicemia de jejum, a maioria permaneceu com exames alterados, principalmente os que apresentavam valores compatíveis com o diagnóstico de diabetes, sugerindo que não conseguem um controle adequado. A baixa frequência de pesquisa de microalbuminúria em indivíduos com glicemia de jejum sugestiva de diabetes reflete a pequena preocupação com o rastreio de suas complicações crônicas. A elevada frequência de dislipidemia nesses indivíduos evidencia ser uma população de elevado risco cardiovascular.

ABSTRACT: Introduction: Fasting glucose is a test used for monitoring diabetes mellitus, as well as its screening and diagnosis. The objective of this study was to evaluate fasting glucose results and their correlation with glycated hemoglobin and lipids. Methods: Cross-sectional study, involving 77,581 patients, attended in 2014. Results: The majority of the patients are women (65%). The age of the patients ranged from 18 to 115 years (mean of 53 ± 15.5). The agreement between fasting glucose and glycated hemoglobin was moderate (kappa = 0.416); however, it was substantial for the levels used for the diagnosis of diabetes (kappa = 0.689) and poor for pre-diabetes (kappa = 0.188). Fasting glucose ≥ 100 mg/dL was observed in 41.1% of the patients and 61.5% present glycated hemoglobin ≥ 5.7%. Lipid abnormalities are likeliest in patients with elevated fasting glucose. From those 14,241 individuals that had fasting glucose ≥ 126 mg/dL, the microalbuminuria test was performed in only 883 (6.2%) patients, with abnormal results in 201 (22.8%). Conclusions: The high frequency of fasting glucose with abnormal results may reflect the high proportion of exams performed by individuals with diagnosis of diabetes, to evaluate their glycemic control. The low frequency of requests for microalbuminuria tests in those with probable diagnosis of diabetes reflects the little attention paid for the screening of chronic complications of diabetes. It calls attention the high frequency of dyslipidemia in those individuals, highlighting the fact that this is a population with high cardiovascular risk.

Objetivo avaliar o efeito de um programa educativo sobre o registro da pressão arterial para profissionais de enfermagem em relação ao conhecimento teórico e à qualidade desses registros. Método estudo quase-experimental conduzido em um serviço hospitalar localizado no município de São Paulo. O conhecimento teórico de 101 profissionais foi mensurado por meio de questionário validado antes e após a intervenção educativa. A qualidade dos registros da pressão arterial foi avaliada utilizando-se formulário validado e aplicado a 354 prontuários no período pré-intervenção e 288 no período pós-intervenção. O programa educativo foi fundamentado em metodologias ativas de ensino-aprendizagem e constituído por duas estratégias: aula expositiva-dialogada e um jogo de tabuleiro. Os testes de Wilcoxon, Mann-Whitney, Fisher e Qui-Quadrado foram utilizados para comparações, adotando-se um nível de significância de α=0,05. Resultados a mediana de acertos dos profissionais passou de 19 para 22 pontos no período pós-intervenção (p<0,001). Houve melhora na qualidade dos registros de pressão arterial quanto às variáveis tamanho do manguito (p<0,001), membro utilizado no procedimento (p<0,001) e posição do paciente (p<0,001). Conclusão o programa educativo mostrou resultados positivos na promoção do conhecimento dos profissionais de enfermagem e na melhora da qualidade dos registros da pressão arterial.

Objective to evaluate the effect of an educational program on blood pressure recording for nursing professionals in relation to theoretical knowledge and the quality of these records. Method quasi-experimental study conducted in a hospital service located in the city of São Paulo. The theoretical knowledge of 101 professionals was measured using a validated questionnaire before and after the educational intervention; the quality of blood pressure records was evaluated using a validated form which was applied to 354 records in the pre-intervention period and 288 in the post-intervention period. The educational program was based on active teaching-learning methodologies and consisted of two strategies: expository/dialogue class and a board game. The Wilcoxon, Mann-Whitney, Fisher and Chi-Square tests were used for comparisons, adopting a level of significance of α=0.05. Results the median of the professionals’ scores increased from 19 to 22 points in the post-intervention period (p<0.001). There was an improvement in the quality of the blood pressure recordings regarding the variables: cuff size (p<0.001), arm used in the procedure (p<0.001) and patient position (p<0.001). Conclusion the educational program showed positive results in the promotion of knowledge among nursing professionals and in the improvement of the quality of blood pressure recording.

