Einstein-Sao Paulo最新文献

{"title":"Brazil's benign breast disease care profile and geospatial analysis.","authors":"Dayan Sansone, Daniela Farah, Afonso Celso Pinto Nazario, Marcelo Cunio Machado Fonseca","doi":"10.31744/einstein_journal/2025AO1132","DOIUrl":"10.31744/einstein_journal/2025AO1132","url":null,"abstract":"<p><strong>Background: </strong>We conducted a quantitative and geospatial analysis of coverage and displacement for the diagnosis and treatment of benign breast illnesses in Brazil's Unified Health System between 2008 and 2019. The results showed that treatment coverage and female displacement differed by region. The North and Midwest have different coverage and displacement rates compared with the other three major regions of the country. These findings demonstrate the importance of addressing gaps in healthcare service access, irrespective of their source, by enhancing the service capacity of existing institutions and ensuring that the healthcare system appropriately allocates resources.</p><p><strong>Objective: </strong>To quantitatively and geospatially analyze coverage and displacement for the diagnosis and treatment of benign breast diseases in the Brazilian Unified Health System between 2008 and 2019.</p><p><strong>Methods: </strong>Datasets from the Brazilian Ministry of Health were used to survey medical care for benign breast diseases in Brazil from 2008 to 2019. These data allowed for the determination of benign breast disease treatments, diagnoses, and patient displacement in each region of the country.</p><p><strong>Results: </strong>Most outpatient consultations were for diagnostic procedures. Approximately 4 million diagnostic procedures and 360,000 hospitalizations for treatment, of which 97% were surgeries, were conducted in this 12-year period. During this period, medical care for benign breast diseases cost more than USD 65 million. The treatment coverage and displacement rates of the female population differed by country region, with the North and Midwest showing patterns different from those of the other three major regions.</p><p><strong>Conclusion: </strong>Addressing disparities in healthcare service access, regardless of their source, by increasing the service capacity of existing facilities and ensuring correct resource allocation by the healthcare system is crucial.</p><p><strong>Background: </strong>■ Most outpatient consultations comprised diagnostic procedures.</p><p><strong>Background: </strong>■ In the past 12 years, medical care for benign breast diseases has cost >USD 65 million.</p><p><strong>Background: </strong>■ Women from North and Midwest Brazil had higher diagnosis and treatment displacement rates.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1132"},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatorenal Syndrome: direct treatment costs and characteristics of patients admitted to intensive care.","authors":"Franciele Robes Hortelã, Rodrigo Sfredo Kruger, Valéria Filomena de Oliveira, Hipolito Carraro Junior, Dominique Araújo Muzzillo, Sérgio Candido Kowalski","doi":"10.31744/einstein_journal/2025GS0390","DOIUrl":"10.31744/einstein_journal/2025GS0390","url":null,"abstract":"<p><strong>Background: </strong>Hepatorenal Syndrome is a potentially reversible syndrome of endstage cirrhosis. It is a severe complication of cirrhosis that involves a high mortality rate and a significant economic impact on the healthcare system. This study shows the costs of the resources used for disease management and complications to be Int$14,189. Quantifying this figure contributes to an understanding of the economic impact of Hepatorenal Syndrome on patient survival.</p><p><strong>Objective: </strong>The purpose of this study was to describe the direct medical costs incurred in Brazil for the treatment of Hepatorenal Syndrome in intensive care and intermediate therapy care units, and to investigate the impact of this syndrome on patient survival.</p><p><strong>Methods: </strong>This longitudinal observational retrospective study included patients with Hepatorenal Syndrome admitted to the intensive and intermediate therapy care units of a public tertiary hospital. The cost generated by each patient was the sum of the direct costs and overheads.</p><p><strong>Results: </strong>Forty-four patients with 49 episodes of suspected Hepatorenal Syndrome were analyzed, 73% male, with a mean age of 55 years (SD= 11). Diagnosis was presumed in 21 episodes (43%), because not all of the Ascites International Club's criteria were met. Alcoholic cirrhosis was the main etiology (43%); 59% of the patients were Child-Pugh Class C at admission, with a mean (SD) model for end-stage liver disease score of 24.6 (8). Seventy-seven percent of the patients died, 32% from multiple organ failure, 29% of septic shock and 27% of hypovolemic shock. The median (IQR) of the total treatment cost for each patient was Int$14,819 (8,732-23,854). The median (IQR) length of intensive care unit stay in intensive care was 11 days (7-19). Patients with a presumed diagnosis did not have a higher hospitalization cost (p=0.249) than those with true Hepatorenal Syndrome.