Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. RESULTS: More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. CONCLUSION: Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances.

An evaluation of alternative methods for sanitizing hatching eggs.

Different sanitization methods were evaluated as alternatives to formaldehyde fumigation for the reduction of eggshell and yolk sac microbiological counts, improvement of eggshell quality, incubation parameters, and day-old chick quality. A total of 10,080 hatching eggs were collected from a 70-wk-old commercial broiler breeder flock and distributed in a completely randomized block design with seven treatments: fumigation with paraformaldehyde (5.03 g/m3/30 min), fumigation with ozone (5-15 ppm/30 min), ultraviolet light-C irradiation (8.09 mW/cm2; 120 s; UV-C), hydrogen peroxide spraying (3%; 0.69 mL/egg), peracetic acid spraying (0.3%; 0.69 mL/egg; PAA), water spraying (0.69 mL/egg; water control), and without disinfection (dry control-DC). Spraying eggs with PAA and UV-C significantly reduced aerobic bacteria plate counts compared to the DC group. In addition, eggs disinfected with PAA had lower Enterobacteriaceae counts than the DC and water control groups. Eggshell quality, incubation parameters, and microbiological counts for yolk sac did not differ (P > 0.05) among treatments. This study demonstrated the potential for the application of PAA and UV-C for eggshell disinfection instead of formaldehyde; however, an electronic microscopic evaluation of the eggshell is necessary to determine if these methods cause any damage to the cuticle.

[Magnetic resonance imaging in spinal dysraphisms]. / Ressonância nuclear magnética nos disrafismos espinais.

We studied by magnetic resonance imaging the incidence of associated malformations in a group of 38 patients with diagnosis of spina bifida followed in our outpatient clinic. Twenty-two children were born with spina aperta and 16 with spina bifida occulta. Tethered cord was found in the majority of patients of both groups. Syringomyelia was found in 13 patients. The craniocervical region was studied in 11 patients with the diagnosis of spina bifida aperta; Chiari malformation was found in 8. The results point to the fact that asymptomatic malformations detected by MRI techniques are frequent in patients with spina bifida.

[Sacral agenesis associated with a teratoma]. / Agenesia sacral associada a teratoma.

A case of a 29-year-old male with a huge sacrococcygeal teratoma completely removed by surgery, and associated with a sacral agenesis is reported. Roentgenograms revealed fusion of the T12, L1, L2, and L3 vertebral bodies, absence of the left 12th rib, partial agenesis of sacrococcygeal elements and a lumbar scoliosis convex to the left. Cystometry and myelograms were normal. No such association has been found in the literature reviewed. Some topics on the embryology of these lesions are discussed.

Malaria seroepidemiology: comparison between indirect fluorescent antibody test and enzyme immunoassay using bloodspot eluates.

Blood sampling on filter paper is a current practice in malaria seroepidemiological studies by indirect fluorescent antibody test (IFAT). There is, however, scant comparative information about the use of bloodspot eluates for detection of malarial IgG antibodies simultaneously by IFAT and enzyme immunoassay (ELISA). Here we report data obtained by both serological methods done on 219 bloodspot eluate samples collected in a rural community in Brazilian Amazon Basin (Alto Paraíso, Ariquemes municipality) where malaria is endemic. Plasmodium falciparum and P. vivax thick smear antigens were used in the IFAT; a detergent-soluble P. falciparum antigen was prepared for ELISA. Substantial agreement of results (Kappa coefficient k = 0.686) was observed when P. falciparum antigen was used in both tests, and IFAT titers were found to be strongly correlated to ELISA antibody units (Spearman correlation coefficient rs = 0.818, p < 0.001). Only moderate agreement (k = 0.467) between IFAT with P. vivax antigen and ELISA with P. falciparum antigen was observed. Spearman correlation coefficient value between quantitative results (IFAT titers and ELISA antibody units) in this case was numerically lower (rs = 0.540, p < 0.0001). Our results suggest that, with P. falciparum antigen, both IFAT and ELISA performed on bloodspot eluates are equivalent for seroepidemiological purposes.