Despite advancements in renal replacement therapies and increased survival, patients still face several physical, psychological and social limitations as consequences of chronic kidney disease and treatment complexity. 1,2 The daily struggle with end-stage renal disease symptoms and related comorbidities, along with the need to cope with psychosocial stressors, directly impacts patients' quality of life and mental health. 3,4 Depression and anxiety are considered to be the most common end-stage renal disease-related psychological disorders, with higher prevalence and incidence rates in this population than those in the general population. 5-10 According to the World Health Organization, the estimated global prevalence rates of depression and anxiety in 2015 were 4.4% and 3.6%, respectively, with an increase in reported cases of 18% between 2005 and 2015. 11 The anxiety and depression rates that have been estimated among end-stage renal disease patients are not accurate: they range from 0 to 100%, depending on the diagnostic criteria, assessment tool and population characteristics. 12 A systematic review of 55 studies revealed prevalence rates of 38% and 27% for anxiety and depression, respectively, among end-stage renal disease patients. 13 The high frequency and impact of affective symptoms in nephrology practice have led the research community to devote increasing attention to depression and anxiety over the last few years. 7 In end-stage renal disease, these mental disorders are associated with various conditions that lead to poorer health outcomes, with direct impacts on patients' quality of life and survival. 14-23 Anxiety and depression are also associated with unhealthy forms of behavior, such as alcohol and tobacco use, poor eating habits, sedentary lifestyle and non-compliance with treatment. 24 These factors translate into increased risks of clinical events and the need for emergency services, thus resulting in higher healthcare costs. 25-26

OBJECTIVE:To describe the clinical and epidemiological profi le of patients under renal replacement therapies, identifying risk factors for death. METHODS:This is a non-concurrent cohort study of data for 90,356 patients in the National Renal Replacement Therapies Database. A deterministicprobabilistic linkage was performed using the Authorization System for High Complexity/Cost Procedures and the Mortality Information System databases. All patients who started dialysis between 1/1/2000 and 12/31/2004 were included and followed until death or the end of 2004. Age, sex, region of residence, primary renal disease and causes of death were analyzed. A proportional hazards model was used to identify factors associated with risk of death. RESULTS:The prevalence of patients under renal replacement therapies increased an average of 5.5%, while incidence remained stable during the period. Hemodialysis was the predominant initial modality (89%). The patients were majority male with mean age 53 years, residents of the Southeast region and presented unknown causes as the main cause of chronic renal disease, followed by hypertension, diabetes and glomerulonephritis. Of these patients, 42% progressed to death and 7% underwent kidney transplantation. The patients on peritoneal dialysis were older and had higher prevalence of diabetes. The death rate varied from 7% among transplanted patients to 45% among non-transplanted patients. In the fi nal Cox proportional hazards model, the risk of mortality was associated with increasing age, female sex, having diabetes, living in the North and Northeast region, peritoneal dialysis as a fi rst modality and not having renal transplantation. CONCLUSIONS:There was an increased prevalence of patients on renal therapy in Brazil. Increased risk of death was associated with advanced age, diabetes, the female sex, residents of the North and Northeast region and lack of renal transplant.

Resumo Introdução: diante da pandemia da COVID-19, torna-se importante rever questões de proteção da saúde dos trabalhadores. Objetivo: discutir as condições de saúde e segurança dos trabalhadores que cuidam de pacientes com COVID-19, sob a perspectiva das informações levantadas por seus representantes de classe profissional e de recomendações institucionais. Métodos: levantamento de informações na literatura científica, em documentos e orientações de entidades oficiais de saúde, em fontes de entidades sindicais e de representação de classes de profissionais de saúde. Discussão: começamos pela descrição das características da infecção pelo SARS-CoV-2 no processo de trabalho em saúde; exemplificamos as iniciativas de organizações representativas dos trabalhadores para o enfrentamento da COVID-19; descrevemos o cenário do trabalho em saúde na pandemia no Brasil; apresentamos o relato das medidas de proteção e de enfrentamento da doença orientadas por entidades e organismos nacionais e internacionais. Finalizamos discutindo que a exposição desses trabalhadores pode levar a outros eventos em saúde, necessitando medidas de adequação em relação a número de profissionais, melhoria na organização e nas condições de trabalho, fornecimento de equipamentos de proteção individual em quantidade e qualidade adequadas e implantação de medidas que propiciem o fortalecimento das equipes para o enfrentamento da COVID-19.

Background Despite being an important cardiovascular risk factor, hypertension has low control levels worldwide. Computerized clinical decision support systems (CDSSs) might be effective in reducing blood pressure with a potential impact in reducing cardiovascular risk. Objective The goal of the research was to evaluate the feasibility, usability, and utility of a CDSS, TeleHAS (tele– hipertensão arterial sistêmica , or arterial hypertension system), in the care of patients with hypertension in the context of a primary care setting in a middle-income country. Methods The TeleHAS app consists of a platform integrating clinical and laboratory data on a particular patient, from which it performs cardiovascular risk calculation and provides evidence-based recommendations derived from Brazilian and international guidelines for the management of hypertension and cardiovascular risk. Ten family physicians from different primary care units in the city of Montes Claros, Brazil, were randomly selected to use the CDSS for the care of hypertensive patients for 6 months. After 3 and 6 months, the feasibility, usability, and utility of the CDSS in the routine care of the health team was evaluated through a standardized questionnaire and semistructured interviews. Results Throughout the study, clinicians registered 535 patients with hypertension, at an average of 1.24 consultations per patient. Women accounted for 80% (8/10) of participant doctors, median age was 31.5 years (interquartile range 27 to 59 years). As for feasibility, 100% of medical users claimed it was possible to use the app in the primary care setting, and for 80% (8/10) of them it was easy to incorporate its use into the daily routine and home visits. Nevertheless, 70% (7/10) of physicians claimed that the time taken to fill out the CDSS causes significant delays in service. Clinicians evaluated TeleHAS as good (8/10, 80% of users), with easy completion and friendly interface (10/10, 100%) and the potential to improve patients’ treatment (10/10, 100%). A total of 90% (9/10) of physicians had access to new knowledge about cardiovascular risk and hypertension through the app recommendations and found it useful to promote prevention and optimize treatment. Conclusions In this study, a CDSS developed to assist the management of patients with hypertension was feasible in the context of a primary health care setting in a middle-income country, with good user satisfaction and the potential to improve adherence to evidence-based practices.

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Objective: to investigate socio-demographic factors associated with non-use of condoms, and to describe the prevalence of sexually transmitted infections (STI) in rural communities of Ouro Preto, Minas Gerais, Brazil, 2014 to 2016. Methods: data were gathered from individual interviews and rapid tests were performed; associations were tested using Poisson regression, with a 95% confidence interval (95%CI). Results: we detected 3.8 cases/10,000 inhabitants for hepatitis B and syphilis, and 1.3 cases/10,000 inhabitants for hepatitis C; no HIV cases were detected; in the multivariate analysis we found higher prevalence rates of condom non-use among the group of individuals who were married, had common law partners or were widowed (PR=1.20 -95%CI 1.06;1.36). Conclusion: individuals in a stable relationship formed the group with the highest prevalence rate of condom non-use; new syphilis and viral hepatitis cases were detected using rapid tests during the survey.