</p><p><strong>Conclusion: </strong>The treatment of Hepatorenal Syndrome represents a significant cost, and new resource allocation in strategic areas, such as the treatment and monitoring of patients with cirrhosis, is necessary to improve their outcomes.</p><p><strong>Background: </strong>■ The treatment of Hepatorenal Syndrome places a huge economic burden on healthcare systems.</p><p><strong>Background: </strong>■ Cost analysis studies of Hepatorenal Syndrome management can help to rationally allocate resources in healthcare.</p><p><strong>Background: </strong>■ Timely diagnosis and management of Hepatorenal Syndrome may reduce mortality, resource utilization and costs.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eGS0390"},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of liver transplantation on the quality of life of a cohort of high-risk recipients.","authors":"Heloisa Barboza Paglione, Daisa de Mesquita Escobosa, Beatriz Mesquita Pimenta, Bianca Della-Guardia, Amanda Pinter Carvalheiro da Silva Boteon, Yuri Longatto Boteon","doi":"10.31744/einstein_journal/2025AO0565","DOIUrl":"10.31744/einstein_journal/2025AO0565","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation significantly improves the health-related quality of life of patients with cirrhosis and high MELD scores. This study highlights rapid health-related quality of life gains after transplantation that were sustained during the one-year follow-up period, emphasizing the role of multidisciplinary care in achieving these outcomes.</p><p><strong>Objective: </strong>To assess the effects of liver transplantation on the health-related quality of life of patients with cirrhosis on the waiting list for transplantation.</p><p><strong>Methods: </strong>This retrospective study analyzed HRQOL using the EQ-5D questionnaire before (T0), and 3 (T3), 6 (T6), and 12 (T12) months after, transplantation. The questionnaire comprised five health status scores, which were also combined into a single utility score. Changes in each dimension and in the utility score were examined.</p><p><strong>Results: </strong>A total of 212 patients were included in the study, with a mean age of 54 (SD, 12) years, and a median Model for End-Stage Liver Disease score of 17 (Q1= 11; Q3= 24). The most frequent etiology was chronic alcoholism (26.9%). Improvements in EQ-5D utility scores were registered at all post-transplantation time points compared to the score at T0: an increase of 0.22 points (p<0.001) at T3, 0.27 (p<0.001) at T6, and 0.268 (p<0.001) at T12. Scores increased over time in all domains of the EQ-5D.</p><p><strong>Conclusion: </strong>In a large sample of high-risk transplant recipients, a significant improvement in HRQOL occurred three months after transplantation, and was sustained over the one-year follow-up period.</p><p><strong>Background: </strong>■ Liver transplantation improves health-related quality of life in patients with cirrhosis and high MELD scores.</p><p><strong>Background: </strong>■ Significant health-related quality of life improvements occur within three months of transplantation.</p><p><strong>Background: </strong>■ Multidisciplinary care programs enhance post-iver transplantation physical and mental recovery.</p><p><strong>Background: </strong>■ Sustained health-related quality of life gains highlight the long-term benefits of liver transplantation.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0565"},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuron-specific enolase and Tau protein as biomarkers for sepsis-associated delirium: a cross-sectional pilot study.","authors":"Agnes Araújo Sardinha Pinto, Maira Mello de Carvalho, Juliana Bahia Santos, Rebeca Souza da Silva, Hermes Vieira Barbeiro, Luz Marina Gómez Gómez, Ian Ward Abdalla Maia, Júlio Flávio Meirelles Marchini, Flávia Barreto Garcez, Thiago Junqueira Avelino-Silva, Lucas de Moraes Soler, Matheus Menão Mochetti, Heraldo Possolo de Souza, Júlio Cesar Garcia Alencar","doi":"10.31744/einstein_journal/2025AO1244","DOIUrl":"10.31744/einstein_journal/2025AO1244","url":null,"abstract":"<p><strong>Background: </strong>In this study, Pinto et al. identified significantly higher levels of neuron-specific enolase and Tau protein in older patients with sepsis-associated delirium in the emergency department, suggesting the potential of these biomarkers as diagnostic tools in this population.