Background. Moderate to severe postoperative pain affects performance of daily activities and it contributes to persistent postoperative pain. In patients submitted to cesarean section, this pain can also interfere with women's ability to care for their babies, to effectively breastfeed, and to satisfactorily interact with their children. Factors influencing the pain perception during the immediate postoperative period have not been widely pursued. Objective. To investigate the incidence and predicting factors of postoperative pain after cesarean section. Methods. A prospective longitudinal study with 1,062 women submitted to cesarean section. We collected sociodemographic, clinical, surgical, and health behavior data. We used the 11-point Numerical Pain and the Hospital Anxiety and Depression Scales. We performed logistic analysis to identify predictors of moderate to severe postoperative pain. Results. The incidence of moderate-severe postoperative pain was 78.4% (CI: 95%: 75.9%–80.8%). The preoperative anxiety (OR = 1.60; CI 95%: 1.22–2.30) and intrathecal morphine with fentanyl (OR = 0,23; CI 95%: 0.08–0.66) were significantly associated with moderate-severe postoperative pain report. Conclusion. The preoperative anxiety increases the risk of moderate-severe postoperative pain in women submitted to cesarean section. The intrathecal morphine with fentanyl added to bupivacaine was a protective factor against this pain.

Background The coronavirus disease (COVID-19) pandemic has impacted health services and healthcare systems worldwide. Studies have shown that hospital admissions for causes related to chronic non-communicable diseases (NCDs) have decreased significantly during peak pandemic periods. An analysis of the impact of the COVID-19 pandemic on hospital admissions for NCDs is essential to implement disability and mortality mitigation strategies for these groups. Therefore, this study aimed to analyze the impact of the COVID-19 pandemic on hospital admissions for NCDs in Brazil according to the type of NCD, sex, age group, and region of Brazil. Methods This is an ecological study conducted in Brazil. Data on hospital admissions from January 1, 2017 to May 31, 2021 were extracted from the Unified Health System’s Hospital Admissions Information System. The hospital admission rates per 100,000 thousand inhabitants were calculated monthly according to the type of NCD, sex, age group, and region of Brazil. Poisson regression models were used to analyze the impact of the COVID-19 pandemic on the number of hospital admissions. In this study, the pre-pandemic period was set from January 1, 2017 to February 29, 2020 and the during-pandemic from March 1, 2020 to May 31, 2021. Results There was a 27.0% (95.0%CI: -29.0; -25.0%) decrease in hospital admissions for NCDs after the onset of the pandemic compared to that during the pre-pandemic period. Decreases were found for all types of NCDs—cancer (-23.0%; 95.0%CI: -26.0; -21.0%), diabetes mellitus (-24.0%; 95.0%CI: -25.0%; -22.0%), cardiovascular diseases (-30.0%; 95.0%CI: -31.0%; -28.0%), and chronic respiratory diseases (-29.0%; 95.0%CI: -30.0%; -27.0%). In addition, there was a decrease in the number of admissions, regardless of the age group, sex, and region of Brazil. The Northern and Southern regions demonstrated the largest decrease in the percentage of hospital admissions during the pandemic period. Conclusions There was a decrease in the hospitalization rate for NCDs in Brazil during the COVID-19 pandemic in a scenario of social distancing measures and overload of health services.