Objetivo evaluar el efecto de un programa educativo sobre el registro de la presión arterial para profesionales de enfermería en relación al conocimiento teórico y a la calidad de esos registros. Método estudio cuasi-experimental conducido en un servicio hospitalario ubicado en la ciudad de São Paulo. El conocimiento teórico de 101 profesionales fue medido a través de un cuestionario validado antes y después de la intervención educativa; la calidad de los registros de la presión arterial fue evaluada utilizando formulario validado y aplicado a 354 prontuarios en el período pre-intervención y 288 en el período post-intervención. El programa educativo fue fundamentado en metodologías activas de enseñanza-aprendizaje y constituido por dos estrategias: clase expositiva-dialogada y un juego de tablero. Las pruebas de Wilcoxon, Mann-Whitney, Fisher y Qui-cuadrado se utilizaron para comparaciones, adoptando un nivel de significancia de α=0,05. Resultados la mediana de aciertos de los profesionales pasó de 19 a 22 puntos en el período post-intervención (p<0,001). Se observó una mejoría en la calidad de los registros de presión arterial en cuanto a las variables: tamaño del manguito (p<0,001), miembro utilizado en el procedimiento (p<0,001) y posición del paciente (p<0,001). Conclusión el programa educativo mostró resultados positivos en la promoción del conocimiento de los profesionales de enfermería y en la mejora de la calidad de los registros de la presión arterial.

Este estudo revisa alguns artigos com delineamento do tipo caso-controle em que se tem os casos classificados em dois ou mais tipos. A aplicação de modelos para respostas multinomiais e a adequabilidade destes aos estudos caso-controle é discutida. Dentre os ajustes possíveis, argumenta-se que o modelo logístico Politômico é o mais indicado para a obtenção de medidas epidemiológicas de risco e associação neste tipo de delineamento. Como ilustração, apresenta-se uma aplicação desse modelo em um estudo caso-controle de base populacional, comparando os resultados com aqueles obtidos em um ajuste logístico binomial. A abordagem multinomial possibilita investigar, em uma única análise, a ocorrência de associações entre co-variáveis e uma ou algumas das classes de casos estudados, abrindo a possibilidade, de grande interesse epidemiológico, de identificação de fatores de risco e de proteção individualizados para cada subgrupo de interesse.

This study reviews articles on case-control studies in which the cases were classified in two or more types. Application of multinomial models and their adequacy for case-control studies are discussed. Among the available multinomial adjustments, we argue that the polytomous logistic model is the most suitable for obtaining epidemiological measures of risk and association in case-control studies. By way of illustration, we present an application of this model in a population-based case-control study, comparing the results with those obtained in a binomial logistic model. The multinomial approach allows investigating, in a single analysis, the occurrence of associations between covariates and more or more subclasses of cases, thus providing the epidemiologically relevant possibility of identifying individualized risk and protective factors for each subclass.

Este estudo revisa alguns artigos com delineamento do tipo caso-controle em que se tem os casos classificados em dois ou mais tipos. A aplicação de modelos para respostas multinomiais e a adequabilidade destes aos estudos caso-controle é discutida. Dentre os ajustes possíveis, argumenta-se que o modelo logístico Politômico é o mais indicado para a obtenção de medidas epidemiológicas de risco e associação neste tipo de delineamento. Como ilustração, apresenta-se uma aplicação desse modelo em um estudo caso-controle de base populacional, comparando os resultados com aqueles obtidos em um ajuste logístico binomial. A abordagem multinomial possibilita investigar, em uma única análise, a ocorrência de associações entre co-variáveis e uma ou algumas das classes de casos estudados, abrindo a possibilidade, de grande interesse epidemiológico, de identificação de fatores de risco e de proteção individualizados para cada subgrupo de interesse.

This study reviews articles on case-control studies in which the cases were classified in two or more types. Application of multinomial models and their adequacy for case-control studies are discussed. Among the available multinomial adjustments, we argue that the polytomous logistic model is the most suitable for obtaining epidemiological measures of risk and association in case-control studies. By way of illustration, we present an application of this model in a population-based case-control study, comparing the results with those obtained in a binomial logistic model. The multinomial approach allows investigating, in a single analysis, the occurrence of associations between covariates and more or more subclasses of cases, thus providing the epidemiologically relevant possibility of identifying individualized risk and protective factors for each subclass.