Avaliação do cuidado hospitalar pelo risco de óbito / Evaluation of hospital care by risk of death

A taxa de mortalidade hospitalar é tradicionalmente usada para medir a qualidade do cuidado nas unidades hospitalares, no entanto a mesma não consegue discriminar o risco de óbito proveniente da assistência oferecida e da carga de comorbidades que o paciente tem no momento da internação. A Razão de Mortalidade Hospitalar Padronizada (RMHP) é um índice que possibilita avaliar a qualidade do cuidado de acordo com o perfil dos pacientes atendidos pelo hospital. Resultados da RMHP < 1 indica uma qualidade melhor que a esperada e resultados > 1 apontam qualidade pior que a esperada. Assim este estudo propôs avaliar a qualidade da assistência hospitalar prestada no âmbito da Secretaria de Estado da Saúde de Goiás, considerando seu perfil assistencial e os tipos de pacientes atendidos, no período de 2014 a 2019. O cálculo da RMHP foi baseado na metodologia de Jarman et al., no Índice de Comorbidades de Charlson (ICC) E Índice de Elixhauser para avaliar o risco de óbito, e posterior aplicação da curva ROC (para encontrar o modelo de ajuste de risco) e da regressão linear logística multivariada. A qualidade da assistência prestada no Estado de Goiás, considerando o perfil dos pacientes atendidos, foi pior que o esperado nos anos de 2014 a 2016, dentro do esperado no ano 2017 e melhor que o esperado nos anos de 2018 e 2019. Observou-se uma melhora gradativa na qualidade do cuidado nos últimos três anos

The hospital mortality rate is traditionally used to measure the quality of care in hospital units, however it cannot discriminate the risk of death resulting from the assistance provided and the burden of comorbidities that the patient has at the time of hospitalization. The Standardized Hospital Mortality Ratio (RMHP) is an index that makes it possible to assess the quality of care according to the profile of patients treated by the hospital. RMHP results < 1 indicate better quality than expected and results > 1 indicate worse quality than expected. Thus, this study proposed to assess the quality of hospital care provided by the State Health Department of Goiás, considering its care profile and the types of patients cared for, in the period from 2014 to 2019. The RMHP calculation was based on Jarman's methodology et al., in the Charlson Comorbidity Index (ICC) and Elixhauser Index to assess the risk of death, and subsequent application of the ROC curve (to find the risk adjustment model) and multivariate logistic linear regression. The quality of care provided in the State of Goiás, considering the profile of the patients cared for, was worse than expected in the years 2014 to 2016, within expectations in 2017 and better than expected in the years 2018 and 2019. A gradual improvement in the quality of care in the last three years

Associação da escoliose toracolombar e peso da mochila em estudantes do ensino médio / Association between thoracolumbar scoliosis and backpack weight in high school students

Introdução: O aparecimento das alterações posturais em es-colares pode estar relacionada à prática de hábitos posturais inadequados, como o transporte de peso excessivo nas mochilas escolares. Objetivo:Verificar se existe associação entre a utilização de mochilas pelos estudantes do ensino médio com escoliose. Casuística e Métodos:Trata-se de uma pesquisa descritiva trans-versal com abordagem quantitativa, com 152 estudantes do en-sino médio de duas escolas, que responderam a um formulário de coleta de dados e foram submetidos à avaliação postural por inspeção estática e fotogrametria. Resultados: A escoliose toracolombar estrutural foi a alteração postural mais frequente identificada após realização do teste de Adams(68%). Hou-ve associação entre a presença de escoliose e gênero feminino (p=0,02), peso da mochila maior que 10% do peso do estu-dante (p= 0,01) e tipo de mochila unilateral (p=0,003). Conclusão: Houve associação estatisticamente significante entre a escoliose toracolombar e o peso mochila maior que 10% da massa corpórea na amostra analisada, além do predomínio de mochila unilateral e gênero feminino.

Introduction:The presence of postural changes in schoolchildren may be related to inappropriate posture habits, such as excessive weight transport in school backpacks.Objective: To verify if there is an association between the uses of backpacks by high school students and scoliosis. Patients and Methods:This is a cross-sectional descriptive research with a quantitative approach, with 152 high school students from two schools, who responded to a data collection form and were submitted to postural evaluation by static inspection and photogrammetry. Results:Structural thoracolumbar scoliosis was the most frequent postural change identified after the Adams test (68%). Results also shown that there was an association between the presence of scoliosis and female students (p=0.02). We found the backpack weight greater than 10% of student weight (p=0.01), and a backpack positioned unilaterally on the back (p=0.003). Conclusion: There was a statistically significant association between thoracolumbar scoliosis and backpack weight greater than 10% of the body mass in the analyzed sample, besides an association between backpack positioned unilaterally on the back and female students.

Characterization of an alcoholic hepatic steatosis model induced by ethanol and high-fat diet in rats

Alcoholic liver disease is characterized by a wide spectrum of liver damage, which increases when ethanol is associated with high-fat diets (HFD). This work aimed to establish a model of alcoholic hepatic steatosis (AHS) by using a combination of 10% ethanol and sunflower seeds as the source of HFD. Male rats received water or 10% ethanol and regular chow diet and/or HFD, which consisted of sunflower seeds. The food consumption, liquid intake and body weight of the rats were monitored for 30 days. After this period, blood was collected for biochemical evaluation, and liver samples were collected for histological, mitochondrial enzyme activity and oxidative stress analyses. Our results indicated that the combination of 10% ethanol and HFD induced micro- and macrosteatosis and hepatocyte tumefaction, decreased the levels of reduced glutathione and glutathione S-transferase activity and increased the level of lipoperoxidation and superoxide dismutase activity. The mitochondrial oxidation of NADH and succinate were partially inhibited. Complexes I and II were the main inhibition sites. Hepatic steatosis was successfully induced after 4 weeks of the diet, and the liver function was modified. The combination of 10% ethanol and sunflower seeds as an HFD produced an inexpensive model to study AHS in rats.