Nº 48 Octubre 2017Página 354 ORIGINALES Dolor postoperatorio en mujeres sometidas a cesáreaDor pós-operatória em mulheres submetidas à cesariana Postoperative pain in women undergoing caesarean section Resultados: La incidencia de dolor fue del 92,7% (IC 95%: 90,9 -94,2) y las puntuaciones de intensidad media en el momento de peor dolor, igual a 6,6 (dp=2,2) . Los descriptores más frecuentes escogidos fueron "dolorida" (91,6%), "dolorida a la palpación" (70,0%) y "palpitante" (56,1%). Conclusiones: El dolor postoperatorio de alta intensidad es una realidad en este grupo, señalando la importancia de la evaluación del dolor para la ejecución de las acciones curativas y preventivas para reducir las pérdidas en la recuperación de las mujeres Palabras clave: Dolor; Dolor Posoperatorio; Cesárea. RESUMO:Objetivo: Estimar a incidência, intensidade e qualidade da dor pós-operatória em mulheres submetidas à cesariana.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused several problems in healthcare systems around the world, as to date, there is no effective and specific treatment against all forms of COVID-19. Currently, drugs with therapeutic potential are being tested, including antiviral, anti-inflammatory, anti-malarial, immunotherapy, and antibiotics. Although antibiotics have no direct effect on viral infections, they are often used against secondary bacterial infections, or even as empiric treatment to reduce viral load, infection, and replication of coronaviruses. However, there are many concerns about this therapeutic approach as it may accelerate and/or increase the long-term rates of antimicrobial resistance (AMR). We focused this overview on exploring candidate drugs for COVID-19 therapy, including antibiotics, considering the lack of specific treatment and that it is unclear whether the widespread use of antibiotics in the treatment of COVID-19 has implications for the emergence and transmission of multidrug-resistant bacteria.

IntroductionMultimorbidity, defined as the coexistence of two or more chronic diseases in the same individual, represents a significant health challenge. However, there is limited evidence on its prevalence and associated factors in developing countries, such as Brazil, especially stratified by sex. Thus, this study aims to estimate the prevalence and analyze the factors associated with multimorbidity in Brazilian adults according to sex.MethodsCross-sectional population-based household survey carried out with Brazilian adults aged 18 years or older. The sampling strategy consisted of a three-stage conglomerate plan. The three stages were performed through simple random sampling. Data were collected through individual interviews. Multimorbidity was classified based on a list of 14 self-reported chronic diseases/conditions. Poisson regression analysis was performed to estimate the magnitude of the association between sociodemographic and lifestyle factors with the prevalence of multimorbidity stratified by sex.ResultsA total of 88,531 individuals were included. In absolute terms, the prevalence of multimorbidity was 29.4%. The frequency in men and women was 22.7 and 35.4%, respectively. Overall, multimorbidity was more prevalent among women, the older people, residents of the South and Southeast regions, urban area residents, former smokers, current smokers, physically inactive, overweight, and obese adults. Individuals with complete high school/incomplete higher education had a lower prevalence of multimorbidity than those with higher educational level. The associations between education and multimorbidity differed between sexes. In men, multimorbidity was inversely associated with the strata of complete middle school/incomplete high school and complete high school/incomplete higher education, while in women, the association between these variables was not observed. Physical inactivity was positively associated with a higher prevalence of multimorbidity only in men. An inverse association was verified between the recommended fruit and vegetable consumption and multimorbidity for the total sample and both sexes.ConclusionOne in four adults had multimorbidity. Prevalence increased with increasing age, among women, and was associated with some lifestyles. Multimorbidity was significantly associated with educational level and physical inactivity only in men. The results suggest the need to adopt integrated strategies to reduce the magnitude of multimorbidity, specific by gender, including actions for health promotion, disease prevention, health surveillance and comprehensive health care in Brazil.

Background: The COVID-19 pandemic has presented high morbidity and mortality, with associated high socioeconomic costs. Brazil ranks third in the number of COVID-19 cases, behind only India and the United States. Objective: To analyze risk factors for mortality in adults hospitalized with COVID-19 in Brazil. Methods: Observational retrospective cohort study including data from all Brazilian states and regions. The study included information from 468,226 in-hospital patients from all regions of Brazil from 1 January 2021 to 31 July 2021. Data from the influenza epidemiological surveillance system were used. The participants were adults hospitalized with COVID-19. A Cox regression model was used to analyze factors associated with mortality in adults with COVID-19. Results: The in-hospital mortality lethality was 37.5%. The risk factors associated with COVID-19 mortality were older age, with a linear increase with increments in age, male sex, black or mixed race, low education level, comorbidities, use of ventilatory support, and living in the southeast, north, or northeast regions of the country. Conclusions: Our results illustrate the severity of the COVID-19 pandemic in Brazil and reinforce that policies and practices to deal with this disease should focus on groups and regions with higher risk, whereas public policies should promote nonpharmacological measures and vaccination in the Brazilian population.