</p><p><strong>Objective: </strong>Sepsis-associated delirium is a common cerebral manifestation in patients with sepsis, potentially caused by a combination of neuroinflammation and other neurophysiological disorders. This study investigated the expression of neuron-specific enolase and Tau protein as biomarkers in patients with sepsis-associated delirium. While neuron-specific enolase and Tau protein are known to be associated with brain injury, their diagnostic potential in patients with sepsis-associated delirium is not well understood.</p><p><strong>Methods: </strong>This cross-sectional pilot study evaluated plasma levels of neuron-specific enolase and Tau protein in patients with delirium and sepsis to explore their potential for identifying sepsis in patients admitted to the emergency department.</p><p><strong>Results: </strong>A total of 25 patients with delirium were analyzed, 56% of whom had sepsis. Patients with sepsis exhibited significantly higher neuron-specific enolase levels (2.7ng/mL [95%CI= 2.2-3.2] versus 1.3 ng/mL [95%CI= 0.8-2.5], p<0.003) and Tau protein levels (96.1pg/mL [95%CI= 77.0-111.3] versus 43.0pg/mL [95%CI= 31.2-84.5], p<0.003) compared to patients without sepsis. Neuron-specific enolase and Tau protein thresholds of >2.08ng/mL and >59.27pg/mL, respectively, demonstrated 90% specificity for identifying sepsis in patients.</p><p><strong>Conclusion: </strong>Neuron-specific enolase and Tau protein levels were significantly higher in patients with sepsis than in those without, underscoring their potential ability to identify the infectious etiology of delirium in older patients admitted to emergency departments. Clinical Trials #RBR-233bct.</p><p><strong>Background: </strong>■ Biomarkers of brain injury, such as neuron-specific enolase and Tau proteins, are higher in older patients with sepsis and delirium.</p><p><strong>Background: </strong>■ Diagnosing sepsis in patients with delirium can be challenging.</p><p><strong>Background: </strong>■ Early identification of sepsis is key to managing sepsisassociated delirium.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1244"},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing webcam-based eye-tracking during comic reading in the classroom: a feasibility study.","authors":"Jade Antunes Nascimento, Paulo Rodrigo Bazán, Raymundo Machado de Azevedo Neto, Edilene Santos Silva, Daniela Arruda Soares, Joana Bisol Balardin, Edson Amaro Junior","doi":"10.31744/einstein_journal/2025AO0911","DOIUrl":"10.31744/einstein_journal/2025AO0911","url":null,"abstract":"<p><strong>Background: </strong>Webcam-based eye tracking offers a practical approach for monitoring reading behavior in classroom environments. Nascimento et al. demonstrated the feasibility of using the Webcam-based eye tracking to observe comic reading patterns among children and showed that it effectively captures fixation time and reading dynamics. Despite the data quality challenges, Webcam-based eye tracking provided an accuracy comparable to that of infrared-based systems.</p><p><strong>Objective: </strong>To evaluate the feasibility and accuracy of webcam-based eye tracking for monitoring comic books reading behavior in a real-world classroom setting.</p><p><strong>Methods: </strong>We tested the feasibility of using the webcam-based eye tracking in a children's classroom experiment (n=22), observing reading patterns as students engaged with a comic strip. Qualitative quality control was implemented to exclude low-quality data. Fixation dwell time was measured to determine whether specific areas of the image received more attention. Additionally, a validation test was conducted (n=3) to assess the accuracy and precision of webcam-based eye tracking compared with an infrared-based eye-tracking system. The accuracy and precision were evaluated, with lower values indicating better performance.</p><p><strong>Results: </strong>During the comic reading task, webcam-based eye tracking effectively captured fixation dwell time, showing that students read the left side significantly faster (2.916 words/s, SD=0.705) compared to the right side (1.962 words/s, SD=0.450, p≤0.001). The validation test showed that webcam-based eye tracking had an average accuracy of 11.581% and a precision of 3.058%, whereas the infrared-based system recorded an accuracy of 11.290% and a precision of 1.264%. Although webcam-based eye tracking demonstrated a slightly lower precision (bias=-1.794, 95%CI=-3.055 to -0.532), no significant difference was observed in accuracy between the two systems.</p><p><strong>Background: </strong>■ Webcam-based eye tracking demonstrated feasibility for monitoring reading behavior in classrooms.