Objetivo: investigar a qualidade de vida de estudantes do curso técnico em enfermagem e os desafios associados à formação profissional. Método: trata-se de um estudo quantitativo, descritivo, observacional, transversal e analítico, com discentes de uma instituição federal de ensino. Coletaram-se os dados utilizando o questionário WHOQOL-breve e o formulário com variáveis complementares. Empregaram-se, na análise bivariada, o teste t de student e a correlação de Pearson. Realizou-se a análise de regressão linear múltipla para verificar os fatores associados aos escores de qualidade de vida (p<0,05). Resultados: compôs-se o estudo por 165 discentes. Evidenciou-se, no domínio social, melhor avaliação média e a pior avaliação foi o domínio meio ambiente. Encontraram-se discentes com vontade de desistir do curso com escore médio de qualidade de vida menor em todos os domínios, sendo que aqueles que relataram dificuldade de se manter no curso por razões financeiras tiveram escores menores nos domínios físico (p=0,024) e ambiental (p<0,001). Conclusão: aferiu-se a pior qualidade de vida entre discentes com fragilidades nas redes de apoio social e financeira, o que pode impactar o rendimento escolar e o risco de evasão. Descritores: Qualidade de Vida; Estudantes de Enfermagem; Avaliação em Saúde; Educação; Enfermagem; Estudantes de Ciências da Saúde.AbstractObjective: to investigate the quality of life of nursing technical students and the challenges associated with vocational training. Method: this is a quantitative, descriptive, observational, cross-sectional and analytical study with students from a federal educational institution. Data was collected using the WHOQOL-brief questionnaire and the form with complementary variables. In the bivariate analysis, the Student's t test and Pearson's correlation were used. Multiple linear regression analysis was performed to verify factors associated with quality of life scores (p <0.05). Results: the study was composed by 165 students. In the social domain, the best average rating was evidenced and the worst one was the environment domain. Students were willing to drop out of the course with a lower average quality of life score in all domains, and those who reported difficulty in maintaining the course for financial reasons had lower scores in the physical (p = 0.024) and environmental domains. (p <0.001). Conclusion: the worst quality of life was assessed among students with weaknesses in social and financial support networks, which may impact school performance and the risk of dropout. Descriptors: Quality of Life; Students, Nursing; Health Evaluation; Education; Nursing, Students, Health Occupations. ResumenObjetivo: investigar la calidad de vida de los estudiantes técnicos de enfermería y los desafíos asociados con la formación profesional. Método: este es un estudio cuantitativo, descriptivo, observacional, transversal y analítico con estudiantes de una institución educativa federal. Los datos fueron recolectados utilizando el cuestionario breve WHOQOL y el formulario con variables complementarias. En el análisis bivariado, se utilizaron la prueba t de Student y la correlación de Pearson. Se realizó un análisis de regresión lineal múltiple para verificar los factores asociados con los puntajes de calidad de vida (p <0.05). Resultados: el estudio estuvo compuesto por 165 estudiantes. En el dominio social, se evidenció la mejor calificación promedio y la peor fue el dominio del medio ambiente. Los estudiantes estaban dispuestos a abandonar el curso con un puntaje promedio de calidad de vida más bajo en todos los dominios, y aquellos que informaron dificultades para mantener el curso por razones financieras tuvieron puntajes más bajos en el dominio físico (p = 0.024) y ambiental (p <0,001). Conclusión: se evaluó la peor calidad de vida entre los estudiantes con debilidades en las redes de apoyo social y financiero, lo que puede afectar el rendimiento escolar y el riesgo de abandono escolar. Descriptores: Calidad de Vida; Estudiantes de Enfermería; Evaluación en Salud; Educación; Enfermería; Estudiantes del Área de la Salud.

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