</p><p><strong>Background: </strong>■ Webcam-based eye tracking captured fixation times, showing differing reading speeds across comic sections.</p><p><strong>Background: </strong>■ Webcam-based eye tracking showed accuracy comparable to infrared-based systems, despite lower precision.</p><p><strong>Background: </strong>■ Limitations resulting in data loss underscore the need for methodological improvements.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0911"},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phacoviscocanalostomy versus phacotrabeculectomy to treat glaucoma associated with cataracts: a meta-analysis.","authors":"Dillan Cunha Amaral, Mário Luiz Ribeiro Monteiro, Denisse J Mora-Paez, Ana Luiza Machado Ribeiro Pimentel, Matheus Mizerani Fernandes de Almeida, Jacqueline L Chen, Raíza Jacometti, Milton Ruiz Alves, Jaime Guedes, Ricardo Noguera Louzada","doi":"10.31744/einstein_journal/2025RW1045","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025RW1045","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness and safety of phacoviscocanalostomy and phacotrabeculectomy in treating combined glaucoma and cataracts.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following the PRISMA guidelines. The PubMed, Web of Science, Cochrane, and Embase databases were searched for randomized controlled trials or observational studies comparing phacotrabeculectomy to phacoviscocanalostomy in patients with glaucoma and cataracts. Statistical analysis was used to compare the efficacy (intraocular pressure reduction, mean deviation of the visual field, and failure rates) and safety (general complication rate and rates of hyphema, hypotony, perforation, and intraocular pressure spikes) between the two procedures.</p><p><strong>Results: </strong>The study included 331 eyes from one randomized controlled trial and two non-randomized controlled trials, with 154 undergoing phacoviscocanalostomy and 177 undergoing phacotrabeculectomy. The results indicated no significant differences in surgical failure rates, mean deviation of the visual field, and intraocular pressure at one, three, six, and twelve months between the phacoviscocanalostomy and phacotrabeculectomy groups. Furthermore, although the overall complication rate between the two procedures showed no difference, the rate of intraocular pressure spikes was higher in patients who underwent phacoviscocanalostomy.</p><p><strong>Conclusion: </strong>Phacotrabeculectomy and phacoviscocanalostomy are effective treatments for glaucoma and cataracts.Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42024502391.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW1045"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is self-perception of cardiac symptoms related to the psychological profile of patients? A cross-sectional study of individuals undergoing 24-hour Holter monitoring.","authors":"Renata Lima Giolo, Guilherme Fenelon, Marcelo Franken, Marcelo Katz","doi":"10.31744/einstein_journal/2025AO0742","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO0742","url":null,"abstract":"<p><strong>Background: </strong>Depression, anxiety, distress and Type D personality traits have been implicated in the pathogenesis of cardiovascular diseases. Mental health status is associated with arrhythmic events. Esler and Lampert reported that anxiety and distress contribute to the occurrence of atrial and ventricular arrhythmias. ■ Self-reported cardiac symptoms not associated with arrhythmias. ■ High prevalence of anxiety and depression symptoms. ■ Anxiety was correlated with self-reported cardiac symptoms.</p><p><strong>Objective: </strong>This study aimed to examine the presence of psychological characteristics and their association with self-reported cardiac symptoms in individuals undergoing 24-hour Holter monitoring.</p><p><strong>Methods: </strong>This observational cross-sectional study included 304 individuals who consecutively underwent 24-hour Holter monitoring. Clinical, demographic, and electrocardiographic data were collected. Psycho-behavioral characteristics were assessed using the Hospital Anxiety and Depression Scale and the Type D Scale. Logistic regression models were employed to examine associations between cardiac symptoms and anxiety, depression, distress, and Type D personality traits. Statistical significance was set at p<0.05.</p><p><strong>Results: </strong>Anxiety, depression, distress, and type D personality traits were observed in 42.7%, 15.1%, 26.3%, and 19% of the participants, respectively. Logistic regression analysis revealed a significant association between the perception of cardiac symptoms and both mild anxiety (odds ratio (OR) = 2.305, 95%CI= 1.098-4.841, p=0.027) and severe anxiety (OR = 9.245, 95%CI= 1.582-54.013, p=0.014) scores. No significant association was found between depression, distress, or Type D personality traits and an increased perception of cardiac symptoms.</p><p><strong>Conclusion: </strong>A high prevalence of anxiety was observed among individuals undergoing 24-hour Holter recording. Anxiety was significantly associated with self-reported cardiac symptoms, though not with the presence of arrhythmias. The findings could have practical implications for clinical practice. The study suggests that patients reporting anxious palpitations should receive a more thorough cardiological assessment, with 24-hour Holter monitoring serving as an effective tool for this evaluation.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0742"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How the COVID-19 pandemic affected routine child vaccination: an integrative review.","authors":"Julia Stoeterau Moré, Daniel Rodrigo Serbena, Luiz Gustavo Gusson de Camargo, Pedro Augusto Clemente, Fernando Sluchensci Dos Santos, Juliana Sartori Bonini","doi":"10.31744/einstein_journal/2025RW1119","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025RW1119","url":null,"abstract":"<p><strong>Background: </strong>Child immunization plays a critical role in preventing numerous diseases. However, the COVID-19) pandemic has profoundly disrupted healthcare systems globally, including routine child vaccination programs.</p><p><strong>Objective: </strong>To provide an overview of the reduction in vaccine coverage among infants and children during the pandemic and analyze the potential impacts of decreased child immunization during this period.</p><p><strong>Methods: </strong>A comprehensive search was conducted using the MeSH terms \"Child,\" \"Vaccination\", and \"COVID-19,\" along with their synonyms. Systematic reviews published between March 11, 2020, and June 1, 2023, in Portuguese or English were included. Databases searched included PubMed, BVS (Biblioteca Virtual em Saúde), Embase, and Scopus. Two blinded independent reviewers performed the selection process, with conflicts resolved by a third reviewer. The AMSTAR-II tool was used to assess the methodological quality of the included studies.</p><p><strong>Results: </strong>Of the 1,534 eligible articles, only 13 addressed the pandemic's impact on children's vaccination coverage. Most studies involved multiple countries and reported a significant decrease in children's vaccination coverage due to the COVID-19 pandemic.</p><p><strong>Conclusion: </strong>The findings were heterogeneous but consistently highlighted the substantial impact of the COVID-19 pandemic on routine vaccination coverage in most countries. Further research is needed to explore the epidemiological consequences of disruptions to vaccination schedules, potentially guiding public policies and raising awareness about the importance of adhering to health protection programs.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW1119"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of mortality due to severe SARS-CoV-2 infection in public and private intensive care units in Brazil: a multicenter retrospective cohort study.","authors":"Thiago Domingos Corrêa, Thais Dias Midega, Ricardo Kenji Nawa, Ricardo Luiz Cordioli, Adriano José Pereira, Moacyr Silva Júnior, Bruno de Arruda Bravim, Niklas Soderberg Campos, Amanda Pascoal Valle Felicio, Angelo Antônio Gomes de Carvalho, Andreia Pardini, Raquel Afonso Caserta Eid, Rodrigo Dias Rodrigues, Marcele Liliane Pesavento, Leonardo Van de Wiel Barros Urbano Andari, Bento Fortunato Cardoso Dos Santos, Claudia Regina Laselva, Felipe Maia de Toledo Piza, Miguel Cendoroglo Neto, Guilherme de Paula Pinto Schettino, Sidney Klajner, Leonardo José Rolim Ferraz","doi":"10.31744/einstein_journal/2025AO1060","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO1060","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This retrospective multicenter cohort study compared characteristics and outcomes of 5,790 critically ill patients with COVID-19 in Brazil's public and private intensive care units. Patients in public intensive care units exhibited greater disease severity, more frequent use of organ support, and higher mortality rates compared to those in private intensive care units. The risk of in-hospital death was more than twice as high in public intensive care units. ■ Public intensive care unit COVID-19 patients presented with more comorbidities and higher severity at admission. ■ Public intensive care units required more invasive organ support (e.g., mechanical ventilation, vasopressors, and renal replacement therapy) but less non-invasive ventilation and high-flow nasal cannula than private intensive care units. ■ In-hospital mortality was higher in public intensive care units, with an increased risk of death even after adjusting for patient characteristics and illness severity at intensive care unit admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the clinical characteristics, use of organ support, and outcomes of critically ill patients with COVID-19 admitted to public and private intensive care units.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This multicenter retrospective cohort study included patients admitted to four intensive care units from March 1, 2020, to December 31, 2021. Patients with COVID-19 admitted to public and private intensive care units were compared. The primary outcome of interest, in-hospital mortality, was assessed using a hierarchical logistic regression (multilevel) model adjusted for study site and patient characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 5,790 patients with COVID-19 were admitted to the participating intensive care units, with 3,321 (57.3%) admitted to private hospitals and 2,469 (42.6%) admitted to public hospitals. Patients in public intensive care units were less likely to be male and had higher median SAPS III scores, Charlson Comorbidity Index values, and SOFA scores. They also required mechanical ventilation (53.1% versus 40.0%, p&lt;0.001), vasopressors (43.1% versus 33.9%, p&lt;0.001), and renal replacement therapy (20.3% versus. 14.5%, p&lt;0.001) more frequently than those in private intensive care units. In contrast, patients in private intensive care units were more frequently managed with non-invasive ventilation (38.0% versus 66.8%; p&lt;0.001) and high-flow nasal cannulas (18.3% versus 48.1%; p&lt;0.001). The in-hospital mortality rate was significantly higher in public intensive care units (40.3%) compared to private intensive care units (16.4%) (adjusted OR=2.96; 95%CI=1.94-4.51; p&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We observed significant differences in resource utilization and mortality rates between patients with COVID-19 admitted to public and private intensive care units. Patients with COVID-19 in public care units face a higher risk of in-hospital morta","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 spe1","pages":"eAO1060"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are changes in physical activity associated with depression? A follow-up study of 1,950 individuals.","authors":"Luana de Lima Queiroga, Oskar Grau Kaufmann, Raphael Mendes Ritti-Dias, Carlos André Minanni, Rafael Mathias Pitta, Nelson Wolosker","doi":"10.31744/einstein_journal/2025AO1128","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO1128","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the association between changes in physical activity and depression among 1,950 Brazilians. Individuals who increased their physical activity and those who decreased it were not associated with reduced depression. Conversely, being consistently active was identified as an independent and significant protective factor against depression in this population. ■ Persistently active individuals have strong independent protective factors against depression. ■ BMI (kg/m) is an independent risk factor for depression. ■ Individuals with depression at follow-up were older than those without depression. ■ Perceived stress is a strong independent risk factor for depression.</p><p><strong>Objective: </strong>To evaluate the association between changes in physical activity and depression in 1,950 Brazilians.</p><p><strong>Methods: </strong>This follow-up study included 1,950 Brazilians, aged ≥18 years, of both sexes, who participated in a health screening initiative between 2008 and 2022. Physical activity levels were evaluated using the International Physical Activity Questionnaire at baseline and follow-up, and groups related to changes in physical activity were created. Depression was assessed using the Beck Depression Inventory. Clinical data and behavioral profiles were also analyzed. Comparative and logistic regression models were used.</p><p><strong>Results: </strong>The multivariate analysis demonstrated that persistently active individuals had reduced depression (odds ratio [OR], 0.70, 95%CI= 0.55-0.91, p=0.006). Individuals who became active and those who became less active were not associated with a reduction in depression (respectively, OR= 0.81, 95%CI= 0.63-1.05, p=0.109 and OR= 1.11, 95%CI= 0.82-1.51, p=0.481).</p><p><strong>Conclusion: </strong>Persistent activity was an independent, strong protective factor against depression in 1,950 Brazilians. Furthermore, becoming active or less active was not associated with depression in the same population.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1128"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}